Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria

a prospective, cross-sectional study

K. Neemann, E. K. Olateju, N. Izevbigie, G. Akaba, G. M. Olanipekun, J. C. Richard, C. I. Duru, N. J. Kocmich, K. K. Samson, A. Rezac-Elgohary, E. A. Anigilaje, T. Yunusa, C. O.N. Megafu, T. O. Ajose, N. Medugu, J. Meza, Stephen K Obaro

Research output: Contribution to journalArticle

Abstract

Objectives: The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. Methods: A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal–neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. Results: A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83–28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63–17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44–16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI.06–0.75) requires further evaluation. Conclusions: Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.

Original languageEnglish (US)
JournalClinical Microbiology and Infection
DOIs
StateAccepted/In press - Jan 1 2019

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Enterobacteriaceae
Nigeria
Infant Mortality
Cross-Sectional Studies
Mothers
Odds Ratio
Maternal Exposure
Stillbirth
Teaching Hospitals
Newborn Infant
Anti-Bacterial Agents

Keywords

  • Acquisition
  • Extended-spectrum
  • Neonatal mortality
  • Neonatal sepsis
  • Risk factors
  • β-Lactamases

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria : a prospective, cross-sectional study. / Neemann, K.; Olateju, E. K.; Izevbigie, N.; Akaba, G.; Olanipekun, G. M.; Richard, J. C.; Duru, C. I.; Kocmich, N. J.; Samson, K. K.; Rezac-Elgohary, A.; Anigilaje, E. A.; Yunusa, T.; Megafu, C. O.N.; Ajose, T. O.; Medugu, N.; Meza, J.; Obaro, Stephen K.

In: Clinical Microbiology and Infection, 01.01.2019.

Research output: Contribution to journalArticle

Neemann, K, Olateju, EK, Izevbigie, N, Akaba, G, Olanipekun, GM, Richard, JC, Duru, CI, Kocmich, NJ, Samson, KK, Rezac-Elgohary, A, Anigilaje, EA, Yunusa, T, Megafu, CON, Ajose, TO, Medugu, N, Meza, J & Obaro, SK 2019, 'Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study', Clinical Microbiology and Infection. https://doi.org/10.1016/j.cmi.2019.07.013
Neemann, K. ; Olateju, E. K. ; Izevbigie, N. ; Akaba, G. ; Olanipekun, G. M. ; Richard, J. C. ; Duru, C. I. ; Kocmich, N. J. ; Samson, K. K. ; Rezac-Elgohary, A. ; Anigilaje, E. A. ; Yunusa, T. ; Megafu, C. O.N. ; Ajose, T. O. ; Medugu, N. ; Meza, J. ; Obaro, Stephen K. / Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria : a prospective, cross-sectional study. In: Clinical Microbiology and Infection. 2019.
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abstract = "Objectives: The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. Methods: A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal–neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. Results: A total of 1161 singleton deliveries were evaluated. In total, 9.7{\%} (113/1161) of mothers and 4.3{\%} (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6{\%} (21/113) vs. 8.4{\%} (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95{\%} CI 7.83–28.15) and vaginal delivery (AOR 6.35; 95{\%} CI 2.63–17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95{\%} CI 1.44–16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95{\%} CI.06–0.75) requires further evaluation. Conclusions: Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.",
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T2 - a prospective, cross-sectional study

AU - Neemann, K.

AU - Olateju, E. K.

AU - Izevbigie, N.

AU - Akaba, G.

AU - Olanipekun, G. M.

AU - Richard, J. C.

AU - Duru, C. I.

AU - Kocmich, N. J.

AU - Samson, K. K.

AU - Rezac-Elgohary, A.

AU - Anigilaje, E. A.

AU - Yunusa, T.

AU - Megafu, C. O.N.

AU - Ajose, T. O.

AU - Medugu, N.

AU - Meza, J.

AU - Obaro, Stephen K

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. Methods: A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal–neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. Results: A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83–28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63–17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44–16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI.06–0.75) requires further evaluation. Conclusions: Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.

AB - Objectives: The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. Methods: A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal–neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. Results: A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83–28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63–17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44–16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI.06–0.75) requires further evaluation. Conclusions: Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.

KW - Acquisition

KW - Extended-spectrum

KW - Neonatal mortality

KW - Neonatal sepsis

KW - Risk factors

KW - β-Lactamases

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