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.
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。