BACKGROUND Neonatal sepsis remains a leading cause of neonatal mortality. Maternal bacterial colonization plays a major role in transmission to the infant, with potential for subsequent development of neonatal sepsis with maternally derived strains. AIM To review the molecular evidence supporting transmission of multidrug-resistant Gram-negative bacteria (MDR-GNB) from colonized mothers to their infants and the risk factors for MDR-GNB transmission. METHODS PubMed and Scopus were searched for studies investigating the mechanisms, risk factors for and/or scale of transmission of MDR-GNB from colonized mothers to their infants. Random effects meta-analyses were performed to determine pooled proportions of MDR-GNB transmission and the neonatal outcomes of transmission. FINDINGS Eight studies were included in the narrative description and six in the meta-analysis. Five studies used pulsed-field gel electrophoresis to assess relatedness of isolates from colonized mothers and their infants. Pooled proportion of MDR-GNB transmission from colonized mothers to their infants was 27% (95% confidence interval (CI): 8-47%). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were the most frequently studied MDR-GNB pathogens transmitted between mother-infant pairs. Following mother-to-infant transmission of an MDR-GNB pathogen, the pooled proportion for the outcome of neonatal colonization was 19% (95% CI: 3-35%). CONCLUSION This systematic review strongly supports MDR and/or ESBL Enterobacteriaceae transmission from colonized mothers to their infants, with subsequent infant colonization. The risk factors contributing to transmission of MDR-GNB between colonized mothers and their infants warrants further research.

中文翻译：

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多药耐药革兰氏阴性菌从定居的母亲向婴儿的传播：系统评价和荟萃分析。

背景技术新生儿败血症仍然是新生儿死亡的主要原因。母体细菌定植在传播给婴儿方面起着主要作用，并可能随后由母体衍生的菌株发展为新生儿败血症。目的审查支持耐多药革兰氏阴性细菌（MDR-GNB）从定居母亲传播至婴儿的分子证据，以及MDR-GNB传播的危险因素。方法搜寻PubMed和Scopus进行研究，以研究MDR-GNB从定居的母亲向婴儿传播的机制，危险因素和/或传播的规模。进行随机效应荟萃分析，以确定MDR-GNB传播的合并比例和新生儿的传播结果。结果八项研究包括在叙述性描述中，六项包括在荟萃分析中。有五项研究使用脉冲场凝胶电泳来评估来自定居的母亲及其婴儿的分离株的相关性。从定居的母亲到婴儿的MDR-GNB传播的合并比例为27％（95％置信区间（CI）：8-47％）。产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌是母婴之间传播的最常研究的MDR-GNB病原体。母婴传播MDR-GNB病原体后，新生儿定植结果的合并比例为19％（95％CI：3-35％）。结论本系统评价强烈支持MDR和/或ESBL肠杆菌科细菌从定植的母亲传播给婴儿，以及随后的婴儿定植。