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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 S. Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study. Clin Microbiol Infect 2019; 26:463-469. [PMID: 31336200 DOI: 10.1016/j.cmi.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/27/2022]
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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Affiliation(s)
- K Neemann
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
| | - E K Olateju
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - N Izevbigie
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - G Akaba
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - G M Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J C Richard
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - C I Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N J Kocmich
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - K K Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - A Rezac-Elgohary
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - E A Anigilaje
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - T Yunusa
- Department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - C O N Megafu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - T O Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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