Growing Threat of Extended-Spectrum β-Lactamase-Producing
Enterobacteriaceae Colonization in High-Risk Pregnancies: a
retrospective cohort study
Abstract
Objective To investigate the epidemiological changes in
extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E)
vaginal colonization in high-risk pregnant women and identify
independent risk factors. Further, the differences in perinatal outcomes
according to maternal ESBL-E vaginal colonization were analyzed. Design
Retrospective cohort study. Setting Republic of Korea Population 1,460
women admitted to our high-risk pregnancy unit between 14+0 and 35+6
gestational weeks. Methods The study period was divided into periods 1
(January 2010 to July 2015) and 2 (August 2015 to December 2020). The
main outcomes were analyzed according to each period and ESBL-E vaginal
colonization. Main Outcome Measures ESBL-E vaginal colonization rate,
risk factors for ESBL-E vaginal colonization, and perinatal outcomes.
Results The ESBL-E vaginal colonization rate was higher in period 2,
which was attributed to a significantly higher proportion of
ESBL-producing Escherichia coli. Cerclage (odds ratio [OR]: 3.248;
95% confidence interval [CI]: 1.744–6.049) and prior antibiotic
treatment (OR: 3.044; 95% CI: 1.713–5.410) were found as independent
risk factors for ESBL-E vaginal colonization. Earlier gestational age at
delivery, and higher proven early-onset neonatal sepsis (EONS) rate were
observed in the ESBL-E-positive group. Conclusions The ESBL-E vaginal
colonization rate in high-risk pregnant patients has increased over the
past decade, and the independent risk factors for colonization are
cerclage and prior antibiotic treatment. Additionally, maternal ESBL-E
vaginal colonization is associated with higher proven EONS rates.
Funding This study received no funding. Keywords Extended-spectrum
β-lactamase, Enterobacteriaceae, vaginal colonization, antibiotics use,
cerclage, neonatal sepsis