Project Details

Molecular Epidemiology of ESBL-Producing Enterobacterales Isolated in Pregnant Women and Neonates

Luria Founou, PhD

Summary

BACKGROUND: Neonatal infections are a major global public health challenge. In 2018, neonatal infections were responsible for more than one-third of the 2.7 million deaths of newborns worldwide. Neonatal bacterial infections remain a leading preventable cause of mortality and morbidity. The escalation of antimicrobial resistance (AMR) is further exacerbating this public health concern. In 2016, 30% of global neonatal sepsis mortality was triggered by resistant bacteria, especially extended-spectrum ß-lactamase producing Enterobacterales (ESBL-E). GAP: The Every Newborn Action Plan aims for countries to have ≤12 neonatal deaths by 2030. The increasing rate of ESBL-E worldwide is thus alarming in clinical practice as it might exacerbate the burden and fatal outcome of severe sepsis in young infants, especially in low-and middle-income countries. HYPOTHESIS: We postulate that maternal ESBL-E colonization coupled with limited antenatal care, sub-optimal hygiene and sanitation are important predictors for neonatal ESBL-E infections in Cameroon. Maternal colonization of ESBL-E is an unheeded threat for neonatal health that is certainly being underestimated in the absence advanced molecular epidemiological studies. METHODS: We conducted a retrospective and prospective observational genomic epidemiology study in mother-neonate dyads in Yaounde, Cameroon. The study samples were collected from February to April in 2021 and 2022. Putative ESBL-E colony originating from recto-vaginal and nasopharyngeal swabs, were characterized molecularly via conventional PCR and clonal relatedness was assessed using ERIC-PCR. RESULTS: Preliminary findings revealed a 46.71% prevalence of ESBL-E among parturient (185/396) and 16.66% (58/348) in neonates. Intriguingly, 30 mother-baby dyads had the same ESBL species. Escherichia coli and Klebsiella pneumoniae were the leading bacterial species. The blaCTX-M predominated among all ß-lactamase genes. ERIC genotypes revealed that some isolates could have been transmitted vertically while others likely spread horizontally. IMPACT: The project contributes to (i) raising awareness on the threat posed by ESBL-E for pregnant women and neonates, and (ii) tailoring antibiotic therapy of neonatal sepsis. It further provides evidence to (i) implement routine screening of ESBL-E in pregnant women and (high-risk) neonates at birth, with view to diminish neonatal sepsis and mortality due to ESBL-E; (ii) de-escalate sustainably excessive use of broad-spectrum antibiotics, and (iii) strengthen stringent infection, prevention and control measures in Cameroon. Website Link(s): www.cedbcam.com https://www.researchgate.net/ https://www.linkedin.com/in/luria-leslie-founou-phd-b2a095b3/