Prevalence and factors associated with faecal carriage of extended-spectrum β-lactamase-producing Enterobacterales among peripartum women in the community in Cambodia

Abstract

Background: In Southeast-Asia, where many conditions associated with dissemination of ESBL-producing Enterobacterales (ESBL-E) in the community are met, data from the community are scarce but show high ESBL-E carriage prevalence. Maternal ESBL-E colonization is considered a risk factor for neonatal colonization, which is the first step towards developing neonatal sepsis. Despite this, ESBL-E carriage prevalence and its risk factors during pregnancy or postpartum remain undefined in Southeast-Asia.

Objectives: To estimate the prevalence of ESBL-E faecal colonization among peripartum women in the community of an urban and a rural area in Cambodia, to investigate ESBL-E genomic characteristics and to identify associated risk factors.

Methods: Epidemiological data and faecal samples from 423 peripartum women were collected in an urban and rural areas in Cambodia (2015-16). Bacterial cultures, antibiotic susceptibility tests and ESBL gene sequencing were performed. Risk factor analysis was conducted using logistic regression.

Results: The prevalence of ESBL-E faecal carriage was 79.2% (95% CI 75.0%-82.8%) among which Escherichia coli (n = 315/335, 94.0%) were most frequent. All isolates were multidrug resistant. Among 318 ESBL-E, the genes most frequently detected were blaCTX-M-15 (41.5%), blaCTX-M-55 (24.8%), and blaCTX-M-27 (15.1%). Low income, undernutrition, multiparity, regular consumption of pork, dried meat, and raw vegetables, were associated with ESBL-E faecal carriage.

Conclusions: The high prevalence of ESBL-E carriage observed among peripartum women in Southeast-Asia and the identified associated factors underline the urgent need for public health measures to address antimicrobial resistance, including a 'One Health' approach.

Figure 1.

Flow chart for study of extended-spectrum β-lactamase-producing Enterobacterales carriage in peripartum women in Cambodia 2015–16.

Figure 2.

Phenotypic profile of 318 ESBL-producing isolates carried by peripartum women in Cambodia 2015–16. TGC, tigecycline; IPM, imipenem; ETP, ertapenem; AMK, amikacin; NIT, nitrofurantoin; CST, colistin; FOF, fosfomycin; TIM, ticarcillin/clavulanate; FOX, cefoxitin; CHL, chloramphenicol; GEN, gentamicin; TET, tetracycline; SXT, trimethoprim/sulfamethoxazole; PEF, pefloxacin; AMP, ampicillin; TIC, ticarcillin; CTX, cefotaxime; CAZ, ceftazidime; ATM, aztreonam. *ATM, NIT and FOF were tested only on 235 isolates at the Institut Pasteur de Cambodge. †FOX and CST were tested only on 83 isolates at the Institut Pasteur, Paris, France.

Figure 3.

Molecular characterization of ESBL genes among 318 isolates carried by peripartum women in Cambodia 2015–16. The total number of genes are >318 as among the 83 isolates characterized by WGS, 8 isolates harboured two different ESBL genes, which are represented here (total number of genes is 326).