Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia

Getnet Amsalu; Christine Tedijanto Wen; Olga Perovic; Addisalem Gebru; Bezawit M Hunegnaw; Fisseha Tadesse; Marshagne Smith; Addisalem Fikre; Delayehu Bekele; Lisanu Taddesse; Grace J Chan

doi:10.1016/j.ijid.2024.107035

Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia

Int J Infect Dis. 2024 Mar 30:143:107035. doi: 10.1016/j.ijid.2024.107035. Online ahead of print.

Authors

Affiliations

¹ Birhan HDSS, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia; HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia.
² Surgo Health, Washington, DC, USA.
³ Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, University of Witwatersrand, Johannesburg, South Africa.
⁴ Birhan HDSS, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia; HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia; Department of Obstetrics and Gynecology, Debre Birhan Hospital, Debre Birhan, Ethiopia.
⁵ HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia; Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
⁶ Department of Obstetrics and Gynecology, Debre Birhan Hospital, Debre Birhan, Ethiopia.
⁷ Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, Johannesburg, South Africa.
⁸ Department of Obstetrics and Gynecology, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
⁹ HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia.
¹⁰ Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. Electronic address: grace.chan@childrens.harvard.edu.

PMID: 38561043
DOI: 10.1016/j.ijid.2024.107035

Abstract

Objectives: Infections are one of the most common causes of neonatal mortality, and maternal colonization has been associated with neonatal infection. In this study, we sought to quantify carriage prevalence of extended-spectrum-beta-lactamase (ESBL) -producing and carbapenem-resistant Enterobacterales (CRE) among pregnant women and their neonates and to characterize risk factors for carriage in rural Amhara, Ethiopia.

Methods: We conducted a prospective cohort study nested in the Birhan field site. We collected rectal and vaginal samples from 211 pregnant women in their third trimester and/or during labor/delivery and perirectal or stool samples from 159 of their neonates in the first week of life.

Results: We found that carriage of ESBL-producing organisms was fairly common (women: 22.3%, 95% CI: 16.8-28.5; neonates: 24.5%, 95% CI: 18.1-32.0), while carriage of CRE (women: 0.9%, 95% CI: 0.1-3.4; neonates: 2.5%, 95% CI: 0.7-6.3) was rare. Neonates whose mothers tested positive for ESBL-producing organisms were nearly twice as likely to also test positive for ESBL-producing organisms (38.7% vs 21.1%, P-value = 0.06). Carriage of ESBL-producing organisms was also associated with Woreda (district) of sample collection and recent antibiotic use.

Conclusion: Understanding carriage patterns of potential pathogens and antibiotic susceptibility among pregnant women and newborns will inform local, data-driven recommendations to prevent and treat neonatal infections.

Keywords: Antibiotic resistance; Carbapenem-resistant Enterobacterales; Extended-spectrum-beta-lactamase-producing organisms; Neonates; Sepsis; Vertical transmission.