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Growing Threat of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Colonization in High-Risk Pregnancies: a retrospective cohort study
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  • Yun-Sun Choi,
  • Yejin Kim,
  • Hye Jung Cho,
  • Ji-Hee Sung,
  • Suk-Joo Choi,
  • Soo-young Oh,
  • Yae-Jean Kim,
  • Cheong-Rae Roh
Yun-Sun Choi
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul

Corresponding Author:ys1102.choi@samsung.com

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Yejin Kim
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Hye Jung Cho
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Ji-Hee Sung
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Suk-Joo Choi
Samsung Medical Center, Sungkyunkwan University School of Medicine
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Soo-young Oh
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Yae-Jean Kim
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Cheong-Rae Roh
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
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Abstract

Objective To investigate the epidemiological changes in extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) vaginal colonization in high-risk pregnant women and identify independent risk factors. Further, the differences in perinatal outcomes according to maternal ESBL-E vaginal colonization were analyzed. Design Retrospective cohort study. Setting Republic of Korea Population 1,460 women admitted to our high-risk pregnancy unit between 14+0 and 35+6 gestational weeks. Methods The study period was divided into periods 1 (January 2010 to July 2015) and 2 (August 2015 to December 2020). The main outcomes were analyzed according to each period and ESBL-E vaginal colonization. Main Outcome Measures ESBL-E vaginal colonization rate, risk factors for ESBL-E vaginal colonization, and perinatal outcomes. Results The ESBL-E vaginal colonization rate was higher in period 2, which was attributed to a significantly higher proportion of ESBL-producing Escherichia coli. Cerclage (odds ratio [OR]: 3.248; 95% confidence interval [CI]: 1.744–6.049) and prior antibiotic treatment (OR: 3.044; 95% CI: 1.713–5.410) were found as independent risk factors for ESBL-E vaginal colonization. Earlier gestational age at delivery, and higher proven early-onset neonatal sepsis (EONS) rate were observed in the ESBL-E-positive group. Conclusions The ESBL-E vaginal colonization rate in high-risk pregnant patients has increased over the past decade, and the independent risk factors for colonization are cerclage and prior antibiotic treatment. Additionally, maternal ESBL-E vaginal colonization is associated with higher proven EONS rates. Funding This study received no funding. Keywords Extended-spectrum β-lactamase, Enterobacteriaceae, vaginal colonization, antibiotics use, cerclage, neonatal sepsis
02 Nov 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
02 Nov 2021Submission Checks Completed
02 Nov 2021Assigned to Editor
04 Nov 2021Reviewer(s) Assigned
13 Jan 2022Review(s) Completed, Editorial Evaluation Pending
28 Jan 2022Editorial Decision: Revise Major
04 Mar 20221st Revision Received
12 Mar 2022Submission Checks Completed
12 Mar 2022Assigned to Editor
12 Mar 2022Review(s) Completed, Editorial Evaluation Pending
20 Mar 2022Editorial Decision: Accept