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Abstract：
Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery.
We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization.
We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10-1.40; CRB 2.46, 95% CI 1.39-4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08-1.59; newborn ESBL-PB 1.34, 95% CI 1.09-1.64; newborn CRB 1.73, 95% CI 1.20-2.47).
In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms.
We enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization.
We enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10-1.40; CRB 2.46, 95% CI 1.39-4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08-1.59; newborn ESBL-PB 1.34, 95% CI 1.09-1.64; newborn CRB 1.73, 95% CI 1.20-2.47).
In this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms.
摘要：
背景：抗菌素耐药性（AMR）是一个日益严重的全球健康威胁，导致大量新生儿死亡率。孟加拉国报道了引起新生儿败血症的细菌中AMR的一些最高比率。由于AMR在新生儿中定植可能会感染这些细菌，我们旨在描述住院分娩期间母亲和新生儿定植的频率和危险因素.
方法：我们招募了前往Faridpur三级医院分娩的孕妇，孟加拉国。我们从分娩前和分娩后的母亲那里收集了阴道和直肠拭子，新生儿的直肠拭子,和医院环境的拭子。将拭子铺在对产超广谱β-内酰胺酶的细菌(ESBL-PB)和碳青霉烯抗性细菌(CRB)具有选择性的琼脂上。我们进行逻辑回归以确定与ESBL-PB/CRB定植相关的因素。
结果：我们在2020年2月至10月期间招募了177名妇女及其新生儿。交货前,77%的母亲被ESBL-PB定植，15%被CRB定植。79%的妇女接受了剖宫产(剖腹产)。98%的妇女接受了抗生素治疗。交付后，98％的母亲和89％的新生儿被ESBL-PB定植，89％的母亲和72％的新生儿被CRB定植。在290个环境样本中，77％的ESBL-PB阳性，69％的CRB阳性。产妇产前定植与妊娠期间住院相关（ESBL-PB的RR1.24，95％CI1.10-1.40；CRB2.46，95％CI1.39-4.37）。产妇分娩后和新生儿定植与剖腹产相关（产妇CRB的RR1.31，95％CI1.08-1.59；新生儿ESBL-PB1.34，95％CI1.09-1.64；新生儿CRB1.73，95％CI1.20-2.47）。
结论：在这项研究中，我们观察到母亲和新生儿中ESBL-PB/CRB定植率很高，分娩前的定植与之前的医疗保健接触有关。我们的研究结果表明，这种趋势可能是由大量使用抗生素驱动的，频繁剖腹产,和受污染的医院环境。这些发现突出表明，应更加重视围产期抗生素的使用，改善剖腹产的手术管理，以及医疗保健环境中的感染预防措施，以减少AMR生物定植的高患病率。
方法：我们招募了前往Faridpur三级医院分娩的孕妇，孟加拉国。我们从分娩前和分娩后的母亲那里收集了阴道和直肠拭子，新生儿的直肠拭子,和医院环境的拭子。将拭子铺在对产超广谱β-内酰胺酶的细菌(ESBL-PB)和碳青霉烯抗性细菌(CRB)具有选择性的琼脂上。我们进行逻辑回归以确定与ESBL-PB/CRB定植相关的因素。
结果：我们在2020年2月至10月期间招募了177名妇女及其新生儿。交货前,77%的母亲被ESBL-PB定植，15%被CRB定植。79%的妇女接受了剖宫产(剖腹产)。98%的妇女接受了抗生素治疗。交付后，98％的母亲和89％的新生儿被ESBL-PB定植，89％的母亲和72％的新生儿被CRB定植。在290个环境样本中，77％的ESBL-PB阳性，69％的CRB阳性。产妇产前定植与妊娠期间住院相关（ESBL-PB的RR1.24，95％CI1.10-1.40；CRB2.46，95％CI1.39-4.37）。产妇分娩后和新生儿定植与剖腹产相关（产妇CRB的RR1.31，95％CI1.08-1.59；新生儿ESBL-PB1.34，95％CI1.09-1.64；新生儿CRB1.73，95％CI1.20-2.47）。
结论：在这项研究中，我们观察到母亲和新生儿中ESBL-PB/CRB定植率很高，分娩前的定植与之前的医疗保健接触有关。我们的研究结果表明，这种趋势可能是由大量使用抗生素驱动的，频繁剖腹产,和受污染的医院环境。这些发现突出表明，应更加重视围产期抗生素的使用，改善剖腹产的手术管理，以及医疗保健环境中的感染预防措施，以减少AMR生物定植的高患病率。
