Abstract
Maternal carriage and vertical transmission of extended-spectrum, beta-lactamase-producing Enterobacteriaceae (ESBL-E), such as Escherichia coli, hamper the treatment of infections, resulting in high morbidity. E. coli is the most frequent cause of early-onset neonatal sepsis (EOS) in preterm infants, where ESBL-E are more frequently isolated. In this prospective, case-controlled study, maternal rectovaginal ESBL-E colonization and vertical transmission to preterm infants were assessed in 160 women with preterm premature rupture of membranes (PPROM; 57.4%) or preterm labor (42.6%); additional cultures were obtained from the placenta, amnion, and umbilical cord during preterm labor. Maternal and neonatal ESBL-E-carriage rates were 17.5% and 12.9%, respectively, and the vertical-transmission rate was 50%. Maternal ESBL-E colonization among women with PPROM was 21.3%, and in women with premature labor it was 12.6%. No correlation was observed between maternal ESBL-E-colonization and previous hospitalization or antibiotic administration during pregnancy. However, a correlation was found between placental inflammation and maternal ESBL-E colonization (p = 0.007). ESBL-E-colonized infants were delivered at an earlier gestational age and were more likely to have complications. Thus, the high ESBL-E carriage rate in women with threatened preterm labor, without obvious risk factors for carriage, and a high vertical transmission rate, combined with a correlation between placental inflammation and ESBL-E carriage, support maternal–neonatal ESBL-E-colonization surveillance and active measures to prevent ESBL-E-related EOS.
Highlights
This study aimed to evaluate the rate of extended-spectrum beta-lactamase (ESBL)-E colonization among women in preterm labor and women with preterm premature rupture of membranes (PPROM), incidence of maternal vertical transmission, intrauterine inflammation, and the clinical significance of ESBL-E in preterm infants
No significant differences in the background data were observed between the two groups, except for previous preterm birth (Table 1)
Of the 160 patients, 139 were screened for rectovaginal Group B Streptococcus (GBS) at the time of admission; carriage rate was similar between both groups (Table 2)
Summary
Preterm neonates who survive are at greater risk of a range of short-term and long-term morbidities [1,2,3]. Neonatal sepsis remains a major cause of morbidity and mortality during the neonatal period, despite significant advancements in perinatal care over the last few decades [4]. Group B Streptococcus (GBS) and Escherichia coli are the most common causes of all cases of neonatal early-onset sepsis (EOS) [5,6], while Klebsiella pneumoniae and E. coli are the most frequent causative organisms in most low- and middleincome countries [7,8]. The incidence of EOS is greater with E. coli than with GBS [9,10]
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