Maternal and Neonatal Colonization of ESBL-Producing and Carbapenem Resistant Enterobacterales in St. Paul’s Hospital Millennium Medical College.

Abstract

ABSTRACT Introduction: Antibiotic-resistant Gram-negative bacteria (ABR-GNB), such as ESBL producing and carbapenem-resistant Enterobacterales (CRE), pose a serious public health threat, particularly to pregnant women and their newborns by causing life threatening infections. Objective: To assess maternal and neonatal colonization with ESBL-producing and carbapenem resistant Enterobacterales (CRE) and associated factors at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia. Method: A cross-sectional study was conducted from April to August 2024, among 295 laboring mothers and their newborns by using consecutive sampling. Structured questionnaires were used to collect clinical and demographic data. Two vaginal and rectal swabs were collected from mothers and external ear swabs from newborns immediately after birth. Samples were inoculated on chromogenic agars and growth was characterized. Biochemical and Antimicrobial susceptibility testing were performed. Data were analyzed using SPSS v27. Logistic regression was used to identify associated factors and P-values < 0.05 considered as statistically significant. Results: Maternal colonization was 23.7% for ESBL-producing Enterobacterales and 1.4% for CRE. Among the 295 newborns, 1.7% (5/295) were colonized with ESBL-producing Enterobacterales and 1.0% (3/295) with CRE. ertical transmission was suggested, as neonates born to colonized mothers were 13 times more likely to be colonized (P = 0.014). Escherichia coli (88.4%) were the most frequent isolate. Highest resistance was seen to β-lactam antibiotics: ampicillin (100%), ceftriaxone (98.9%), and cefepime (80.0%). Resistance to carbapenems was lower (7.0–9.5%). Amikacin (96.8%) and chloramphenicol (91.6%) were the most effective drugs. Multidrug resistance was observed in 80.0% of isolates. Key predictors of maternal colonization included lower education level (AOR = 3.527; 95% CI: 1.235–10.074; P = 0.019) and fewer antenatal care visits (AOR = 0.804; 95% CI: 0.658–0.982; P = 0.033). Conclusion and Recommendation: There is a high rate of maternal colonization with ESBL producing Enterobacterales and concerning levels of neonatal colonization and multidrug resistance. Strengthening antenatal care, improving maternal health education, and reinforcing infection prevention strategies are crucial, particularly to protect high-risk newborns. Surveillance and stewardship programs should be prioritized in maternity care settings. Keywords: ESBL-producing Enterobacterales, Carbapenem-resistant Enterobacterales, Maternal colonization, Neonatal colonization, Vertical transmission, Multidrug resistance, Ethiopia.