Surveillance of ESBL-gene fecal carriage by neonates in an Indian community setting

Background: There have been increasing reports of bloodstream infections in neonates by ESBL-producing gram-negative bacteria, affecting treatment outcomes. While ESBL-strains continue to be an important nosocomial pathogen worldwide, there is a paucity of data in community settings. Objectives: To determine the prevalence and risk factors of fecal carriage of ESBL-Gram negative bacteria among neonates with clinical sepsis using multiplex-PCR. Methods: Stool samples were collected from 395 neonates (<60 days-old) during a population based surveillance of suspected sepsis in Indian villages. Most of the babies were born at home and had never received antibiotics. DNA extracted from Gram-negative stool isolates was subjected to ESBL-gene profiling. Descriptive analyses were conducted to examine risk factors (including maternal and infant demographics) associated with sepsis and ESBL fecal carriage. Results: Of 395 infants, 293(74%) were colonized with bacteria harboring one or more ESBL-genes and 64(16%) had blood-culture positive sepsis. Nine percent of Gram negative sepsis cases were positive for all three genes including CTX-M. Rates of death were not significantly higher in infants carrying two or more ESBL genes (5-12%), compared to those in non-carriers (2%). Carriers of two or more ESBL-genes in stool were at a significant risk (p=0.007) of developing culture positive sepsis. No other maternal or infant factors (including gestational age, sex, and weight) were associated with acquisition of ESBL. Conclusions: The alarming rates of ESBL-gene carriage in a rural community raise serious concerns. This calls for further surveillance to identify ESBL reservoirs and institution of alternative infection control measures in the community.