Vertical Transmission of Extended-Spectrum, Beta-Lactamase-Producing <i>Enterobacteriaceae</i> during Preterm Delivery: A Prospective Study

• Main Authors: Maya Frank Wolf, Raneen Abu Shqara, Karina Naskovica, Inna Amdur Zilberfarb, Inshirah Sgayer, Daniel Glikman, Hagai Rechnitzer, Vered Fleisher Sheffer, Jacob Bornstein
• Format: Article
• Language: English
• Published: MDPI AG 2021-02-01
• Series: Microorganisms
• Subjects: extended-spectrum, beta-lactamase-producing <i>Enterobacteriaceae</i>; <i>Escherichia coli</i>; maternal colonization; preterm birth
• Online Access: https://www.mdpi.com/2076-2607/9/3/506

Maternal carriage and vertical transmission of extended-spectrum, beta-lactamase-producing <i>Enterobacteriaceae </i>(ESBL-E), such as <i>Escherichia coli</i>, hamper the treatment of infections, resulting in high morbidity. <i>E. coli</i> is the most frequent cause of early-onset neonatal sepsis (EOS) in preterm infants, where ESBL-E are more frequently isolated. In this prospective, case-controlled study, maternal rectovaginal ESBL-E colonization and vertical transmission to preterm infants were assessed in 160 women with preterm premature rupture of membranes (PPROM; 57.4%) or preterm labor (42.6%); additional cultures were obtained from the placenta, amnion, and umbilical cord during preterm labor. Maternal and neonatal ESBL-E-carriage rates were 17.5% and 12.9%, respectively, and the vertical-transmission rate was 50%. Maternal ESBL-E colonization among women with PPROM was 21.3%, and in women with premature labor it was 12.6%. No correlation was observed between maternal ESBL-E-colonization and previous hospitalization or antibiotic administration during pregnancy. However, a correlation was found between placental inflammation and maternal ESBL-E colonization (<i>p</i> = 0.007). ESBL-E-colonized infants were delivered at an earlier gestational age and were more likely to have complications. Thus, the high ESBL-E carriage rate in women with threatened preterm labor, without obvious risk factors for carriage, and a high vertical transmission rate, combined with a correlation between placental inflammation and ESBL-E carriage, support maternal–neonatal ESBL-E-colonization surveillance and active measures to prevent ESBL-E-related EOS.