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. 2021 Feb 27;9(3):506.
doi: 10.3390/microorganisms9030506.

Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing Enterobacteriaceae during Preterm Delivery: A Prospective Study

Maya Frank Wolf  1   2 , Raneen Abu Shqara  1   2 , Karina Naskovica  1   2 , Inna Amdur Zilberfarb  1   2 , Inshirah Sgayer  1   2 , Daniel Glikman  2 , Hagai Rechnitzer  2   3 , Vered Fleisher Sheffer  2   4 , Jacob Bornstein  1   2
Affiliations

Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing Enterobacteriaceae during Preterm Delivery: A Prospective Study

Maya Frank Wolf et al. Microorganisms. .

Abstract

Maternal carriage and vertical transmission of extended-spectrum, beta-lactamase-producing Enterobacteriaceae (ESBL-E), such as Escherichia coli, hamper the treatment of infections, resulting in high morbidity. E. coli is the most frequent cause of early-onset neonatal sepsis (EOS) in preterm infants, where ESBL-E are more frequently isolated. In this prospective, case-controlled study, maternal rectovaginal ESBL-E colonization and vertical transmission to preterm infants were assessed in 160 women with preterm premature rupture of membranes (PPROM; 57.4%) or preterm labor (42.6%); additional cultures were obtained from the placenta, amnion, and umbilical cord during preterm labor. Maternal and neonatal ESBL-E-carriage rates were 17.5% and 12.9%, respectively, and the vertical-transmission rate was 50%. Maternal ESBL-E colonization among women with PPROM was 21.3%, and in women with premature labor it was 12.6%. No correlation was observed between maternal ESBL-E-colonization and previous hospitalization or antibiotic administration during pregnancy. However, a correlation was found between placental inflammation and maternal ESBL-E colonization (p = 0.007). ESBL-E-colonized infants were delivered at an earlier gestational age and were more likely to have complications. Thus, the high ESBL-E carriage rate in women with threatened preterm labor, without obvious risk factors for carriage, and a high vertical transmission rate, combined with a correlation between placental inflammation and ESBL-E carriage, support maternal-neonatal ESBL-E-colonization surveillance and active measures to prevent ESBL-E-related EOS.

Keywords: Escherichia coli; extended-spectrum, beta-lactamase-producing Enterobacteriaceae; maternal colonization; preterm birth.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study population. ESBL-E: extended-spectrum beta-lactamase-producing Enterobacteriaceae; NICU: neonatal intensive care unit; PPROM: preterm premature rupture of membranes.
Figure 2
Figure 2
Proportion of extended-spectrum, beta-lactamase-producing Enterobacteriaceae (ESBL-E) isolates in maternal and neonatal colonization.
Figure 3
Figure 3
Extended-spectrum, beta-lactamase-producing Enterobacteriaceae (ESBL-E) transmission rate during preterm delivery.
See this image and copyright information in PMC

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