Prevalence of Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Pregnant Women in the Primary Health Care Center and Hospital Setting in Indonesia

Background: The incidence of healthy individuals carrying Extended-Spectrum Beta-Lactamase producing Enterobacteriaceae (ESBL-E), especially E. coli (ESBL-EC) and Klebsiella pneumoniae (ESBL-KP), is increasing worldwide. ESBL-E causes early or late onset of neonatal sepsis, resulting in increased morbidity and mortality rates. Although maternal-neonatal transmissions of ESBL-E have been reported in several countries, the prevalence of ESBL-E carriage among pregnant women in Indonesia is not clear. In the present study, we compared the prevalence of carriage of ESBL-E among pregnant women in a primary health care center (PHC) versus two hospitals in Indonesia and identified the phenotypic and genotypic characteristics of the isolated ESBL-E strains. Methods: We collected rectal swab samples from 200 pregnant women who visited a PHC (101 women) or were admitted to Dr. Soetomo Referral Hospital or Airlangga University Hospital (99 women) in Surabaya, Indonesia from July to October 2018. The samples were cultivated on MacConkey Agar plates supplemented with cefotaxime 2 mg/L, at 37oC overnight. The isolated strains were identified by Bruker MALDI BiotyperÒ System, phenotypic detection of ESBL was performed by the combination disk method, and antibiotic susceptibility was tested by the disk diffusion method. In addition, ESBL gene was identified by PCR and DNA sequencing and molecular epidemiological studies were performed by PFGE. Results: ESBL-E strains were isolated from 25 (rate of fecal carriage; 24.8%) pregnant women who visited the PHC and 49 (49.5%) pregnant women who were admitted to the hospitals. The rate of ESBL-E carriage of pregnant women in the hospitals was significantly higher than that in the PHC. Among the 74 isolated ESBL-E strains, ESBL-EC was most frequently isolated (62 strains), followed by ESBL-KP (12 strains). In addition, blaCTX-M15 was the most frequent ESBL gene type of the isolated ESBL-E strains. Conclusion: Our results revealed the high prevalence of ESBL-E carriage in pregnant women, especially those who were admitted to the hospitals. CTX-M15 ESBL-EC was the most frequent type of ESBL-E in the pregnant women in our study. Continuous surveillance for ESBL-E carriage in pregnant women is strongly recommended to reduce the incidence of neonatal sepsis in Indonesia.