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. 2025 Oct 9:58:100999.
doi: 10.1016/j.ijmmb.2025.100999. Online ahead of print.

Temporal burden of WHO Critical-priority Enterobacteriaceae in the infant gut during early life influenced by maternal postpartum antibiotic exposure

Saahithya Mahesh  1 , Vidya Rajesh  2 , Vignesh Shetty  3 , Ankur Mutreja  4 , Asha Hegde  5 , Veena G Kamath  6 , Manjula A Kunder  7 , Shrikiran Aroor  8 , Thandavarayan Ramamurthy  9 , Shruti R Pai  10 , Mamatha Ballal  11
Affiliations

Temporal burden of WHO Critical-priority Enterobacteriaceae in the infant gut during early life influenced by maternal postpartum antibiotic exposure

Saahithya Mahesh et al. Indian J Med Microbiol. .

Abstract

Purpose: Antimicrobial resistance (AMR) in the gut microbiome progressively evolves during infancy. This study aimed to evaluate the prevalence of WHO Critical Priority Enterobacteriaceae in infants' gut commensals and investigate the factors associated with the development of AMR.

Methods: Stool samples were collected from 67 infants at birth, 6-weeks and 14-weeks. E. coli, Klebsiella pneumoniae and Enterobacter species were isolated and tested for susceptibility to 22 antibiotics and screened for extended-spectrum beta-lactamase (ESBL) production. Chi-square test and logistic regression tests were performed to evaluate the influence of clinical and demographic factors on the carriage of drug-resistant Enterobacteriaceae.

Results: Of the 67 infants, stool samples from 38 infants (58.4 %) yielded 200 isolates of Enterobacteriaceae across three-timepoints. E. coli was predominant at 6-weeks (53%) and 14-weeks (63%). Cephalosporin resistance peaked at 6-weeks, with E. coli showing the highest resistance to 3rd (43%) and 4th (38%) generation cephalosporins. ESBL production was highest at 6-weeks, with 40% of E. coli producing ESBL, and 34% of infants carrying ESBL-producing strains. Maternal postpartum cephalosporin use significantly increased the likelihood of infants carrying cephalosporin-resistant Enterobacteriaceae (p-value = 0.001; OR: 10.4; 95% CI: 2.31-46.83), ESBL-producers (p-value = 0.009), and multidrug-resistant isolates (p-value = 0.027).

Conclusion: These findings highlight that cephalosporin-resistant Enterobacteriaceae colonize the infant gut as early as 6-weeks, with maternal postpartum antibiotic exposure playing a significant role. Understanding these early-life drivers of AMR could help inform strategies to mitigate AMR spread in vulnerable populations.

Keywords: Antimicrobial resistance; Cephalosporin resistance; ESBL production; Enterobacteriaceae; Maternal antibiotic exposure.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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