Sgayer Inshirah, Zidan Muhammad, Nakhleh Francis Yara, Abu Shqara Raneen, Glikman Daniel, Lowenstein Lior, Frank Wolf Maya
Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel.
J Obstet Gynaecol Can. 2025 Feb;47(2):102755. doi: 10.1016/j.jogc.2024.102755. Epub 2024 Dec 27.
Maternal colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) has risen, and the antimicrobial resistance of ESBL-E is significant. We aimed to evaluate the rates of ESBL-E colonization among women with preterm premature rupture of membranes (PPROM) and of maternal-neonatal vertical transmission. We also aimed to compare obstetrical and neonatal complications among ESBL-E positive versus negative maternal colonization in pregnancies complicated by PPROM.
This retrospective study included women with PPROM who were admitted from 2018 to 2022 for expectant management and were screened for ESBL-E recto-vaginal colonization on their admission. Obstetrical and neonatal outcomes were compared between positive and negative ESBL-E pregnancies. Neonatal outcomes were compared between positive and negative ESBL-E neonates.
Of 118 women with PPROM, 27 (23%) had positive ESBL-E cultures. ESBL-E isolates (cultures from the placenta, cord, amnion, or uterus) were more common in colonized versus non-colonized ESBL-E mothers (55.6% vs. 11.0%, P < 0.001). ESBL-E isolates were more common in neonates of mothers with positive versus negative ESBL-E cultures (33.3% vs. 4.2%, P = 0.017). A higher proportion of neonates of ESBL-E positive than ESBL-E negative mothers needed antibiotic treatment in the neonatal intensive care unit. Neonatal ESBL-E colonization at birth was a predictor of longer stays in the neonatal intensive care unit (P = 0.006).
In women with PPROM, maternal-ESBL-E colonization was a significant risk factor for neonatal colonization and was associated with neonatal morbidity. The high maternal colonization rate in PPROM raises the need for routine maternal ESBL screening. Future studies should establish the ideal empiric antibiotic regimen in the neonatal intensive care unit for neonates born to ESBL-E colonized mothers.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）引起的孕产妇定植率上升，且ESBL-E的抗菌耐药性显著。我们旨在评估胎膜早破（PPROM）女性中ESBL-E定植率及母婴垂直传播率。我们还旨在比较PPROM合并妊娠中ESBL-E阳性与阴性孕产妇定植的产科和新生儿并发症。
这项回顾性研究纳入了2018年至2022年因期待治疗入院的PPROM女性，并在入院时对其直肠-阴道ESBL-E定植情况进行筛查。比较ESBL-E阳性与阴性妊娠的产科和新生儿结局。比较ESBL-E阳性与阴性新生儿的新生儿结局。
118例PPROM女性中，27例（23%）ESBL-E培养阳性。ESBL-E分离株（来自胎盘、脐带、羊膜或子宫的培养物）在ESBL-E定植母亲中比未定植母亲更常见（55.6%对11.0%，P<0.001）。ESBL-E培养阳性母亲的新生儿中ESBL-E分离株比培养阴性母亲的新生儿更常见（33.3%对4.2%，P=0.017）。ESBL-E阳性母亲的新生儿比ESBL-E阴性母亲的新生儿在新生儿重症监护病房需要抗生素治疗的比例更高。出生时新生儿ESBL-E定植是新生儿重症监护病房住院时间延长的一个预测因素（P=0.006）。
在PPROM女性中，孕产妇ESBL-E定植是新生儿定植的一个重要危险因素，并与新生儿发病率相关。PPROM中孕产妇高定植率增加了对孕产妇进行ESBL常规筛查的必要性。未来研究应确定针对ESBL-E定植母亲所生新生儿在新生儿重症监护病房的理想经验性抗生素治疗方案。
