Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka
Abstract Background The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among in...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | Antimicrobial Resistance and Infection Control |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13756-021-00938-3 |
| _version_ | 1818937482470752256 |
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| author | Hannah R. Meredith Sarath Kularatna Kristin Nagaro Ajith Nagahawatte Champica Bodinayake Ruvini Kurukulasooriya Nishadhi Wijesingha Lyndy B. Harden Bhagya Piyasiri Amr Hammouda Brian M. Wiegmann Bradly P. Nicholson Maria Joyce Christopher W. Woods Arnoud H. M. Van Vliet Siddhartha Thakur L. Gayani Tillekeratne |
| author_facet | Hannah R. Meredith Sarath Kularatna Kristin Nagaro Ajith Nagahawatte Champica Bodinayake Ruvini Kurukulasooriya Nishadhi Wijesingha Lyndy B. Harden Bhagya Piyasiri Amr Hammouda Brian M. Wiegmann Bradly P. Nicholson Maria Joyce Christopher W. Woods Arnoud H. M. Van Vliet Siddhartha Thakur L. Gayani Tillekeratne |
| author_sort | Hannah R. Meredith |
| collection | DOAJ |
| description | Abstract Background The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among infants in southern Sri Lanka. Methods Women and their newborn children were enrolled within 48 h after delivery in southern Sri Lanka. Rectal swabs were collected from women and infants at enrollment and 4–6 weeks later. Enterobacteriaceae were isolated and identified as MDRE (positive for extended-spectrum β-lactamases or carbapenem resistant) using standard microbiologic procedures. We used exact methods (Fisher’s exact and Kruskal–Wallis tests) and multivariable logistic regression to identify sociodemographic and clinical features associated with MDRE intestinal colonization. Whole-genome sequencing was performed on selected MDRE isolates to identify phylogroups and antibiotic resistance-encoding genes were identified with NCBI’s AMRfinder tool. Results Overall, 199 post-partum women and 199 infants were enrolled; 148/199 (74.4%) women and 151/199 (75.9%) infants were reassessed later in the community. Twenty-four/199 (12.1%) women and 3/199 (1.5%) infants displayed intestinal colonization with MDRE at enrollment, while 26/148 (17.6%) women and 24/151 (15.9%) infants displayed intestinal colonization with MDRE at the reassessment. While there were no risk factors associated with infant colonization at enrollment, multivariable analysis indicated that risk factors for infant colonization at reassessment included mother colonized at enrollment (aOR = 3.62) or reassessment (aOR = 4.44), delivery by Cesarean section (aOR = 2.91), and low birth weight (aOR = 5.39). Of the 20 MDRE isolates from infants that were sequenced, multilocus sequence typing revealed that 6/20 (30%) were clustered on the same branch as MDRE isolates found in the respective mothers. All sequenced isolates for mothers (47) and infants (20) had at least one ESBL-producing gene. Genes encoding fosfomycin resistance were found in 33/47 (70%) of mothers’ isolates and 16/20 (80%) of infants’ isolates and genes encoding resistance to colistin were found in one (2%) mother’s isolate. Conclusions Our results suggest that a substantial proportion of infants undergo MDRE intestinal colonization within 6 weeks of birth, potentially due to postnatal rather than intranatal transmission. |
| first_indexed | 2024-12-20T05:52:40Z |
| format | Article |
| id | doaj.art-f7cc929be601480e8dae19d0f4707379 |
| institution | Directory Open Access Journal |
| issn | 2047-2994 |
| language | English |
| last_indexed | 2024-12-20T05:52:40Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Antimicrobial Resistance and Infection Control |
| spelling | doaj.art-f7cc929be601480e8dae19d0f47073792022-12-21T19:51:08ZengBMCAntimicrobial Resistance and Infection Control2047-29942021-04-0110111210.1186/s13756-021-00938-3Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri LankaHannah R. Meredith0Sarath Kularatna1Kristin Nagaro2Ajith Nagahawatte3Champica Bodinayake4Ruvini Kurukulasooriya5Nishadhi Wijesingha6Lyndy B. Harden7Bhagya Piyasiri8Amr Hammouda9Brian M. Wiegmann10Bradly P. Nicholson11Maria Joyce12Christopher W. Woods13Arnoud H. M. Van Vliet14Siddhartha Thakur15L. Gayani Tillekeratne16Department of Biomedical Engineering, Duke UniversityDepartment of Obstetrics and Gynecology, Faculty of Medicine, University of RuhunaDivision of Infectious Diseases, Department of Medicine, Duke University School of MedicineDepartment of Microbiology, Faculty of Medicine, University of RuhunaDuke Global Health Institute, Duke UniversityDepartment of Microbiology, Faculty of Medicine, University of RuhunaDepartment of Microbiology, Faculty of Medicine, University of RuhunaDepartment of Population Health and Pathobiology, NC State UniversityTeaching Hospital KarapitiyaDurham Veterans Affairs Health SystemDepartment of Entomology and Plant Pathology, NC State UniversityInstitute of Medical ResearchDivision of Infectious Diseases, Department of Medicine, Duke University School of MedicineDivision of Infectious Diseases, Department of Medicine, Duke University School of MedicineDepartment of Pathology and Infectious Diseases, School of Veterinary Medicine, University of SurreyDepartment of Population Health and Pathobiology, NC State UniversityDivision of Infectious Diseases, Department of Medicine, Duke University School of MedicineAbstract Background The timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among infants in southern Sri Lanka. Methods Women and their newborn children were enrolled within 48 h after delivery in southern Sri Lanka. Rectal swabs were collected from women and infants at enrollment and 4–6 weeks later. Enterobacteriaceae were isolated and identified as MDRE (positive for extended-spectrum β-lactamases or carbapenem resistant) using standard microbiologic procedures. We used exact methods (Fisher’s exact and Kruskal–Wallis tests) and multivariable logistic regression to identify sociodemographic and clinical features associated with MDRE intestinal colonization. Whole-genome sequencing was performed on selected MDRE isolates to identify phylogroups and antibiotic resistance-encoding genes were identified with NCBI’s AMRfinder tool. Results Overall, 199 post-partum women and 199 infants were enrolled; 148/199 (74.4%) women and 151/199 (75.9%) infants were reassessed later in the community. Twenty-four/199 (12.1%) women and 3/199 (1.5%) infants displayed intestinal colonization with MDRE at enrollment, while 26/148 (17.6%) women and 24/151 (15.9%) infants displayed intestinal colonization with MDRE at the reassessment. While there were no risk factors associated with infant colonization at enrollment, multivariable analysis indicated that risk factors for infant colonization at reassessment included mother colonized at enrollment (aOR = 3.62) or reassessment (aOR = 4.44), delivery by Cesarean section (aOR = 2.91), and low birth weight (aOR = 5.39). Of the 20 MDRE isolates from infants that were sequenced, multilocus sequence typing revealed that 6/20 (30%) were clustered on the same branch as MDRE isolates found in the respective mothers. All sequenced isolates for mothers (47) and infants (20) had at least one ESBL-producing gene. Genes encoding fosfomycin resistance were found in 33/47 (70%) of mothers’ isolates and 16/20 (80%) of infants’ isolates and genes encoding resistance to colistin were found in one (2%) mother’s isolate. Conclusions Our results suggest that a substantial proportion of infants undergo MDRE intestinal colonization within 6 weeks of birth, potentially due to postnatal rather than intranatal transmission.https://doi.org/10.1186/s13756-021-00938-3ESBLCREMultidrug-resistant EnterobacteriaceaeSri LankaIntestinal colonization |
| spellingShingle | Hannah R. Meredith Sarath Kularatna Kristin Nagaro Ajith Nagahawatte Champica Bodinayake Ruvini Kurukulasooriya Nishadhi Wijesingha Lyndy B. Harden Bhagya Piyasiri Amr Hammouda Brian M. Wiegmann Bradly P. Nicholson Maria Joyce Christopher W. Woods Arnoud H. M. Van Vliet Siddhartha Thakur L. Gayani Tillekeratne Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka Antimicrobial Resistance and Infection Control ESBL CRE Multidrug-resistant Enterobacteriaceae Sri Lanka Intestinal colonization |
| title | Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka |
| title_full | Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka |
| title_fullStr | Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka |
| title_full_unstemmed | Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka |
| title_short | Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka |
| title_sort | colonization with multidrug resistant enterobacteriaceae among infants an observational study in southern sri lanka |
| topic | ESBL CRE Multidrug-resistant Enterobacteriaceae Sri Lanka Intestinal colonization |
| url | https://doi.org/10.1186/s13756-021-00938-3 |
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