Transmission of multidrug-resistant Gram-negative bacteria from colonized mothers to their infants: a systematic review and meta-analysis

A N H Bulabula; A Dramowski; S Mehtar

doi:10.1016/j.jhin.2019.10.001

Transmission of multidrug-resistant Gram-negative bacteria from colonized mothers to their infants: a systematic review and meta-analysis

J Hosp Infect. 2020 Jan;104(1):57-67. doi: 10.1016/j.jhin.2019.10.001. Epub 2019 Oct 8.

Authors

A N H Bulabula¹, A Dramowski², S Mehtar³

Affiliations

¹ Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Infection Control Africa Network, Cape Town, South Africa. Electronic address: andybulabula@gmail.com.
² Infection Control Africa Network, Cape Town, South Africa; Paediatric Infectious Diseases, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa.
³ Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Infection Control Africa Network, Cape Town, South Africa.

PMID: 31604126
DOI: 10.1016/j.jhin.2019.10.001

Abstract

Background: Neonatal sepsis remains a leading cause of neonatal mortality. Maternal bacterial colonization plays a major role in transmission to the infant, with potential for subsequent development of neonatal sepsis with maternally derived strains.

Aim: To review the molecular evidence supporting transmission of multidrug-resistant Gram-negative bacteria (MDR-GNB) from colonized mothers to their infants and the risk factors for MDR-GNB transmission.

Methods: PubMed and Scopus were searched for studies investigating the mechanisms, risk factors for and/or scale of transmission of MDR-GNB from colonized mothers to their infants. Random effects meta-analyses were performed to determine pooled proportions of MDR-GNB transmission and the neonatal outcomes of transmission.

Findings: Eight studies were included in the narrative description and six in the meta-analysis. Five studies used pulsed-field gel electrophoresis to assess relatedness of isolates from colonized mothers and their infants. Pooled proportion of MDR-GNB transmission from colonized mothers to their infants was 27% (95% confidence interval (CI): 8-47%). Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae were the most frequently studied MDR-GNB pathogens transmitted between mother-infant pairs. Following mother-to-infant transmission of an MDR-GNB pathogen, the pooled proportion for the outcome of neonatal colonization was 19% (95% CI: 3-35%).

Conclusion: This systematic review strongly supports MDR and/or ESBL Enterobacteriaceae transmission from colonized mothers to their infants, with subsequent infant colonization. The risk factors contributing to transmission of MDR-GNB between colonized mothers and their infants warrants further research.

Keywords: Colonization; MDR-GNB; Mother-to-child transmission.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Drug Resistance, Multiple, Bacterial / drug effects
Drug Resistance, Multiple, Bacterial / genetics*
Electrophoresis, Gel, Pulsed-Field / methods
Enterobacteriaceae / drug effects
Enterobacteriaceae / isolation & purification
Female
Gram-Negative Bacteria / isolation & purification*
Gram-Negative Bacterial Infections / epidemiology
Gram-Negative Bacterial Infections / transmission*
Humans
Infant
Infectious Disease Transmission, Vertical / prevention & control
Mothers / statistics & numerical data
Neonatal Sepsis / mortality
Risk Factors
beta-Lactamases / genetics*

Substances

beta-Lactamases