Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

doi:10.3390/microorganisms9061245

. 2021 Jun 8;9(6):1245.

doi: 10.3390/microorganisms9061245.

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

Lital Ashtamkar Matok¹, Maya Azrad², Tamar Leshem², Anan Abuzahya³, Thanaa Khamaisi³, Tatiana Smolkin⁴, Avi Peretz^{1

2}

Affiliations

¹ The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel.
² Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel.
³ Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel.
⁴ Department of Neonatology and Neonatal Intensive Care Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1311502, Israel.

PMID: 34201210
PMCID: PMC8229721
DOI: 10.3390/microorganisms9061245

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

Lital Ashtamkar Matok et al. Microorganisms. 2021.

. 2021 Jun 8;9(6):1245.

doi: 10.3390/microorganisms9061245.

Authors

Lital Ashtamkar Matok¹, Maya Azrad², Tamar Leshem², Anan Abuzahya³, Thanaa Khamaisi³, Tatiana Smolkin⁴, Avi Peretz^{1

2}

Affiliations

¹ The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel.
² Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel.
³ Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Tiberias 1311502, Israel.
⁴ Department of Neonatology and Neonatal Intensive Care Unit, The Baruch Padeh Medical Center Poriya, Tiberias 1311502, Israel.

PMID: 34201210
PMCID: PMC8229721
DOI: 10.3390/microorganisms9061245

Abstract

We evaluated carriage rates of extended spectrum β-lactam-producing Enterobacterales (ESBL-E), Carbapeneme-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) among pregnant women and determined the maternal-to-neonate transmission rates of these antibiotic-resistant bacteria (ARB). Pregnant women provided rectal and vaginal samples, proximal to delivery. Stool samples were collected from newborns within 48 h of birth. All samples were cultured on selective media for ARB identification. Clinical and demographic data were collected from the participants' medical files. We performed molecular and phenotypic characterization of the different resistance mechanisms, and determined the isolates' antibiotic susceptibility and biofilm-forming ability. The prevalence of ESBL-E, MRSA and VRE among pregnant women were 16%, 6% and 1%, respectively. The prevalence of ESBL-E and MRSA among neonates were 7.6% and 1.6%, respectively. Maternal-to-neonate transmission rates of ESBL-E and MRSA were 48% and 27.8%, respectively. Maternal and neonatal isolates shared similar characteristics. Maternal-to-neonate transmission of ARB plays an important role in bacterial colonization in newborns. Future studies should investigate the outcomes of the high ESBL-E transmission rate. The biofilm-forming ability of ARB was found to affect transmission. Additional factors should be investigated in order to understand the differences between transmitted and non-transmitted bacteria.

Keywords: antibiotic resistant bacteria; carbapeneme-resistant Enterobacterales; colonization prevalence; extended spectrum β-lactam-producing Enterobacterales; methicillin-resistant Staphylococcus aureus; mother-to-neonate transmission; vancomycin-resistant Enterococci.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

**Figure 1**
Distribution of resistance mechanisms and bacterial type among all study’s isolates. (A,B) Distribution of antibiotic resistant bacteria among pregnant women (A) and neonates (B). (C,D) Distribution of bacterial species of maternal (C) and neonatal (D) isolates.

**Figure 2**
Antibiotic susceptibility rates of ESBL and MRSA isolates. (A) Susceptibility profiles of ESBL isolates, divided to maternal transmitted isolates, non-transmitted isolates and neonatal isolates. (B) Susceptibility profiles of MRSA isolates, divided to maternal transmitted isolates, non-transmitted isolates and neonatal isolates.

**Figure 3**
A summary of study’s results regarding maternal and neonatal prevalence of ARB and mother-to-neonate transmission rates. (A) Maternal and neonatal carriage rates of ESBL-producing bacteria (divided into *E. coli* and *K. pneumoniae* isolates) and maternal-to-neonate transmission rate of ESBL-producing bacteria. (B) Maternal and neonatal carriage rates of MRSA and maternal-to-neonate transmission rate of MRSA.

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[1] Yelin I., Snitser O., Novich G., Katz R., Tal O., Parizade M., Chodick G., Koren G., Shalev V., Kishony R. Personal clinical history predicts antibiotic resistance of urinary tract infections. Nat. Med. 2019;25:1143–1152. doi: 10.1038/s41591-019-0503-6. - DOI - PMC - PubMed

[2] Yelin I., Snitser O., Novich G., Katz R., Tal O., Parizade M., Chodick G., Koren G., Shalev V., Kishony R. Personal clinical history predicts antibiotic resistance of urinary tract infections. Nat. Med. 2019;25:1143–1152. doi: 10.1038/s41591-019-0503-6. - DOI - PMC - PubMed

[3] Eppes C.S., Clark S.L. Extended-spectrum β-lactamase infections during pregnancy: A growing threat. Am. J. Obstet. Gynecol. 2015;213:650–652. doi: 10.1016/j.ajog.2015.03.020. - DOI - PubMed

[4] Eppes C.S., Clark S.L. Extended-spectrum β-lactamase infections during pregnancy: A growing threat. Am. J. Obstet. Gynecol. 2015;213:650–652. doi: 10.1016/j.ajog.2015.03.020. - DOI - PubMed

[5] Denkel L.A., Schwab F., Kola A., Leistner R., Garten L., Von Weizsäcker K., Geffers C., Gastmeier P., Piening B. The mother as most important risk factor for colonization of very low birth weight (VLBW) infants with extended-spectrum -lactamase-producing Enterobacteriaceae (ESBL-E) J. Antimicrob. Chemother. 2014;69:2230–2237. doi: 10.1093/jac/dku097. - DOI - PubMed

[6] Denkel L.A., Schwab F., Kola A., Leistner R., Garten L., Von Weizsäcker K., Geffers C., Gastmeier P., Piening B. The mother as most important risk factor for colonization of very low birth weight (VLBW) infants with extended-spectrum -lactamase-producing Enterobacteriaceae (ESBL-E) J. Antimicrob. Chemother. 2014;69:2230–2237. doi: 10.1093/jac/dku097. - DOI - PubMed

[7] Bulabula A.N., Dramowski A., Mehtar S. Transmission of multidrug-resistant Gram-negative bacteria from colonized mothers to their infants: A systematic review and meta-analysis. J. Hosp. Infect. 2020;104:57–67. doi: 10.1016/j.jhin.2019.10.001. - DOI - PubMed

[8] Bulabula A.N., Dramowski A., Mehtar S. Transmission of multidrug-resistant Gram-negative bacteria from colonized mothers to their infants: A systematic review and meta-analysis. J. Hosp. Infect. 2020;104:57–67. doi: 10.1016/j.jhin.2019.10.001. - DOI - PubMed

[9] Giuffrè M., Geraci D.M., Bonura C., Saporito L., Graziano G., Insinga V., Aleo A., Vecchio D., Mammina C. The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli: Results of a 5-Year Active Surveillance Program in a Neonatal Intensive Care Unit. Medicine. 2016;95:e3016. doi: 10.1097/MD.0000000000003016. - DOI - PMC - PubMed

[10] Giuffrè M., Geraci D.M., Bonura C., Saporito L., Graziano G., Insinga V., Aleo A., Vecchio D., Mammina C. The Increasing Challenge of Multidrug-Resistant Gram-Negative Bacilli: Results of a 5-Year Active Surveillance Program in a Neonatal Intensive Care Unit. Medicine. 2016;95:e3016. doi: 10.1097/MD.0000000000003016. - DOI - PMC - PubMed

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Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

Affiliations

Mother-to-Neonate Transmission of Antibiotic-Resistant Bacteria: A Cross-Sectional Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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Cited by

References

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