Pauline Getanda, Isatou Jagne, Joel D Bognini, Bully Camara, Bakary Sanyang, Saffiatou Darboe, Ellen Sambou, Momodou Barry, Kady Kassibo, Aminata Cham, Harriet Mendy, Bintou K J Singateh, Ebrahim Ndure, Toussaint Rouamba, Abdoulie Bojang, Christian Bottomley, Benjamin P Howden, Umberto D'Alessandro, Halidou Tinto, Anna Roca
{"title":"产前服用阿奇霉素对母亲及其新生儿体内大肠埃希菌和肺炎克雷伯菌的携带和抗生素耐药性的影响：在冈比亚和布基纳法索进行的随机双盲试验的子研究。","authors":"Pauline Getanda, Isatou Jagne, Joel D Bognini, Bully Camara, Bakary Sanyang, Saffiatou Darboe, Ellen Sambou, Momodou Barry, Kady Kassibo, Aminata Cham, Harriet Mendy, Bintou K J Singateh, Ebrahim Ndure, Toussaint Rouamba, Abdoulie Bojang, Christian Bottomley, Benjamin P Howden, Umberto D'Alessandro, Halidou Tinto, Anna Roca","doi":"10.1093/cid/ciae280","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Limited data exist on the effects of intrapartum azithromycin on the prevalence of carriage and antibiotic resistance of Enterobacterales.</p><p><strong>Methods: </strong>We conducted a randomized trial in The Gambia and Burkina Faso where women received intrapartum azithromycin (2 g) or placebo. We determined the impact of treatment on the prevalence of carriage and antibiotic resistance of Escherichia coli and Klebsiella pneumoniae by analyzing rectal swabs (RS), nasopharyngeal swabs (NPS), breast milk, and rectovaginal swabs (RVS). Bacteria were isolated microbiologically; antibiotic susceptibility was confirmed with an E-test. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were used for comparison between arms.</p><p><strong>Results: </strong>In infants, E. coli carriage in RS was lower in the intervention than in the placebo arm at day 6 (63.0% vs 75.2%; PR, 0.84; 95% CI, .75-.95) and day 28 (52.7% vs 70.4%; 0.75; 0.64-0.87) post-intervention. Prevalence of azithromycin-resistant E. coli was higher in the azithromycin arm at day 6 (13.4% vs 3.6%; 3.75; 1.83-7.69) and day 28 (16.4% vs 9.6%; 1.71; 1.05-2.79). For K. pneumoniae, carriage in RS was higher in the intervention than in the placebo arm at day 6 (49.6% vs 37.2%, 1.33; 1.08-1.64) and day 28 (53.6% vs 32.9%, 1.63; 1.31-2.03). Prevalence of azithromycin-resistant K. pneumoniae was higher in the azithromycin arm at day 28 (7.3% vs 2.1%; 3.49; 1.30-9.37). No differences were observed for other sample types.</p><p><strong>Conclusions: </strong>Intrapartum azithromycin decreased E. coli carriage but increased both K. pneumoniae carriage and azithromycin resistance in both bacteria. These data need to be considered together with efficacy results to balance the potential short- and long-term impact of the intervention. Clinical Trials Registration. www.clinicaltrials.gov: NCT03199547.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"1338-1345"},"PeriodicalIF":8.2000,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Intrapartum Azithromycin on the Carriage and Antibiotic Resistance of Escherichia coli and Klebsiella pneumoniae in Mothers and Their Newborns: A Substudy of a Randomized, Double-Blind Trial Conducted in The Gambia and Burkina Faso.\",\"authors\":\"Pauline Getanda, Isatou Jagne, Joel D Bognini, Bully Camara, Bakary Sanyang, Saffiatou Darboe, Ellen Sambou, Momodou Barry, Kady Kassibo, Aminata Cham, Harriet Mendy, Bintou K J Singateh, Ebrahim Ndure, Toussaint Rouamba, Abdoulie Bojang, Christian Bottomley, Benjamin P Howden, Umberto D'Alessandro, Halidou Tinto, Anna Roca\",\"doi\":\"10.1093/cid/ciae280\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Limited data exist on the effects of intrapartum azithromycin on the prevalence of carriage and antibiotic resistance of Enterobacterales.</p><p><strong>Methods: </strong>We conducted a randomized trial in The Gambia and Burkina Faso where women received intrapartum azithromycin (2 g) or placebo. We determined the impact of treatment on the prevalence of carriage and antibiotic resistance of Escherichia coli and Klebsiella pneumoniae by analyzing rectal swabs (RS), nasopharyngeal swabs (NPS), breast milk, and rectovaginal swabs (RVS). Bacteria were isolated microbiologically; antibiotic susceptibility was confirmed with an E-test. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were used for comparison between arms.</p><p><strong>Results: </strong>In infants, E. coli carriage in RS was lower in the intervention than in the placebo arm at day 6 (63.0% vs 75.2%; PR, 0.84; 95% CI, .75-.95) and day 28 (52.7% vs 70.4%; 0.75; 0.64-0.87) post-intervention. Prevalence of azithromycin-resistant E. coli was higher in the azithromycin arm at day 6 (13.4% vs 3.6%; 3.75; 1.83-7.69) and day 28 (16.4% vs 9.6%; 1.71; 1.05-2.79). For K. pneumoniae, carriage in RS was higher in the intervention than in the placebo arm at day 6 (49.6% vs 37.2%, 1.33; 1.08-1.64) and day 28 (53.6% vs 32.9%, 1.63; 1.31-2.03). Prevalence of azithromycin-resistant K. pneumoniae was higher in the azithromycin arm at day 28 (7.3% vs 2.1%; 3.49; 1.30-9.37). No differences were observed for other sample types.</p><p><strong>Conclusions: </strong>Intrapartum azithromycin decreased E. coli carriage but increased both K. pneumoniae carriage and azithromycin resistance in both bacteria. These data need to be considered together with efficacy results to balance the potential short- and long-term impact of the intervention. Clinical Trials Registration. www.clinicaltrials.gov: NCT03199547.</p>\",\"PeriodicalId\":10463,\"journal\":{\"name\":\"Clinical Infectious Diseases\",\"volume\":\" \",\"pages\":\"1338-1345\"},\"PeriodicalIF\":8.2000,\"publicationDate\":\"2024-12-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/cid/ciae280\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/cid/ciae280","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：关于产前阿奇霉素对肠杆菌携带率和抗生素耐药性影响的数据有限：关于产前服用阿奇霉素对肠杆菌携带率和抗生素耐药性影响的数据有限：我们在冈比亚和布基纳法索进行了一项随机试验，让产妇在产前服用阿奇霉素（2 克）或安慰剂。我们通过分析直肠拭子（RS）、鼻咽拭子（NPS）、母乳和直肠阴道拭子（RVS），确定了治疗对大肠埃希菌和肺炎克雷伯菌携带率和抗生素耐药性的影响。细菌是通过微生物学方法分离出来的；抗生素敏感性是通过 E 试验确认的。采用患病率比（PR）和 95% 置信区间（CI）进行两组间比较：在干预后第 6 天（63.0% 对 75.2%，PR，0.84；CI，0.75-0.95）和第 28 天（52.7% 对 70.4%，0.75；0.64-0.87），干预组婴儿 RS 中的大肠杆菌携带率低于安慰剂组。阿奇霉素组在干预后第6天（13.4% vs. 3.6%，3.75；1.83-7.69）和第28天（16.4% vs. 9.6%，1.71；1.05-2.79）的耐阿奇霉素大肠杆菌感染率较高。就肺炎克氏菌而言，在第 6 天（49.6% 对 37.2%，1.33；1.08-1.64）和第 28 天（53.6% 对 32.9%，1.63；1.31-2.03），干预组 RS 中的携带率高于安慰剂组。阿奇霉素治疗组在第28天时耐阿奇霉素肺炎克氏菌的流行率更高（7.3% vs. 2.1%，3.49；1.30-9.37）。其他样本类型未观察到差异：结论：产前阿奇霉素可减少大肠杆菌携带量，但会增加肺炎双球菌携带量和两种细菌的阿奇霉素耐药性。临床试验注册：www.clinicaltrials.gov：NCT03199547。
Impact of Intrapartum Azithromycin on the Carriage and Antibiotic Resistance of Escherichia coli and Klebsiella pneumoniae in Mothers and Their Newborns: A Substudy of a Randomized, Double-Blind Trial Conducted in The Gambia and Burkina Faso.
Background: Limited data exist on the effects of intrapartum azithromycin on the prevalence of carriage and antibiotic resistance of Enterobacterales.
Methods: We conducted a randomized trial in The Gambia and Burkina Faso where women received intrapartum azithromycin (2 g) or placebo. We determined the impact of treatment on the prevalence of carriage and antibiotic resistance of Escherichia coli and Klebsiella pneumoniae by analyzing rectal swabs (RS), nasopharyngeal swabs (NPS), breast milk, and rectovaginal swabs (RVS). Bacteria were isolated microbiologically; antibiotic susceptibility was confirmed with an E-test. Prevalence ratios (PRs) with 95% confidence intervals (CIs) were used for comparison between arms.
Results: In infants, E. coli carriage in RS was lower in the intervention than in the placebo arm at day 6 (63.0% vs 75.2%; PR, 0.84; 95% CI, .75-.95) and day 28 (52.7% vs 70.4%; 0.75; 0.64-0.87) post-intervention. Prevalence of azithromycin-resistant E. coli was higher in the azithromycin arm at day 6 (13.4% vs 3.6%; 3.75; 1.83-7.69) and day 28 (16.4% vs 9.6%; 1.71; 1.05-2.79). For K. pneumoniae, carriage in RS was higher in the intervention than in the placebo arm at day 6 (49.6% vs 37.2%, 1.33; 1.08-1.64) and day 28 (53.6% vs 32.9%, 1.63; 1.31-2.03). Prevalence of azithromycin-resistant K. pneumoniae was higher in the azithromycin arm at day 28 (7.3% vs 2.1%; 3.49; 1.30-9.37). No differences were observed for other sample types.
Conclusions: Intrapartum azithromycin decreased E. coli carriage but increased both K. pneumoniae carriage and azithromycin resistance in both bacteria. These data need to be considered together with efficacy results to balance the potential short- and long-term impact of the intervention. Clinical Trials Registration. www.clinicaltrials.gov: NCT03199547.
期刊介绍：
Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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