ABSTRACT
Background: Transmission of pathogens can occur through direct materno-fetal contact during antepartum period or delivery.Presence of maternal reproductive tract colonization or bacterial infections during pregnancy increases the risk of puerperal sepsisand early onset neonatal sepsis (EONS). This study was thus planned to screen the etiological agents and antibiogramfromsuspected maternal sepsis/ colonization cases.Materials and methods:Data was collected over a period of 1 year (September2017- September 2018). Clinical samples-placental membrane, placental tissue, retained product of conception (RPOCs) and highvaginal swabs (HVS) received for screening of maternal sepsis or colonization were processed as per conventionalmicrobiological techniques. Antimicrobial sensitivity was performed as per CLSI guidelines.Result:A total of 2405 maternalsamples were included in the study. Only about 13.18% ( 317 samples) showed the presence of bacterial isolate, Escherichia coli(39%) was the predominant etiological agent isolated followed by Staphylococcus aureus(18%)and Enterococcus species (17%).There was an alarming level of drug resistance seen in both the gram positive and negative organisms.Conclusion:Introduction ofpathogens into the female genital tract is a major risk factor for development of uterine infections and chorioamnionitis which caneventually lead to puerperal sepsis and Early onset neonatal sepsis. EONS. As seen in the present study the organisms such asEscherichia coli and Staphylococcus aureusisolated from maternal sepsis and colonization cases are the same organismsimplicated from EONS.In view of increase in drug-resistant organisms prompt detection and treatment of maternal infectionsbecomes crucial to prevent neonatal infections.
ABSTRACT
Background & objectives: Information about the genetic diversity of the extended-spectrum β-lactamases (ESBLs) and the clonal relationship of the organisms causing neonatal infections is limited, particularly from India where neonatal mortality is high. This study was undertaken to investigate the molecular epidemiology and risk factors associated with neonatal septicaemia caused by ESBL-producing Klebsiella pneumoniae and Escherichia coli. Methods: Bloodstream isolates (n=26) of K. pneumoniae (n=10) and E. coli (n=16) from the neonates admitted in a tertiary care hospital in New Delhi during January to May 2008 were characterized. Antimicrobial susceptibility tests were carried out and ESBL production was assessed phenotypically. PCR was carried out for ESBL and ampC genes. Genotyping was performed by pulsed-field gel electrophoresis (PFGE). Conjugation experiments were done to determine the mobility of ESBL genes. Risk factors associated with ESBL-producing K. pneumoniae and E. coli infections were analysed. Results: Resistance rates to most of the antibiotics tested were high, except for imipenem. Among the isolates tested, 60 per cent of K. pneumoniae and 75 per cent of E. coli were ESBL producers. PFGE of the isolates demonstrated a vast diversity of genotypes with no epidemic clones. Despite the clonal diversity, blaCTX-M-15 was detected in 100 per cent of ESBL-positive isolates. The other genes present in ESBL-positive isolates were blaTEM-1, blaSHV-1, blaSHV-28, blaSHV-11, and blaSHV-12. Class 1 integrons were detected in 7 of 18 ESBL-positive isolates. Moreover, the plasmid carrying blaCTX-M-15, in E. coli and K. pneumoniae were self transferable. Feeding through an enteral tube was identified as the only risk factor for sepsis by ESBL-producing organisms. Interpretation & conclusions: The study emphasises the presence of blaCTX-M-15 in clonally diverse isolates indicating probable horizontal transfer of this gene. The widespread dissemination of CTX-M-15 is of great concern as it further confines the limited therapeutic interventions available for neonates.