Siren Rettedal - Academia.edu (original) (raw)
Papers by Siren Rettedal
Simulation in healthcare, Mar 6, 2024
Acta pædiatrica, Jan 26, 2024
Research Square (Research Square), Mar 11, 2024
Archives of Disease in Childhood, Nov 1, 2008
Microbial genomics, May 18, 2023
All supporting data, code and protocols have been provided within the article or through suppleme... more All supporting data, code and protocols have been provided within the article or through supplementary data files. Five supplementary figures and five supplementary tables are available with the online version of this article.
bioRxiv (Cold Spring Harbor Laboratory), Nov 1, 2022
Klebsiella pneumoniae sequence type (ST) 17 is a global problem clone that causes multidrug-resis... more Klebsiella pneumoniae sequence type (ST) 17 is a global problem clone that causes multidrug-resistant (MDR) hospital infections worldwide. In 2008-2009, an outbreak of MDR ST17 occurred at a neonatal intensive care unit (NICU) in Stavanger, Norway. Fifty-seven children were colonised. We observed intestinal persistence of ST17 in all of the children for up to two years after hospital discharge. Here, we investigated the within-host evolution of ST17 in 45 of those children during long-term colonisation and compared the outbreak with 254 global strains. Ninety-two outbreak-related isolates were whole-genome sequenced. They had capsule locus KL25, O locus O5 and carried yersiniabactin. During within-host colonisation ST17 remained stable with few single nucleotide polymorphisms, no acquisition of antimicrobial resistance (AMR) or virulence determinants, and persistent carriage of a blaCTX-M-15-encoding IncFII(K) IncFIB(K) plasmid (pKp2177_1). The global collection included ST17 from 1993-2020 from 34 countries, that were from human infection (41.3%), colonisation (39.3%) and respiratory specimens (7.3%), from animals (9.3%), and from the environment (2.7%). We estimate that ST17 emerged mid-to-late 19th century (1859, 95% HPD 1763-1939) and diversified through recombinations of the K and O loci to form several sublineages, with various AMR genes, virulence loci and plasmids. There was limited evidence of persistence of AMR genes in any of these lineages. A globally disseminated sublineage with KL25/O5 accounted for 52.7% of the genomes. It included a monophyletic subclade that emerged in the mid-1980s, which comprised the Stavanger NICU outbreak and 10 genomes from three other countries, which all carried pKp2177_1. The plasmid was also observed in a KL155/OL101 subclade from the 2000s. Three clonal expansions of ST17 were identified, all were healthcare-associated and carried either yersiniabactin and/or pKp2177_1. To conclude, ST17 is globally disseminated and associated with opportunistic hospital-acquired infections. It contributes to the burden of global MDR infections, but many diverse lineages persist without acquired AMR. We hypothesise that non-human sources and human colonisation may play a crucial role for severe infections in vulnerable patients, such as preterm neonates. .
Neonatology, 2020
ObjectiveNewborn resuscitation guidelines recommend initial assessment of heart rate (HR) and ini... more ObjectiveNewborn resuscitation guidelines recommend initial assessment of heart rate (HR) and initiation of positive pressure ventilation (PPV) within 60 s after birth in non-breathing newborns. Pulse oximeter (PO) and electrocardiogram (ECG) are suggested methods for continuous HR monitoring during resuscitation. Our aim was to evaluate compliance with guidelines and the efficacy of PO versus ECG monitoring in real-life newborn resuscitations.MethodsIn this prospective observational study, we video recorded resuscitations of newborns ≥34 weeks of gestation receiving PPV at birth.Results104 resuscitations were analysed. Median (IQR) time from birth to arrival at the resuscitation bay was 48 (22–68) s (n = 62), to initial HR assessment 70 (47–118) s (n = 61), and to initiation of PPV 78 (42–118) s (n = 62). Initial HR assessment (stethoscope or palpation) and initiation of PPV were achieved within 60 s for 35% of the resuscitated newborns. Time to initial HR assessment and initiating PPV was significantly longer following vaginal deliveries than caesarean sections: 84 (70–139) versus 44 (30–66) s (p < 0.001) and 93 (73–139) versus 38 (30–66) s (p < 0.001). Time from birth and sensor application to provision of a reliable HR signal from PO versus ECG was 348 (217–524) (n = 42) versus 174 (105–277) s (n = 30) (p < 0.001) and 199 (77–352) (n = 65) versus 16 (11–22) s (n = 52) (p < 0.001).ConclusionInitial HR assessment and initiation of PPV were achieved within 60 s after birth in only 1/3 of newborn resuscitations. When applied for continuous HR monitoring, ECG was superior to PO in time to achieve reliable HR signals in real-life resuscitations.
Archives of Disease in Childhood-fetal and Neonatal Edition, Nov 10, 2020
Objective To determine heart rate centiles during the first 5 min after birth in healthy term new... more Objective To determine heart rate centiles during the first 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping. Design Single-centre prospective observational study.
BMJ Paediatrics Open, Dec 1, 2019
What is known about the subject? ► A significant percentage of newborns require some assistance t... more What is known about the subject? ► A significant percentage of newborns require some assistance to enable the transition to independent life. ► The incidence of different resuscitation measures is likely to vary between different settings and gestational age (GA) groups. What this study adds? ► Most compromised newborns respond to airway support alone and full cardiopulmonary resuscitation is rare. ► There is a similar increase in resuscitation measures in near-term (34-37 weeks' GA) and postmature (>42 weeks' GA) deliveries. ► Most newborns treated with resuscitative interventions are not severely affected and short-term outcomes are good.
Journal of Antimicrobial Chemotherapy, Jan 3, 2013
To investigate the duration of faecal carriage of CTX-M-15-producing Klebsiella pneumoniae in inf... more To investigate the duration of faecal carriage of CTX-M-15-producing Klebsiella pneumoniae in infants colonized during a nosocomial neonatal intensive care unit (NICU) outbreak after discharge from hospital, possible risk factors for long-term colonization and transmission to household contacts (HCs). Methods: Fifty-one infants colonized with two unrelated clones of CTX-M-15 K. pneumoniae [sequence type (ST) 17 and ST485] during an NICU outbreak and 60 HCs provided faecal and rectal samples, respectively, every 1-3 months after hospital discharge. Extended-spectrum b-lactamase (ESBL)-producing strains of K. pneumoniae were identified on Chrom ID ESBL agar and examined by antimicrobial susceptibility testing. bla CTX-M-15 was detected by PCR and DNA sequencing. Clonal relationship was examined by PFGE. Results: The median carriage time in infants after discharge was 12.5 months (IQR 9.5-17.5). Stable antimicrobial susceptibility patterns in PFGE-related strains confirmed the intestinal persistence of both outbreak strains. Risk factors for prolonged faecal carriage in infants were delivery by caesarean section [hazard ratio (HR) 2.4, 95% CI 1.1-5.5, P ¼ 0.029] and treatment with antibiotics during hospitalization (HR 4.5, 95% CI 1.6-12.6, P ¼ 0.004). Transmission of CTX-M-15 K. pneumoniae was observed in 9/28 (32%) households. Median carriage length in parents was 2.5 months (IQR 1.0-5.0) (P, 0.001 compared with infants). Conclusions: Infants may be long-term faecal carriers of ESBL-producing K. pneumoniae after colonization during hospitalization in the neonatal period. Delivery by caesarean section and antibiotic treatment during hospitalization are possible risk factors for prolonged carriage. Faecal ESBL carriage in infants represents a reservoir for intra-household spread of ESBL-producing K. pneumoniae.
Acta Paediatrica, Nov 18, 2022
AimTo investigate the impact of immediate skin‐to‐skin contact with a parent after birth on therm... more AimTo investigate the impact of immediate skin‐to‐skin contact with a parent after birth on thermal regulation in very preterm infants.MethodsThis clinical trial was conducted in three neonatal intensive care units in Scandinavia from 2018 to 2021. Infants born between 28 + 0 and 32 + 6 weeks and days of gestation were randomised to immediate skin‐to‐skin contact or conventional care in an incubator during the first 6 postnatal hours. We report on a secondary outcome: serial measurements of axillary temperature.ResultsNinety‐one infants were randomised to skin‐to‐skin contact or conventional care. Mean (range) gestational ages were 31 + 2 (28 + 6, 32 + 5) and 31 + 0 (28 + 4, 32 + 6) weeks and days, mean birth weights were 1572 (702, 2352) and 1495 (555, 2440) grams, respectively. Mean (95%CI, p‐value) temperatures were within the normal range in both groups, 0.2°C (−0.29, −0.14, p < 0.001) lower in the skin‐to‐skin contact group. The skin‐to‐skin contact group had a lower relative risk (95%CI, p‐value) of developing events of hyperthermia, RR = 0.70 (0.50, 0.99, p = 0.04).ConclusionsVery preterm infants, irrespective of clinical stability, do not develop hypothermia during immediate skin‐to‐skin contact after birth. Immediate skin‐to‐skin contact did protect against events of hyperthermia. Concerns about thermal regulation should not limit implementation of immediate skin‐to‐skin contact in high‐resource settings.
Scandinavian Journal of Infectious Diseases, Sep 19, 2012
Children (Basel), Dec 2, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Children (Basel), Oct 19, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Children (Basel), Jun 28, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Acta Paediatrica, Apr 28, 2022
AimOur aim was to investigate what effect immediate skin‐to‐skin contact with a parent had on the... more AimOur aim was to investigate what effect immediate skin‐to‐skin contact with a parent had on the cardiorespiratory stabilisation of very preterm infants.MethodsThis randomised clinical trial was conducted during 2018–2021 at two university hospitals with three neonatal intensive care units in Norway and Sweden. Infants born from 28+0 to 32+6 weeks of gestation were randomised to immediate skin‐to‐skin contact with a parent for the first six postnatal hours or standard incubator care. The outcome was a composite cardiorespiratory stability score, based on serial measures of heart and respiratory rate, respiratory support, fraction of inspired oxygen and oxygen saturation.ResultsWe recruited 91 newborn infants with a mean gestational age of 31+1 (range 28+4–32+6) weeks and mean birth weight of 1534 (range 555–2440) g: 46 received immediate skin‐to‐skin contact and 45 received incubator care. The group who received skin‐to‐skin contact had an adjusted mean score of 0.52 higher (95% confidence interval 0.38–0.67, p < 0.001) on a scale from zero to six when compared to the control group.ConclusionImmediate skin‐to‐skin contact for the first six postnatal hours had beneficial effects on the cardiorespiratory stabilisation of very preterm infants.
BMJ Open, Sep 1, 2022
Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation... more Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation of ventilation after birth: protocol for a randomised controlled trial. BMJ Open 2022;12:e061839.
Journal of Perinatology, Jul 9, 2015
Objective:To study (i) the prevalence and risk factors for carriage of extended-spectrum β-lactam... more Objective:To study (i) the prevalence and risk factors for carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant women, (ii) the maternal–neonatal transmission rate of ESBL-E at birth and (iii) the prevalence of ESBL-E in expressed breast milk of colonized mothers.Study design:In this cross-sectional, population-based study with case follow-up on maternal–neonatal transmission of ESBL-E, women were screened for rectal ESBL-E colonization at 36 weeks of pregnancy and delivery. Possible risk factors for colonization were studied by logistic regression. Infants of ESBL-E-positive mothers were screened for ESBL-E during their first weeks of life. ESBL-encoding genes were detected by PCR and clonal relatedness was investigated by pulsed-field gel electrophoreses.Results:In total, 26 out of 901 (2.9%) women were colonized by ESBL-producing Escherichia coli at 36 weeks of pregnancy. One of the women carried an additional ESBL Klebsiella pneumoniae strain. Adjusted for traveling, African or Asian nationality was a risk factor for colonization; OR=5.62 (2.21, 14.27) (LR-p=0.003). Fourteen women remained ESBL-E carriers at delivery. ESBL-E strains indistinguishable from the strains isolated from their respective mothers were detected in 5 (35.7%) infants during their first days of life (median day 3; range=2 to 8). A total of 146 expressed milk samples were cultured from 25 out of 26 colonized mothers, all were ESBL-E negative.Conclusions:The prevalence of ESBL-E carriage among pregnant women was low in our region, but the high maternal–neonatal transmission rate suggests that colonized mothers represent a substantial risk for infant colonization.
Children (Basel), Jun 28, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
EClinicalMedicine, Jun 1, 2023
Simulation in healthcare, Mar 6, 2024
Acta pædiatrica, Jan 26, 2024
Research Square (Research Square), Mar 11, 2024
Archives of Disease in Childhood, Nov 1, 2008
Microbial genomics, May 18, 2023
All supporting data, code and protocols have been provided within the article or through suppleme... more All supporting data, code and protocols have been provided within the article or through supplementary data files. Five supplementary figures and five supplementary tables are available with the online version of this article.
bioRxiv (Cold Spring Harbor Laboratory), Nov 1, 2022
Klebsiella pneumoniae sequence type (ST) 17 is a global problem clone that causes multidrug-resis... more Klebsiella pneumoniae sequence type (ST) 17 is a global problem clone that causes multidrug-resistant (MDR) hospital infections worldwide. In 2008-2009, an outbreak of MDR ST17 occurred at a neonatal intensive care unit (NICU) in Stavanger, Norway. Fifty-seven children were colonised. We observed intestinal persistence of ST17 in all of the children for up to two years after hospital discharge. Here, we investigated the within-host evolution of ST17 in 45 of those children during long-term colonisation and compared the outbreak with 254 global strains. Ninety-two outbreak-related isolates were whole-genome sequenced. They had capsule locus KL25, O locus O5 and carried yersiniabactin. During within-host colonisation ST17 remained stable with few single nucleotide polymorphisms, no acquisition of antimicrobial resistance (AMR) or virulence determinants, and persistent carriage of a blaCTX-M-15-encoding IncFII(K) IncFIB(K) plasmid (pKp2177_1). The global collection included ST17 from 1993-2020 from 34 countries, that were from human infection (41.3%), colonisation (39.3%) and respiratory specimens (7.3%), from animals (9.3%), and from the environment (2.7%). We estimate that ST17 emerged mid-to-late 19th century (1859, 95% HPD 1763-1939) and diversified through recombinations of the K and O loci to form several sublineages, with various AMR genes, virulence loci and plasmids. There was limited evidence of persistence of AMR genes in any of these lineages. A globally disseminated sublineage with KL25/O5 accounted for 52.7% of the genomes. It included a monophyletic subclade that emerged in the mid-1980s, which comprised the Stavanger NICU outbreak and 10 genomes from three other countries, which all carried pKp2177_1. The plasmid was also observed in a KL155/OL101 subclade from the 2000s. Three clonal expansions of ST17 were identified, all were healthcare-associated and carried either yersiniabactin and/or pKp2177_1. To conclude, ST17 is globally disseminated and associated with opportunistic hospital-acquired infections. It contributes to the burden of global MDR infections, but many diverse lineages persist without acquired AMR. We hypothesise that non-human sources and human colonisation may play a crucial role for severe infections in vulnerable patients, such as preterm neonates. .
Neonatology, 2020
ObjectiveNewborn resuscitation guidelines recommend initial assessment of heart rate (HR) and ini... more ObjectiveNewborn resuscitation guidelines recommend initial assessment of heart rate (HR) and initiation of positive pressure ventilation (PPV) within 60 s after birth in non-breathing newborns. Pulse oximeter (PO) and electrocardiogram (ECG) are suggested methods for continuous HR monitoring during resuscitation. Our aim was to evaluate compliance with guidelines and the efficacy of PO versus ECG monitoring in real-life newborn resuscitations.MethodsIn this prospective observational study, we video recorded resuscitations of newborns ≥34 weeks of gestation receiving PPV at birth.Results104 resuscitations were analysed. Median (IQR) time from birth to arrival at the resuscitation bay was 48 (22–68) s (n = 62), to initial HR assessment 70 (47–118) s (n = 61), and to initiation of PPV 78 (42–118) s (n = 62). Initial HR assessment (stethoscope or palpation) and initiation of PPV were achieved within 60 s for 35% of the resuscitated newborns. Time to initial HR assessment and initiating PPV was significantly longer following vaginal deliveries than caesarean sections: 84 (70–139) versus 44 (30–66) s (p < 0.001) and 93 (73–139) versus 38 (30–66) s (p < 0.001). Time from birth and sensor application to provision of a reliable HR signal from PO versus ECG was 348 (217–524) (n = 42) versus 174 (105–277) s (n = 30) (p < 0.001) and 199 (77–352) (n = 65) versus 16 (11–22) s (n = 52) (p < 0.001).ConclusionInitial HR assessment and initiation of PPV were achieved within 60 s after birth in only 1/3 of newborn resuscitations. When applied for continuous HR monitoring, ECG was superior to PO in time to achieve reliable HR signals in real-life resuscitations.
Archives of Disease in Childhood-fetal and Neonatal Edition, Nov 10, 2020
Objective To determine heart rate centiles during the first 5 min after birth in healthy term new... more Objective To determine heart rate centiles during the first 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping. Design Single-centre prospective observational study.
BMJ Paediatrics Open, Dec 1, 2019
What is known about the subject? ► A significant percentage of newborns require some assistance t... more What is known about the subject? ► A significant percentage of newborns require some assistance to enable the transition to independent life. ► The incidence of different resuscitation measures is likely to vary between different settings and gestational age (GA) groups. What this study adds? ► Most compromised newborns respond to airway support alone and full cardiopulmonary resuscitation is rare. ► There is a similar increase in resuscitation measures in near-term (34-37 weeks' GA) and postmature (>42 weeks' GA) deliveries. ► Most newborns treated with resuscitative interventions are not severely affected and short-term outcomes are good.
Journal of Antimicrobial Chemotherapy, Jan 3, 2013
To investigate the duration of faecal carriage of CTX-M-15-producing Klebsiella pneumoniae in inf... more To investigate the duration of faecal carriage of CTX-M-15-producing Klebsiella pneumoniae in infants colonized during a nosocomial neonatal intensive care unit (NICU) outbreak after discharge from hospital, possible risk factors for long-term colonization and transmission to household contacts (HCs). Methods: Fifty-one infants colonized with two unrelated clones of CTX-M-15 K. pneumoniae [sequence type (ST) 17 and ST485] during an NICU outbreak and 60 HCs provided faecal and rectal samples, respectively, every 1-3 months after hospital discharge. Extended-spectrum b-lactamase (ESBL)-producing strains of K. pneumoniae were identified on Chrom ID ESBL agar and examined by antimicrobial susceptibility testing. bla CTX-M-15 was detected by PCR and DNA sequencing. Clonal relationship was examined by PFGE. Results: The median carriage time in infants after discharge was 12.5 months (IQR 9.5-17.5). Stable antimicrobial susceptibility patterns in PFGE-related strains confirmed the intestinal persistence of both outbreak strains. Risk factors for prolonged faecal carriage in infants were delivery by caesarean section [hazard ratio (HR) 2.4, 95% CI 1.1-5.5, P ¼ 0.029] and treatment with antibiotics during hospitalization (HR 4.5, 95% CI 1.6-12.6, P ¼ 0.004). Transmission of CTX-M-15 K. pneumoniae was observed in 9/28 (32%) households. Median carriage length in parents was 2.5 months (IQR 1.0-5.0) (P, 0.001 compared with infants). Conclusions: Infants may be long-term faecal carriers of ESBL-producing K. pneumoniae after colonization during hospitalization in the neonatal period. Delivery by caesarean section and antibiotic treatment during hospitalization are possible risk factors for prolonged carriage. Faecal ESBL carriage in infants represents a reservoir for intra-household spread of ESBL-producing K. pneumoniae.
Acta Paediatrica, Nov 18, 2022
AimTo investigate the impact of immediate skin‐to‐skin contact with a parent after birth on therm... more AimTo investigate the impact of immediate skin‐to‐skin contact with a parent after birth on thermal regulation in very preterm infants.MethodsThis clinical trial was conducted in three neonatal intensive care units in Scandinavia from 2018 to 2021. Infants born between 28 + 0 and 32 + 6 weeks and days of gestation were randomised to immediate skin‐to‐skin contact or conventional care in an incubator during the first 6 postnatal hours. We report on a secondary outcome: serial measurements of axillary temperature.ResultsNinety‐one infants were randomised to skin‐to‐skin contact or conventional care. Mean (range) gestational ages were 31 + 2 (28 + 6, 32 + 5) and 31 + 0 (28 + 4, 32 + 6) weeks and days, mean birth weights were 1572 (702, 2352) and 1495 (555, 2440) grams, respectively. Mean (95%CI, p‐value) temperatures were within the normal range in both groups, 0.2°C (−0.29, −0.14, p < 0.001) lower in the skin‐to‐skin contact group. The skin‐to‐skin contact group had a lower relative risk (95%CI, p‐value) of developing events of hyperthermia, RR = 0.70 (0.50, 0.99, p = 0.04).ConclusionsVery preterm infants, irrespective of clinical stability, do not develop hypothermia during immediate skin‐to‐skin contact after birth. Immediate skin‐to‐skin contact did protect against events of hyperthermia. Concerns about thermal regulation should not limit implementation of immediate skin‐to‐skin contact in high‐resource settings.
Scandinavian Journal of Infectious Diseases, Sep 19, 2012
Children (Basel), Dec 2, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Children (Basel), Oct 19, 2021
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Children (Basel), Jun 28, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Acta Paediatrica, Apr 28, 2022
AimOur aim was to investigate what effect immediate skin‐to‐skin contact with a parent had on the... more AimOur aim was to investigate what effect immediate skin‐to‐skin contact with a parent had on the cardiorespiratory stabilisation of very preterm infants.MethodsThis randomised clinical trial was conducted during 2018–2021 at two university hospitals with three neonatal intensive care units in Norway and Sweden. Infants born from 28+0 to 32+6 weeks of gestation were randomised to immediate skin‐to‐skin contact with a parent for the first six postnatal hours or standard incubator care. The outcome was a composite cardiorespiratory stability score, based on serial measures of heart and respiratory rate, respiratory support, fraction of inspired oxygen and oxygen saturation.ResultsWe recruited 91 newborn infants with a mean gestational age of 31+1 (range 28+4–32+6) weeks and mean birth weight of 1534 (range 555–2440) g: 46 received immediate skin‐to‐skin contact and 45 received incubator care. The group who received skin‐to‐skin contact had an adjusted mean score of 0.52 higher (95% confidence interval 0.38–0.67, p < 0.001) on a scale from zero to six when compared to the control group.ConclusionImmediate skin‐to‐skin contact for the first six postnatal hours had beneficial effects on the cardiorespiratory stabilisation of very preterm infants.
BMJ Open, Sep 1, 2022
Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation... more Impact of immediate and continuous heart rate feedback by dry electrode ECG on time to initiation of ventilation after birth: protocol for a randomised controlled trial. BMJ Open 2022;12:e061839.
Journal of Perinatology, Jul 9, 2015
Objective:To study (i) the prevalence and risk factors for carriage of extended-spectrum β-lactam... more Objective:To study (i) the prevalence and risk factors for carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant women, (ii) the maternal–neonatal transmission rate of ESBL-E at birth and (iii) the prevalence of ESBL-E in expressed breast milk of colonized mothers.Study design:In this cross-sectional, population-based study with case follow-up on maternal–neonatal transmission of ESBL-E, women were screened for rectal ESBL-E colonization at 36 weeks of pregnancy and delivery. Possible risk factors for colonization were studied by logistic regression. Infants of ESBL-E-positive mothers were screened for ESBL-E during their first weeks of life. ESBL-encoding genes were detected by PCR and clonal relatedness was investigated by pulsed-field gel electrophoreses.Results:In total, 26 out of 901 (2.9%) women were colonized by ESBL-producing Escherichia coli at 36 weeks of pregnancy. One of the women carried an additional ESBL Klebsiella pneumoniae strain. Adjusted for traveling, African or Asian nationality was a risk factor for colonization; OR=5.62 (2.21, 14.27) (LR-p=0.003). Fourteen women remained ESBL-E carriers at delivery. ESBL-E strains indistinguishable from the strains isolated from their respective mothers were detected in 5 (35.7%) infants during their first days of life (median day 3; range=2 to 8). A total of 146 expressed milk samples were cultured from 25 out of 26 colonized mothers, all were ESBL-E negative.Conclusions:The prevalence of ESBL-E carriage among pregnant women was low in our region, but the high maternal–neonatal transmission rate suggests that colonized mothers represent a substantial risk for infant colonization.
Children (Basel), Jun 28, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
EClinicalMedicine, Jun 1, 2023