Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing Enterobacteriaceae during Preterm Delivery: A Prospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Description
2.2. Maternal Screening
2.3. Neonatal Screening and Birth Cultures
2.4. Identification of ESBL Bacteria in Culture and Susceptibility Tests
2.5. Risk Factors for Maternal ESBL Carriage
2.6. Risk Factors for Vertical Transmission of ESBL
2.7. Neonatal Outcome
2.8. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Prevalence of Maternal ESBL-E Colonization and Risk Factors
3.3. Maternal ESBL-E Colonization and Obstetric Outcomes
3.4. Neonatal Outcomes
3.5. Vertical Transmission of ESBL
4. Discussion
4.1. Main Findings
4.2. Ascending Infection and Placental Involvement
4.3. Clinical Outcomes
4.4. Strengths and Limitations
4.5. Implications
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
ESBL-E | extended-spectrum beta-lactamase producing Enterobacteriaceae. |
EOS early | onset neonatal sepsis |
PPROM | preterm premature rupture of membranes |
ESBL | extended-spectrum beta-lactamase |
GBS | Group B Streptococcus |
E. coli | Escherichia coli |
NICU | neonatal intensive care unit |
VLBW | very-low-birthweight |
GA | gestational age |
APGAR score | appearance, pulse, grimace, activity, and respiration |
RDS | respiratory distress syndrome |
NEC | necrotizing enterocolitis |
IVH | intraventricular hemorrhage |
MRI | magnetic resonance imaging |
BPD | bronchopulmonary dysplasia |
CPAP | continuous positive airway pressure |
SD | standard deviation |
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Baseline Characteristic | Cohort (n = 160) | Preterm Labor (n = 71) | PPROM (n = 89) | p-Value | |
---|---|---|---|---|---|
Maternal Age (y) | Mean ± SD | 29.6 ± 6.3 | 28.8 ± 6.2 | 29.9 ± 6.4 | 0.29 |
Parity | Median (range) | 2 (1–10) | 2 (1–5) | 2 (1–10) | 0.295 |
Gravidity | Median (range) | 2 (1–14) | 2 (1–7) | 2 (1–14) | 0.191 |
Previous Preterm Birth | 36 (22.5%) | 21 (29.6%) | 15 (17%) | 0.033 | |
Cervical Cerclage in Situ | 11 (6.8%) | 3 (4.2%) | 8 (8.9%) | 0.358 | |
Maternal Diabetes | 16 (10.0%) | 9 (12.7%) | 7 (7.9%) | 0.284 | |
Multiple Gestations | 7 (4.5%) | 5 (7.0%) | 2 (2.2%) | 0.132 |
Variable | Cohort (n = 160) | Preterm Labor (n = 71) | PPROM (n = 89) | p-Value | |
---|---|---|---|---|---|
ESBL-E Status | 28 (%5.17) | 9 (12.6%) | 19 (21.3%) | 0.292 | |
Sampling Week | Median (range) | 33.64 (24.1–36.9) | 33.57 (24.9–36.9) | 33.71 (24.1–36.9) | 0.481 |
GBS Carriage Status | n =139 | 22/139 (15.8%) | 11/59 (18.6%) | 11/80 (13.8%) | 0.485 |
Delivery Week | Median (range) | 35.8 (25.4–42.3) | 37.0 (29.1–40.6) | 34.6 (25.4–42.3) | <0.001 |
Delivery Mode among Final Sample | Cesarean | 45 (28.1%) | 13 (18.3%) | 32 (36.0%) | 0.032 |
Variable | Cohort (n = 160) | Negative Maternal ESBL-E-Colonization (n = 132) | Positive Maternal ESBL-E Colonization (n = 28) | p-Value | |
---|---|---|---|---|---|
Sampling Week | Mean ± SD | 32.63 ± 3.45 | 32.75 ± 3.42 | 32.09 ± 3.61 | 0.356 |
Maternal Age (years) | Mean ± SD | 29.61 ± 6.36 | 29.43 ± 6.02 | 30.54 ± 7.93 | 0.251 |
Gravidity | Mean ± SD | 2.55 ±1.86 | 2.48 ± 1.65 | 2.88 ± 2.70 | 0.301 |
Parity | Mean ± SD | 1.95 ± 1.29 | 1.88 ± 1.08 | 2.31 ± 2.015 | 0.253 |
Hospital Admissions | Median(range) | 0.54 ± 0.78 | 0.56 ± 0.79 | 0.46 ± 0.71 | 0.331 |
Positive GBS Status | n = 139 | 22/139 (15.8%) | 19/117 (16.2%) | 3/22 (13.6%) | 1.00 |
UTI in Current Pregnancy | 19 (11.8%) | 14 (10.6%) | 5 (17.9%) | 0.332 | |
Antibiotic Administration (Prior to Sampling) | 12 (7.5%) | 8 (6) | 4 (14.2%) | 0.110 |
Variable | Cohort (n = 160) | Negative Maternal ESBL-E-Colonization (n = 132) | Positive Maternal ESBL-E Colonization (n = 28) | p-Value | |
---|---|---|---|---|---|
Delivery Week | Median (range) | 35.8 (25.4–42.3) | 35.9 (26.6–42.3) | 35.4 (25.4–40.0) | 0.659 |
Delivery Mode | Cesarean | 45 (28.1%) | 36 (27.3%) | 9 (32.1%) | 0.60 |
Placental Inflammation Signs | n = 61 | 17/61 (27.9%) | 10/50 (20%) | 7/11 (63.6%) | 0.007 |
ESBL-E Isolates (Placenta, Cord, Amnion) | Pooled ratio (n = 80) | 5/80 (6.3%) | 2/63 (3.2%) | 3/17 (17.6%) | 0.062 |
Perinatal Outcome | |||||
NICU Admission | n = 85 | 85 (53.1%) | 69/132 (52.2%) | 16/28 (57.1%) | 0.835 |
Positive Neonatal ESBL-E-Colonization (at Admission) | n = 85 | 11/85 (12.9%) | 3/69 (4.3%) | 8/16 (50%) | <0.001 |
Risk Factor | NICU Admission (n = 85) | Negative Neonatal ESBL-E-Colonization (n = 74) | Positive Neonatal ESBL-E-Colonization (n = 11) | p-Value | |
---|---|---|---|---|---|
Maternal ESBL Colonization | 16 (18.8%) | 8 (10.8%) | 8 (72.7%) | <0.001 | |
Neonatal Gender | Male Female | 56% 44% | 52.1% 47.9% | 81.8% 18.2% | 0.102 |
Delivery Mode | Cesarean | 38 (44.7%) | 34 (45.9%) | 4 (36.4%) | 0.747 |
Vaginal | 47 (55.3%) | 40 (54.1%) | 7 (63.6%) | ||
Delivery Week (Weeks) * | Median (range) | 33.6 (25.4–36.9) | 34 (26.6–36.9) | 30.3 (25.4–34.0) | 0.007 |
Antepartum Antibiotics (7-Day Interval) | 33 (38.8%) | 31 (41.9%) | 2 (18.2%) | 0.190 | |
Intrapartum Antibiotics | 79 (94.0%) | 70 (94.6%) | 9 (90.0%) | 0.478 | |
Intrapartum Fever | 5 (5.9%) | 5 (6.8%) | 0 (0%) | 0.491 | |
Latency Period (days) | Median (range) | 2 (0–60) | 2 (0–52) | 3.5 (0–60) | 0.974 |
PROM | 64 (75.3%) | 54 (73%) | 10 (90.9%) | 0.279 | |
Outcomes | |||||
Birthweight (g) * | Mean ± SD | 1966.7 ± 628.1 | 2032.5 ± 692.6 | 1502.4 ± 498.9 | 0.011 |
NICU Hospitalization Length (days) | Median (range) | 18.0 (21–04) | 15.5 (2–104) | 23.0 (6–98) | 0.049 |
Antibiotic Administration in NICU (%) | 61 (71.8%) | 51 (68.9%) | 10 (90.0%) | 0.168 | |
Antibiotic Administration in NICU (days) | Mean ± SD | 2.52 ± 2.48 | 0.59 ± 2.12 | 6.00 ± 4.30 | 0.03 |
Ventilation Support | 39 (45.9%) | 31 (41.9%) | 8 (72.2%) | 0.056 | |
Neonatal Morbidity Pooled Ratio in NICU | 34 (40%) | 26 (35.1%) | 8 (72.7%) | 0.023 |
Neonatal Complications (R2 = 46.3%) | p-Value | Odds Ratio | 95% CI Lower Limit | 95% CI Upper Limit |
---|---|---|---|---|
Positive Neonatal ESBL-E-Colonization | 0.124 | 3.656 | 0.7000 | 18.984 |
Delivery Week | p < 0.001 | 0.0170 | 0.002 | 0.164 |
Delivery Mode (Cesarean vs. Vaginal) | 0.647 | 1.302 | 0.420 | 4.034 |
Gender (Female vs. Male) | 0.076 | 0.322 | 0.092 | 1.125 |
Need for Ventilation (R2 = 58.0%) | p-Value | Odds Ratio | 95% CI Lower limit | 95% CI Upper |
Positive Neonatal ESBL-E-Colonization (Positive versus Negative) | 0.1990 | 9.082 | ||
Delivery Mode (Cesarean versus Vaginal) | 0.776 | 1.208 | 0.329 | 4.432 |
Delivery Week | p < 0.001 | 0.450 | 0.313 | 0.646 |
Gender (Female versus Male) | 0.363 | 0.559 | 0.160 | 1.955 |
NICU Hospitalization Length (R2 = 60.9%) | p-Value | B-Standardized coefficients | ||
Positive Neonatal ESBL-E-Colonization | 0.179 | 0.097 | ||
Delivery Mode (Cesarean versus Vaginal) | p < 0.001 | 0.291 | ||
Delivery Week | p < 0.001 | −0.648 | ||
Gender (Female versus Male) | 0.190 | −0.093 |
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Frank Wolf, M.; Abu Shqara, R.; Naskovica, K.; Zilberfarb, I.A.; Sgayer, I.; Glikman, D.; Rechnitzer, H.; Fleisher Sheffer, V.; Bornstein, J. Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing Enterobacteriaceae during Preterm Delivery: A Prospective Study. Microorganisms 2021, 9, 506. https://doi.org/10.3390/microorganisms9030506
Frank Wolf M, Abu Shqara R, Naskovica K, Zilberfarb IA, Sgayer I, Glikman D, Rechnitzer H, Fleisher Sheffer V, Bornstein J. Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing Enterobacteriaceae during Preterm Delivery: A Prospective Study. Microorganisms. 2021; 9(3):506. https://doi.org/10.3390/microorganisms9030506
Chicago/Turabian StyleFrank Wolf, Maya, Raneen Abu Shqara, Karina Naskovica, Inna Amdur Zilberfarb, Inshirah Sgayer, Daniel Glikman, Hagai Rechnitzer, Vered Fleisher Sheffer, and Jacob Bornstein. 2021. "Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing Enterobacteriaceae during Preterm Delivery: A Prospective Study" Microorganisms 9, no. 3: 506. https://doi.org/10.3390/microorganisms9030506