Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia

Abstract

Abstract Background Infections are one of the most common causes of neonatal mortality, and maternal colonization has been associated with neonatal infection. Data on carriage of bacterial pathogens and mother-child transmission patterns in low- and middle-income countries is sparse. Methods We sought to quantify carriage prevalence of extended-spectrum-beta-lactamase (ESBL) - producing and carbapenem-resistant Enterobacterales (CRE) among pregnant women and their neonates and to characterize risk factors for carriage in a rural area of Amhara, Ethiopia. We sampled 211 pregnant women in their third trimester and/or labor/delivery and 159 of their neonates in the first week of life. Results We found that carriage of ESBL-producing organisms was fairly common (women: 22.3%, 95% CI: 16.8-28.5; neonates: 24.5%, 95% CI: 18.1-32.0), while carriage of CRE (women: 0.9%, 95% CI: 0.1-3.4; neonates: 2.5%, 95% CI: 0.7-6.3) was rare. Neonates whose mothers tested positive for ESBL-producing organisms were nearly twice as likely to also test positive for ESBL-producing organisms (38.7% vs. 21.1%, p-value: 0.06). Carriage of ESBL-producing organisms was also associated with woreda (district) of sample collection (Fisher exact test maternal p-value: <0.01; neonatal p-value: <0.01) and recent antibiotic use (maternal p-value: 0.55; neonatal p-value: 0.011). Conclusions Understanding carriage patterns of potential pathogens and antibiotic susceptibility among pregnant women and newborns in this region will help to inform local, data-driven recommendations to prevent and treat neonatal infections. Main point Carriage prevalence of ESBL-producing Enterobacterales was high among pregnant women and neonates in a rural area of Ethiopia, and neonates were more likely to test positive if their mother tested positive. This work informs prevention and treatment of neonatal infections.