Mwandigha Ambele M, Kamori Doreen, Kibwana Upendo O, Masoud Salim, Manyahi Joel, Majigo Mtebe
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania.
Trop Med Health. 2020 Oct 8;48:84. doi: 10.1186/s41182-020-00271-2. eCollection 2020.
Infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are increasing worldwide. Evidence indicates that fecal carriage of ESBL-E in pregnancy predisposes women to potential life-threatening urinary tract infections and subsequently increasing the risk of neonatal infections. There is limited data regarding fecal carriage of ESBL-E and associated factors among pregnant women in Tanzania. We aimed to address the gap by determining the proportion of pregnant women with ESBL-E fecal carriage and identify the related factors.
A hospital-based cross-sectional study was conducted at Muhimbili National Hospital in Dar es Salaam, Tanzania. A total of 182 pregnant women at the gestational age of 37 weeks and above were enrolled. Participants' socio-demographic, clinical, and hygienic information were collected by using a well-structured questionnaire. Rectal swabs were collected and processed for isolation of ESBL-E. The extended-spectrum β-lactamase production and antibiotic susceptibility test (AST) were performed using a double-disc synergy test and Kirby-Bauer disc diffusion method, respectively.
A total of 117 (64.3%) pregnant women were found to carry ESBL-E. Factors such as self-prescription of antibiotic medication during pregnancy, low education level, and toilet sharing were independently associated with ESBL-E fecal carriage. Five ESBL-E species that were isolated include (84.6%), (8.9%), (3.3%), spp. (1.6%), and spp. (1.6%). ESBL-E isolates demonstrated high resistance to aztreonam and sulphamethoxazole-trimethoprim.
This study has revealed a relatively high fecal carriage of ESBL-E among pregnant women, suggesting that there is a need for routine screening among that population. We recommend further studies to explore comprehensively the factors associated with high fecal carriage of ESBL-E in pregnancy and the potential transmission kinetics to their newborn babies.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）引起的感染在全球范围内呈上升趋势。有证据表明，孕期粪便携带ESBL-E会使女性易患潜在的危及生命的尿路感染，并随后增加新生儿感染的风险。关于坦桑尼亚孕妇中ESBL-E粪便携带情况及相关因素的数据有限。我们旨在通过确定携带ESBL-E粪便的孕妇比例并识别相关因素来填补这一空白。
在坦桑尼亚达累斯萨拉姆的穆希姆比利国家医院进行了一项基于医院的横断面研究。共纳入182名孕周37周及以上的孕妇。通过使用结构良好的问卷收集参与者的社会人口统计学、临床和卫生信息。采集直肠拭子并进行处理以分离ESBL-E。分别使用双纸片协同试验和 Kirby-Bauer 纸片扩散法进行超广谱β-内酰胺酶产生情况及抗生素敏感性试验（AST）。
共发现117名（64.3%）孕妇携带ESBL-E。孕期自行使用抗生素、低教育水平和共用厕所等因素与ESBL-E粪便携带独立相关。分离出的5种ESBL-E菌种包括大肠埃希菌（84.6%）、肺炎克雷伯菌（8.9%）、产气肠杆菌（3.3%）、阴沟肠杆菌属（1.6%）和弗劳地枸橼酸杆菌属（1.6%）。ESBL-E分离株对氨曲南和复方磺胺甲恶唑表现出高度耐药性。
本研究揭示了孕妇中ESBL-E粪便携带率相对较高，表明有必要对该人群进行常规筛查。我们建议进一步开展研究，以全面探索孕期ESBL-E粪便高携带率的相关因素及其向新生儿的潜在传播动力学。
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