Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study,Clinical Microbiology and Infection

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Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study
Clinical Microbiology and Infection ( IF 10.9 ) Pub Date : 2019-07-20 , DOI: 10.1016/j.cmi.2019.07.013
K. Neemann , E.K. Olateju , N. Izevbigie , G. Akaba , G.M. Olanipekun , J.C. Richard , C.I. Duru , N.J. Kocmich , K.K. Samson , A. Rezac-Elgohary , E.A. Anigilaje , T. Yunusa , C.O.N. Megafu , T.O. Ajose , N. Medugu , J. Meza , S. Obaro

Objectives

The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality.

Methods

A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal–neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days.

Results

A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83–28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63–17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44–16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI .06–0.75) requires further evaluation.

Conclusions

Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.

中文翻译：

尼日利亚产前直肠阴道定植与广谱β-内酰胺酶产肠杆菌科相关的新生儿结局：一项前瞻性，横断面研究

目标

这项研究的目的是评估产妇直肠阴道超广谱β-内酰胺酶产肠杆菌（ESBL-E）菌落的患病率，确定产妇和新生儿ESBL-E菌落的危险因素，以及其对新生儿死亡率的影响。

方法

2016年4月至2017年5月在阿布贾大学教学医院进行了一项前瞻性，横断面研究。在分娩时对母婴组合进行ESBL-E暴露筛查。在28天时评估新生儿死亡率。

结果

总共评估了1161单例交付。在分娩时，总计有9.7％（113/1161）的母亲和4.3％（50/1161）的婴儿具有ESBL-E阳性培养物。母体抗生素暴露与ESBL-E直肠阴道定植有关（18.6％（21/113）对8.4％（88/1048），p <0.001）。ESBL-E新生儿表面培养阳性的风险因素被确定为母亲ESBL-E的定植（校正比值比（AOR）14.85； 95％的CI 7.83–28.15）和阴道分娩（AOR 6.35； 95％的CI 2.63-17.1）。新生儿阳性的ESBL-E表面培养是新生儿死亡的危险因素（包括死产，AOR为4.84； 95％CI为1.44–16.31）。孕妇ESBL-E直肠阴道定植对新生儿死亡率具有保护作用（AOR 0.22； 95％CI .06-0.75），这一发现需要进一步评估。