Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Oct;1502(1):54-71.
doi: 10.1111/nyas.14650. Epub 2021 Jul 2.

Risk factors for, and molecular epidemiology and clinical outcomes of, carbapenem- and polymyxin-resistant Gram-negative bacterial infections in pregnant women, infants, and toddlers: a systematic review and meta-analyses

John Osei Sekyere  1 , Melese Abate Reta  1 , Petrus Bernard Fourie  1
Affiliations
Meta-Analysis

Risk factors for, and molecular epidemiology and clinical outcomes of, carbapenem- and polymyxin-resistant Gram-negative bacterial infections in pregnant women, infants, and toddlers: a systematic review and meta-analyses

John Osei Sekyere et al. Ann N Y Acad Sci. 2021 Oct.

Abstract

In the following systematic review and meta-analyses, we report several conclusions about resistance to carbapenem and polymyxin last-resort antibiotics for treating multidrug-resistant bacterial infections among pregnant women and infants. Resistance to carbapenems and polymyxins is increasing, even in otherwise vulnerable groups such as pregnant women, toddlers, and infants, for whom therapeutic options are limited. In almost all countries, carbapenem-/polymyxin-resistant Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii infect and/or colonize neonates and pregnant women, causing periodic outbreaks with very high infant mortalities. Downregulation of plasmid-borne blaNDM , blaKPC , blaOXA-48 , blaIMP, blaVIM , blaGES-5 , and ompK35/36 in clonal strains accelerates the horizontal and vertical transmissions of carbapenem resistance among these pathogens. New Delhi metallo-β-lactamase (NDM)-positive isolates in infants/neonates have been mainly detected in China and India, while OXA-48-positive isolates in infants/neonates have been mainly detected in Africa. NDM-positive isolates in pregnant women have been found only in Madagascar. Antibiotic therapy, prolonged hospitalization, invasive procedures, mechanical ventilation, low birth weight, and preterm delivery have been common risk factors associated with carbapenem/polymyxin resistance. The use of polymyxins to treat carbapenem-resistant infections may be selecting for resistance to both agents, restricting therapeutic options for infected infants and pregnant women. Currently, low- and middle-income countries have the highest burden of these pathogens. Antibiotic stewardship, periodic rectal and vaginal screening, and strict infection control practices in neonatal ICUs are necessary to forestall future outbreaks and deaths.

Keywords: antibiotic resistance; carbapenem; carbapenemase; colistin; infants; neonates; polymyxin; pregnant women.

PubMed Disclaimer

References

    1. Osei Sekyere, J. & M.A. Reta. 2020. Genomic and resistance epidemiology of Gram-negative bacteria in Africa: a systematic review and phylogenomic analyses from a One Health perspective. mSystems 5: e00897-20.
    1. Kopotsa, K., N.M. Mbelle & J. Osei Sekyere. 2020. Epigenomics, genomics, resistome, mobilome, virulome and evolutionary phylogenomics of carbapenem-resistant Klebsiella pneumoniae clinical strains. Microb. Genomics 6: mgen000474.
    1. Osei Sekyere, J. & E. Mensah. 2020. Molecular epidemiology and mechanisms of antibiotic resistance in Enterococcus spp., Staphylococcus spp., and Streptococcus spp. in Africa: a systematic review from a One Health perspective. Ann. N.Y. Acad. Sci. 1465: 29-58.
    1. Osei Sekyere, J., N.E. Maningi, L. Modipane & N.M. Mbelle. 2020. Emergence of mcr-9.1 in ESBL-producing clinical Enterobacteriaceae in Pretoria, South Africa: global evolutionary phylogenomics, resistome and mobilome. mSystems 5: e00148-20.
    1. Van Boeckel, T.P. et al. 2019. Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science 365: eaaw1944.

Publication types

MeSH terms

LinkOut - more resources