Abstract
Introduction Infections caused by extended spectrum beta lactamase (ESBL) producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics. The aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon, to examine their phenotypic and genotypic characterization and to study the association between ESBL colonization with adverse neonatal outcomes. Method In this cross-sectional study, vaginal samples from 308 pregnant women at 35–37 weeks of gestation were studied during a one-year period. The samples were plated on MacConkey agar and selective MacConkey agar supplemented with ceftazidime. Phenotypic confirmation of ESBL production was performed by double-disc synergy test and all isolates were screened by PCR for the resistance genes blaSHV, blaTEM, and blaCTX-M. Clonal relatedness of Escherichia coli isolates was investigated by pulsed-field gel electrophoresis. Results In total, 59 women out of 308 (19.1%) were colonized by ESBL producing gram negative bacteria. Two babies born to mothers colonized with ESBL were diagnosed with sepsis. The susceptibility rates of isolates to other antibiotics were 39% to co-trimoxazole, 49.2% to ciprofloxacin, 91.5% to gentamicin, 18.6% to aztreonam and 35.6% to cefepime. Most of isolates were highly sensitive to meropenem and imipenem, with a susceptibility of 93.2%. PCR was performed on all E. coli isolates to detect the most common ESBL producing genes; blaCTX-M was the predominant gene (90.7%), followed by blaTEM (88.4%) and finally blaSHV (44.2%). PFGE analysis of 34 E. coli isolates revealed 22 distinct clusters showing more than 85% similarity. Conclusion In conclusion, this study showed that Lebanon has a high prevalence of ESBL carriage in pregnant women. Further studies that include a continuous screening of pregnant women and follow up of their newborn clinical status should be conducted to foresee the risk of transmission.
Highlights
Infections caused by extended spectrum beta lactamase (ESBL) producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics. e aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon, to examine their phenotypic and genotypic characterization and to study the association between ESBL colonization with adverse neonatal outcomes
Infections caused by ESBL producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics [5, 6]
Antimicrobial Susceptibility of ESBL Producing Isolates. e present study was conducted on 308 participating pregnant women, 59 (19.1%) ESBL producing Gram-negative bacilli were obtained where the most commonly isolated organism among gram-negative bacilli was E. coli, 43 isolates (72.9%), followed by 15 isolates of K. pneumonia (25.4%) and one isolate of Proteus mirabilis (1.7%)
Summary
Onset neonatal sepsis (EOS) is considered the main cause of mortality and morbidity in neonates [1]. It occurs in the first three days of life and usually transmitted from mother to baby during delivery [1]. Sparse information exists in the literature regarding ESBL producing bacteria colonization in pregnant women. E aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon and to examine their phenotypic and genotypic characterization. E study aimed to explore the association between ESBL colonization with adverse neonatal outcomes E aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon and to examine their phenotypic and genotypic characterization. e study aimed to explore the association between ESBL colonization with adverse neonatal outcomes
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