Maternal Colonization of Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Preterm Rupture of Membranes

IF 2 Q2 OBSTETRICS & GYNECOLOGY

Journal of obstetrics and gynaecology Canada Pub Date : 2025-02-01 DOI:10.1016/j.jogc.2024.102755

Inshirah Sgayer MD , Muhammad Zidan MD , Yara Nakhleh Francis MD , Raneen Abu Shqara MD , Daniel Glikman MD , Lior Lowenstein MD , Maya Frank Wolf MD

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引用次数: 0

Abstract

Objectives

Maternal colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) has risen, and the antimicrobial resistance of ESBL-E is significant. We aimed to evaluate the rates of ESBL-E colonization among women with preterm premature rupture of membranes (PPROM) and of maternal-neonatal vertical transmission. We also aimed to compare obstetrical and neonatal complications among ESBL-E positive versus negative maternal colonization in pregnancies complicated by PPROM.

Methods

This retrospective study included women with PPROM who were admitted from 2018 to 2022 for expectant management and were screened for ESBL-E recto-vaginal colonization on their admission. Obstetrical and neonatal outcomes were compared between positive and negative ESBL-E pregnancies. Neonatal outcomes were compared between positive and negative ESBL-E neonates.

Results

Of 118 women with PPROM, 27 (23%) had positive ESBL-E cultures. ESBL-E isolates (cultures from the placenta, cord, amnion, or uterus) were more common in colonized versus non-colonized ESBL-E mothers (55.6% vs. 11.0%, P < 0.001). ESBL-E isolates were more common in neonates of mothers with positive versus negative ESBL-E cultures (33.3% vs. 4.2%, P = 0.017). A higher proportion of neonates of ESBL-E positive than ESBL-E negative mothers needed antibiotic treatment in the neonatal intensive care unit. Neonatal ESBL-E colonization at birth was a predictor of longer stays in the neonatal intensive care unit (P = 0.006).

Conclusions

In women with PPROM, maternal–ESBL-E colonization was a significant risk factor for neonatal colonization and was associated with neonatal morbidity. The high maternal colonization rate in PPROM raises the need for routine maternal ESBL screening. Future studies should establish the ideal empiric antibiotic regimen in the neonatal intensive care unit for neonates born to ESBL-E colonized mothers.

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产广谱β -内酰胺酶肠杆菌科在胎膜早破中的母体定植。

目的：产广谱β-内酰胺酶（ESBL-E）的肠杆菌科细菌在母系的定植量有所增加，且ESBL-E的耐药性显著。我们的目的是评估ESBL-E在早产胎膜早破（PPROM）妇女中的定植率和母婴垂直传播率。我们还旨在比较妊娠合并PPROM的孕妇中ESBL-E阳性和阴性母体定植的产科和新生儿并发症。方法：本回顾性研究纳入了2018-2022年期间因预期治疗而入院的PPROM女性，并在入院时进行了ESBL-E直肠-阴道定植筛查。比较ESBL-E阳性和阴性妊娠的产科和新生儿结局。比较ESBL-E阳性和阴性新生儿的新生儿结局。结果：118例PPROM患者中，27例（23%）ESBL-E培养阳性。ESBL-E分离株（来自胎盘、脐带、羊膜或子宫的培养物）在定植的ESBL-E母亲中比在非定植的ESBL-E母亲中更常见（55.6%比11.0%,P < 0.001）。ESBL-E分离株在ESBL-E培养阳性和阴性母亲的新生儿中更常见（33.3%比4.2%,P = 0.017）。在新生儿重症监护病房，ESBL-E阳性的新生儿比ESBL-E阴性的母亲需要抗生素治疗的比例更高。新生儿出生时ESBL-E定植是新生儿重症监护病房停留时间较长的预测因子（P = 0.006）。结论：在患有PPROM的女性中，母体- esbl - e定植是新生儿定植的重要危险因素，并与新生儿发病率相关。PPROM中较高的母体定植率提高了常规母体ESBL筛查的必要性。未来的研究应该为ESBL-E定殖的母亲所生的新生儿在NICU建立理想的经经验抗生素方案。

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来源期刊

Journal of obstetrics and gynaecology Canada OBSTETRICS & GYNECOLOGY-

CiteScore

3.30

自引率

5.60%

发文量

302

审稿时长

32 days

期刊介绍： Journal of Obstetrics and Gynaecology Canada (JOGC) is Canada"s peer-reviewed journal of obstetrics, gynaecology, and women"s health. Each monthly issue contains original research articles, reviews, case reports, commentaries, and editorials on all aspects of reproductive health. JOGC is the original publication source of evidence-based clinical guidelines, committee opinions, and policy statements that derive from standing or ad hoc committees of the Society of Obstetricians and Gynaecologists of Canada. JOGC is included in the National Library of Medicine"s MEDLINE database, and abstracts from JOGC are accessible on PubMed.