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Published on: August 12, 2020
Neonatal Colonization With Antibiotic-Resistant Pathogens in Low- and Middle-Income Countries: A Systematic Review
Anne-Lise Beaumont1,2, Elsa Kermorvant-Duchemin3, Sébastien Breurec4,5,6,7
1Anti-Infective Evasion and Pharmacoepidemiology Team, Center for Epidemiology and Population Health, Université Paris-Saclay, UVSQ, INSERM, Montigny-le-Bretonneux, France.
Insights
Neonatal colonization with antibiotic-resistant bacteria like third-generation cephalosporin-resistant Enterobacterales (3GCRE) is common in LMICs. Hospital birth and neonatal antibiotic use increase the risk of 3GCRE colonization, highlighting the need for preventive strategies.
Area of Science:
- Medical Microbiology
- Public Health
- Infectious Diseases
Background:
- Neonatal bacterial infections in low- and middle-income countries (LMICs) are primarily caused by Enterobacterales and Staphylococcus aureus.
- These pathogens are leading causes of mortality linked to antimicrobial resistance (AMR).
- Understanding bacterial colonization patterns is crucial for preventing antibiotic-resistant neonatal sepsis.
Purpose of the Study:
- To synthesize evidence on the prevalence of and factors associated with colonization by third-generation cephalosporin-resistant Enterobacterales (3GCRE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant S. aureus (MRSA).
- To assess colonization in neonates and infants up to 3 months of age in LMICs.
Main Methods:
- Systematic review and meta-analysis of studies published between 2000 and 2024.
- Searched PubMed, Scopus, Web of Science, and WHO Global Index Medicus.
- Included studies from LMICs reporting prevalence or associated factors for 3GCRE, CRE, or MRSA colonization in infants up to 3 months; excluded outbreak reports.
Main Results:
- Pooled prevalence of 3GCRE colonization was 30.2%, higher in hospitalized (48.2%) versus non-hospitalized (18.2%) individuals.
- Prevalence of CRE colonization was 2.6%, and MRSA colonization was 2.7%.
- Increased risk of 3GCRE colonization was associated with hospital birth (OR 1.87), neonatal antibiotic use (OR 2.96), and prolonged rupture of membranes (OR 3.86).
Conclusions:
- A substantial prevalence of antibiotic-resistant pathogen colonization exists in neonates and young infants in LMICs.
- High heterogeneity among studies limits broad extrapolation.
- Further research is needed to identify transmission routes and develop targeted preventive measures against neonatal sepsis.
Importance:
In low- and middle-income countries (LMICs), neonatal bacterial infections are mainly caused by Enterobacterales species and Staphylococcus aureus, which are also the leading causes of mortality directly attributable to antimicrobial resistance. As bacterial colonization often precedes infection, better knowledge of colonization is crucial to prevent antibiotic-resistant neonatal sepsis.
Objective:
To synthesize current evidence on the prevalence of and factors associated with colonization with third-generation cephalosporin-resistant Enterobacterales (3GCRE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant S aureus (MRSA) during the first 3 months of life in LMICs.
Data Sources:
PubMed, Scopus, Web of Science, and the World Health Organization Global Index Medicus were searched for articles published from January 1, 2000, through July 29, 2024.
Study Selection:
Included studies were conducted in LMICs and reported prevalence rates or factors associated with colonization with 3GCRE, CRE, or MRSA in neonates and infants up to 3 months of age. Outbreak reports were excluded.
Data Extraction And Synthesis:
Data extraction and risk-of-bias assessment using a Joanna Briggs Institute tool were performed by 2 independent reviewers. Pooled prevalence for each pathogen was computed using a random-effects model. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.
Main Outcomes And Measures:
Prevalence of and factors associated with 3GCRE, CRE, and MRSA colonization.
Results:
Of the 3147 articles identified in the search, 67 studies (51 for 3GCRE and CRE and 16 for MRSA) including 17 152 individuals were eligible. The pooled prevalence of 3GCRE colonization was 30.2% (95% CI, 21.4%-40.7%; τ2 = 1.48; I2 = 95.1%), varying from 18.2% (95% CI, 10.8%-29.1%) in nonhospitalized individuals to 48.2% (95% CI, 36.4%-60.2%) in hospitalized individuals. The prevalence of CRE colonization was 2.6% (95% CI, 0.7%-8.8%; τ2 = 7.79; I2 = 95.6%), while it was 2.7% (95% CI, 1.0%-6.7%; τ2 = 2.58; I2 = 93.5%) for MRSA. Increased risk of colonization with 3GCRE was associated with hospital birth (odds ratio [OR], 1.87; 95% CI, 1.33-2.64), neonatal antibiotic use (OR, 2.96; 95% CI, 1.43-6.11), and prolonged rupture of membranes (OR, 3.86; 95% CI, 2.19-6.84).
Conclusions And Relevance:
In this systematic review and meta-analysis of antibiotic-resistant pathogen carriage in individuals aged 0 to 3 months, the pooled prevalence was substantial despite a limited exposure period. Although high heterogeneity between studies limited extrapolation of results, the findings highlight the need for further investigation to identify transmission routes and to design targeted and effective preventive measures.
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