Risk Factors and Prevalence of Mother to New-born Transmission of Carbapenemase producing Enterobacteriaceae in two Hospitals in Yaounde, Cameroon

Résumé fourni par la source

Abstract In low- and middle-income countries (LMICs), where the burden of neonatal sepsis is the highest, the spread of Carbapenemase producing Enterobacteriaceae (CPE) in the community, potentially contributing to the neonatal mortality, is a public health concern. Data regarding the acquisition of CPE during the perinatal period are scarce. The routes of transmission are not well defined and particularly the possible key role played by pregnant women. This study aimed to understand the neonatal acquisition of CPE in Yaounde. A transversal analytical study was conducted in an urban area. Maternal stool samples at delivery and the first stool from her new-born were collected and cultured to isolate Enterobacteriaceae. After isolation of Enterobacteriaceae, a phenotypic characterization using API20E identification system and antibiotic susceptibility testing were performed according to the Antibiogram Committee of the French Society of Microbiology (AC-SFM 2020). The detection and classification of carbapenemases was done on each carbapenem-resistant strains by Modified Hodge Test (MHT) and synergy tests with different inhibitors (Boronic acid and EDTA). Of the 54 CPE isolates identified, Escherichia coli was the most frequent species (n = 29, 53.70%), followed by Klebsiella pneumoniae (n = 12, 22.22%). Class D and class B carbapenemases (n = 27, 11.25%) were equally represented. Out of the 120 couples, the estimated prevalence of vertical transmission, based on the carriage of the same CPE strain producing enzymes of the same class in mothers and their new-borns, and the similarities in their resistance profile was 10% (n = 12). Logistic regression showed that CPE carriage in mothers and CPE acquisition in their new-borns were independently associated with the presence of greenish amniotic fluid (OR = 3.96, p < 0.0001 in mothers and OR = 3.5, p = 0.05 in new-borns), and meconial amniotic fluid (OR = 1.37, p = 0.02 in mothers and OR = 4.92, p = 0.02 in new-borns). Our results highlight the non-negligeable role played by pregnant women carriage in the neonatal acquisition of Carbapenemases Producing Enterobacteriaceae. The CPE, of which the most prevalent is Carbapenemase class D followed by class B; and also supported by the presence of prenatal fetal distress.

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