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Randomized Controlled Trial
. 2024 Dec 17;79(6):1338-1345.
doi: 10.1093/cid/ciae280.

Impact of Intrapartum Azithromycin on the Carriage and Antibiotic Resistance of Escherichia coli and Klebsiella pneumoniae in Mothers and Their Newborns: A Substudy of a Randomized, Double-Blind Trial Conducted in The Gambia and Burkina Faso

Pauline Getanda  1 , Isatou Jagne  1 , Joel D Bognini  2 , Bully Camara  1 , Bakary Sanyang  1 , Saffiatou Darboe  1 , Ellen Sambou  1 , Momodou Barry  1 , Kady Kassibo  1 , Aminata Cham  1 , Harriet Mendy  1 , Bintou K J Singateh  1 , Ebrahim Ndure  1 , Toussaint Rouamba  2 , Abdoulie Bojang  1 , Christian Bottomley  3 , Benjamin P Howden  4 , Umberto D'Alessandro  1 , Halidou Tinto  2 , Anna Roca  1 ; PregnAnZI-2 Carriage Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Impact of Intrapartum Azithromycin on the Carriage and Antibiotic Resistance of Escherichia coli and Klebsiella pneumoniae in Mothers and Their Newborns: A Substudy of a Randomized, Double-Blind Trial Conducted in The Gambia and Burkina Faso

Pauline Getanda et al. Clin Infect Dis. .

Abstract

Background: Limited data exist on the effects of intrapartum azithromycin on the prevalence of carriage and antibiotic resistance of Enterobacterales.

Methods: We conducted a randomized trial in The Gambia and Burkina Faso where women received intrapartum azithromycin (2 g) or placebo. We determined the impact of treatment on the prevalence of carriage and antibiotic resistance of Escherichia coli and Klebsiella pneumoniae by analyzing rectal swabs (RS), nasopharyngeal swabs (NPS), breast milk, and rectovaginal swabs (RVS). Bacteria were isolated microbiologically; antibiotic susceptibility was confirmed with an E-test. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were used for comparison between arms.

Results: In infants, E. coli carriage in RS was lower in the intervention than in the placebo arm at day 6 (63.0% vs 75.2%; PR, 0.84; 95% CI, .75-.95) and day 28 (52.7% vs 70.4%; 0.75; 0.64-0.87) post-intervention. Prevalence of azithromycin-resistant E. coli was higher in the azithromycin arm at day 6 (13.4% vs 3.6%; 3.75; 1.83-7.69) and day 28 (16.4% vs 9.6%; 1.71; 1.05-2.79). For K. pneumoniae, carriage in RS was higher in the intervention than in the placebo arm at day 6 (49.6% vs 37.2%, 1.33; 1.08-1.64) and day 28 (53.6% vs 32.9%, 1.63; 1.31-2.03). Prevalence of azithromycin-resistant K. pneumoniae was higher in the azithromycin arm at day 28 (7.3% vs 2.1%; 3.49; 1.30-9.37). No differences were observed for other sample types.

Conclusions: Intrapartum azithromycin decreased E. coli carriage but increased both K. pneumoniae carriage and azithromycin resistance in both bacteria. These data need to be considered together with efficacy results to balance the potential short- and long-term impact of the intervention. Clinical Trials Registration. www.clinicaltrials.gov: NCT03199547.

Keywords: Escherichia coli; Klebsiella pneumoniae; antibiotic resistance; bacterial carriage; intrapartum azithromycin.

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Conflict of interest statement

Potential conflicts of interest . The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/impact-of-intrapartum-azithromycin-on-the-carriage-and-antibiotic-resistance-of-escherichia-coli-and-klebsiella-pneumoniae-in-mothers-and-their-newborns-a-sub-study-of-a-randomized-double-blind-trial-con-4ee9b8f1-72e6-47b1-8dcc-ba7b68c092ea?utm_campaign=tidbitlinkshare&utm_source=ITP
Figure 1.
Figure 1.
Study profile. Abbreviations: BM, breast milk; NPSb, nasopharyngeal swab (baby); NPSm, nasopharyngeal swab (mother); RS, rectal swab; RVS, rectovaginal swab. aSample collection affected by coronavirus disease 2019 disruptions.
Figure 2.
Figure 2.
RS Escherichia coli and Klebsiella pneumoniae carriage and azithromycin resistance. Abbreviations: AZM, azithromycin; RS, rectal swab.
See this image and copyright information in PMC

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