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Published on: February 17, 2023
The Prevalence of Multidrug-Resistant Enterobacteriaceae among Neonates in Kuwait
Rehab Zafer Alajmi1, Wadha Ahmed Alfouzan1,2, Abu Salim Mustafa1
1Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City 13110, Kuwait.
Insights
Antibiotic resistance in neonatal Enterobacteriaceae is low in Kuwait. Neonates appear to acquire resistance from the environment post-birth, not from their mothers, offering encouraging findings for infant health.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Neonatal Health
Background:
- Serious bacterial infections in neonates pose significant morbidity and mortality risks.
- Rising antibiotic resistance in bacteria complicates treatment strategies for neonatal infections.
Purpose of the Study:
- To assess the prevalence of drug-resistant Enterobacteriaceae in neonates and their mothers at Farwaniya Hospital, Kuwait.
- To investigate the genetic basis of antibiotic resistance in these bacterial isolates.
Main Methods:
- Rectal swabs collected from 242 mothers and 242 neonates.
- Bacterial identification and antibiotic susceptibility testing using VITEK® 2 and E-test methods.
- Detection of resistance genes via PCR and Sanger sequencing.
Main Results:
- No multidrug-resistant (MDR) Enterobacteriaceae were found in neonates.
- 13.6% of maternal isolates showed MDR Enterobacteriaceae.
- Resistance genes for ESBL, aminoglycosides, fluoroquinolones, and folate pathway inhibitors were detected; resistance to carbapenems and tigecycline was not.
Conclusions:
- Antibiotic resistance in Enterobacteriaceae is notably low among neonates in Kuwait.
- Neonates likely acquire resistance from environmental sources after birth rather than in utero.
- Findings suggest a low risk of mother-to-neonate transmission of resistant Enterobacteriaceae in this setting.
Abstract:
Increasing numbers of neonates with serious bacterial infections, due to resistant bacteria, are associated with considerable morbidity and mortality rates. The aim of this study was to evaluate the prevalence of drug-resistant Enterobacteriaceae in the neonatal population and their mothers in Farwaniya Hospital in Kuwait and to determine the basis of resistance. Rectal screening swabs were taken from 242 mothers and 242 neonates in labor rooms and wards. Identification and sensitivity testing were performed using the VITEK® 2 system. Each isolate flagged with any resistance was subjected to the E-test susceptibility method. The detection of resistance genes was performed by PCR, and the Sanger sequencing method was used to identify mutations. Among 168 samples tested by the E-test method, no MDR Enterobacteriaceae were detected among the neonates, while 12 (13.6%) isolates from the mothers' samples were MDR. ESBL, aminoglycosides, fluoroquinolones, and folate pathway inhibitor resistance genes were detected, while beta-lactam-beta-lactamase inhibitor combinations, carbapenems, and tigecycline resistance genes were not. Our results showed that the prevalence of antibiotic resistance in Enterobacteriaceae obtained from neonates in Kuwait is low, and this is encouraging. Furthermore, it is possible to conclude that neonates are acquiring resistance mostly from the environment and after birth but not from their mothers.
