Carriage of antimicrobial-resistant Enterobacterales among pregnant women and newborns in Amhara, Ethiopia

Int J Infect Dis. 2024 Jun:143:107035. doi: 10.1016/j.ijid.2024.107035. Epub 2024 Mar 30.


Objectives: Infections are one of the most common causes of neonatal mortality, and maternal colonization has been associated with neonatal infection. In this study, we sought to quantify carriage prevalence of extended-spectrum-beta-lactamase (ESBL) -producing and carbapenem-resistant Enterobacterales (CRE) among pregnant women and their neonates and to characterize risk factors for carriage in rural Amhara, Ethiopia.

Methods: We conducted a prospective cohort study nested in the Birhan field site. We collected rectal and vaginal samples from 211 pregnant women in their third trimester and/or during labor/delivery and perirectal or stool samples from 159 of their neonates in the first week of life.

Results: We found that carriage of ESBL-producing organisms was fairly common (women: 22.3%, 95% CI: 16.8-28.5; neonates: 24.5%, 95% CI: 18.1-32.0), while carriage of CRE (women: 0.9%, 95% CI: 0.1-3.4; neonates: 2.5%, 95% CI: 0.7-6.3) was rare. Neonates whose mothers tested positive for ESBL-producing organisms were nearly twice as likely to also test positive for ESBL-producing organisms (38.7% vs 21.1%, P-value = 0.06). Carriage of ESBL-producing organisms was also associated with Woreda (district) of sample collection and recent antibiotic use.

Conclusion: Understanding carriage patterns of potential pathogens and antibiotic susceptibility among pregnant women and newborns will inform local, data-driven recommendations to prevent and treat neonatal infections.

Keywords: Antibiotic resistance; Carbapenem-resistant Enterobacterales; Extended-spectrum-beta-lactamase-producing organisms; Neonates; Sepsis; Vertical transmission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents* / pharmacology
  • Carrier State* / epidemiology
  • Carrier State* / microbiology
  • Enterobacteriaceae Infections* / drug therapy
  • Enterobacteriaceae Infections* / epidemiology
  • Enterobacteriaceae Infections* / microbiology
  • Enterobacteriaceae* / drug effects
  • Enterobacteriaceae* / isolation & purification
  • Ethiopia / epidemiology
  • Feces / microbiology
  • Female
  • Humans
  • Infant, Newborn
  • Microbial Sensitivity Tests
  • Pregnancy
  • Pregnancy Complications, Infectious* / drug therapy
  • Pregnancy Complications, Infectious* / epidemiology
  • Pregnancy Complications, Infectious* / microbiology
  • Prevalence
  • Prospective Studies
  • Rectum / microbiology
  • Risk Factors
  • Vagina / microbiology
  • Young Adult
  • beta-Lactamases*


  • Anti-Bacterial Agents
  • beta-Lactamases