Page 94 - Ebook-Book JCMS 2025

Maternal Colonization with Extended-spectrum-beta-
lactamase-producing Enterobacteriaceae and Vertical
Transmission during Preterm Delivery
Thanyaporn Suntiviriyapadung1, Sophida Boonsathorn1*, Nopporn Apiwattanakul1, Buranee Swatesutipun1
,
Pracha Nuntnarumit1, Piya Chaemsaithong2, Puntabut Warintaksa2
1 Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
2 Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University
*Corresponding Author E-mail: nattoo_nat@yahoo.com
Background: Abstract
Preterm infants are at higher risk of morbidity and mortality, with early-onset neonatal
sepsis (EOS) being a critical concern. Extended-spectrum beta-lactamase-producing
Enterobacteriaceae (ESBL-E) complicate treatment due to antimicrobial resistance. This
study evaluates the prevalence of maternal ESBL-E colonization, vertical transmission rates,
and its impact on neonatal outcomes.
Methods: A prospective cohort study was conducted between August 2023 and September 2024 at
Ramathibodi Hospital, Bangkok, Thailand. Pregnant women <37 weeks’ gestation admitted
with preterm labor or preterm premature rupture of membranes were screened for vaginal
ESBL-E colonization upon admission, with repeat swabs taken if hospitalization >72
hours. Neonatal surface cultures were obtained at birth. Maternal risk factors and neonatal
outcomes were compared between exposed and unexposed groups.
Results: Conclusions: Among 155 deliveries, 6% (10/155) of mothers were colonized with ESBL-E, with vertical
transmission rate of 20% (2/10). Risk factors included cervical cerclage/pessary (20% vs.
2.1%, p=0.03) and prior Group B Streptococcus (GBS) colonization (40% vs. 11%, p=0.03).
Infants born to colonized mothers had significantly earlier gestational age (33.3 weeks [IQR
32.9–33.7] vs. 35.3 weeks [IQR 33–36.8]), p=0.04), higher cesarean delivery rates (100%
vs. 59.3%, p=0.01), lower birth weights (1,870 grams, [IQR 1,485-2,440] vs. 2,360 grams,
[IQR 1,900-2,780], p=0.03), and longer hospital stays (17 days [IQR 10-27] vs. 5 days [IQR
3-18], p=0.01).
Cervical procedures and prior GBS colonization were significant risk factors for maternal
ESBL-E colonization. Infants born to colonized mothers had poorer outcomes, highlighting
the need for targeted screening and consideration of broader empiric antibiotics for at-risk
preterm infants.
92 Joint Conference in Medical Sciences 2025