Hospital Perinatal Transmission Dynamics of Antimicrobial Resistance, Bangladesh, 2020

Antimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. To better understand routes of AMR transmission to newborns, we aimed to characterize the frequency of and risk factors for AMR colonization of mothers and newborns during hospitalization for delivery. We enrolled 177 pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh, during February-October 2020. We collected vaginal and rectal swabs from mothers on presentation and after delivery as well as rectal swabs from newborns. We also collected swabs from the hospital environment proximal to the patients. Swabs were plated on chromogenic agars selective for extended-spectrum-beta-lactamase producing organisms (ESBL) and carbapenem-resistant organisms (CRO). We performed univariable and multivariable analyses to determine factors associated with ESBL/CRO colonization. Prior to delivery, 17% of mothers had vaginal colonization and 71% had rectal colonization with ESBLs; 4% had vaginal colonization and 13% had rectal colonization with CROs. Seventy-nine percent of women underwent cesarean deliveries (C-section). Ninety-eight percent of women received prophylactic antibiotics during hospitalization. Following delivery, nearly 90% of mothers and newborns were colonized with ESBLs and over 70% with CROs. Of the 290 environmental samples, 77% were positive for ESBLs, and 69% were positive for CROs. Maternal and newborn colonization at discharge were both associated with C-section (RR for maternal 1.4; 95% CI 1.0-1.8 and newborn 1.3; 95% CI 1.1-1.7). Facility-based deliveries increase exposure to AMR organisms, likely driven by intense use of antibiotics and frequent C-sections. Greater attention should be given to the use of perinatal antibiotics, indications for C-sections, and infection prevention practices to reduce the high prevalence of colonization with antibiotic resistant bacteria.