Centre for Intervention Science for Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Antimicrob Resist Infect Control. 2021 Feb 17;10(1):37. doi: 10.1186/s13756-021-00897-9.
BACKGROUND: According to WHO ( CISMAC. Centre for Intervention Science in Maternal and Child health), the antimicrobial resistant bacteria considered to be clinically most important for human health and earmarked for surveillance include extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, carbapenem-resistant bacteria, methicillin-resistant (MRSA) and, macrolide-lincosamide-streptogramin B -resistant vancomycin-resistant (VRSA) Staphylococcus aureus and vancomycin-resistant Enterococcus (VRE). If these bacteria are carried in the female genital tract, they may be transmitted to the neonate causing local or systemic neonatal infections that can be difficult to treat with conventionally available antimicrobials. In order to develop effective treatment strategies, there is need for updated information about the prevalence of colonization with important antimicrobial-resistant pathogens. OBJECTIVE: We sought to estimate the prevalence of vaginal colonization with potentially pathogenic and clinically important AMR bacteria among women in labour in Uganda and to identify factors associated with colonization. METHODS: We conducted a cross-sectional study among HIV-1 and HIV-2 negative women in labour at three primary health care facilities in Uganda. Drug susceptibility testing was done using the disk diffusion method on bacterial isolates cultured from vaginal swabs. We calculated the prevalence of colonization with potentially pathogenic and clinically important AMR bacteria, in addition to multidrug-resistant (MDR) bacteria, defined as bacteria resistant to antibiotics from ≥ 3 antibiotic classes. RESULTS: We found that 57 of the 1472 enrolled women (3.9% prevalence; 95% Confidence interval [CI] 3.0%, 5.1%) were colonized with ESBL-producing Enterobacteriaceace, 27 (1.8%; 95% CI 1.2%, 2.6%) were colonized with carbapenem-resistant Enterobacteriaceae, and 85 (5.8%; 95% CI 4.6%, 7.1%) were colonized with MRSA. The prevalence of colonization with MDR bacteria was high (750/1472; 50.9%; 95% CI 48.4%, 53.5%). Women who were ≥ 30 years of age had higher odds of being colonized with MDR bacteria compared to women aged 20-24 years (OR 1.6; 95% CI 1.1, 2.2). CONCLUSION: Most of the women included in our study were vaginally colonized with potentially pathogenic MDR and other clinically important AMR bacteria. The high prevalence of colonization with these bacteria is likely to further increase the incidence of difficult-to-treat neonatal sepsis.
背景：根据世卫组织（CISMAC. 孕产妇保健中的干预科学中心）的说法，被认为对人类健康具有临床重要性并被指定用于监测的抗微生物药物耐药细菌包括产超广谱β-内酰胺酶（ESBL）的肠杆菌科、碳青霉烯类耐药菌、耐甲氧西林金黄色葡萄球菌（MRSA）和大环内酯类-林可酰胺类-链阳菌素 B-耐药万古霉素耐药（VRSA）金黄色葡萄球菌和万古霉素耐药肠球菌（VRE）。如果这些细菌存在于女性生殖道中，它们可能会传播给新生儿，导致局部或全身新生儿感染，这些感染可能难以用常规可用的抗生素治疗。为了制定有效的治疗策略，需要了解具有重要抗微生物药物耐药性的病原体的定植情况的最新信息。
目的：我们旨在估计乌干达分娩妇女阴道定植具有潜在致病性和临床重要抗微生物药物耐药性的细菌的流行率，并确定与定植相关的因素。
方法：我们在乌干达的三个初级保健机构对 HIV-1 和 HIV-2 阴性的分娩妇女进行了横断面研究。使用纸片扩散法对从阴道拭子培养的细菌分离株进行药敏试验。我们计算了具有潜在致病性和临床重要抗微生物药物耐药性（定义为对≥3 种抗生素类别的抗生素耐药）的细菌、多药耐药（MDR）细菌的定植率。
结果：我们发现，在 1472 名入组妇女中，有 57 名（3.9%的流行率；95%置信区间 [CI] 3.0%，5.1%）定植了产 ESBL 的肠杆菌科，27 名（1.8%；95% CI 1.2%，2.6%）定植了碳青霉烯类耐药肠杆菌科，85 名（5.8%；95% CI 4.6%，7.1%）定植了耐甲氧西林金黄色葡萄球菌。MDR 细菌的定植率很高（750/1472；50.9%；95% CI 48.4%，53.5%）。与 20-24 岁的妇女相比，年龄≥30 岁的妇女定植 MDR 细菌的可能性更高（OR 1.6；95% CI 1.1，2.2）。
结论：我们研究中的大多数妇女阴道定植了具有潜在致病性的 MDR 和其他具有临床重要性的抗微生物药物耐药细菌。这些细菌的高定植率可能会进一步增加难以治疗的新生儿败血症的发病率。
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