Contribution of maternal gut carriage to neonatal acquisition of extended-spectrum beta-lactamase-producing Enterobacterales in Madagascar and Cambodia

Anne-Lise Beaumont (), Agathe de Lauzanne, Alexis Criscuolo, Laetitia Fabre, Mamitina Alain Noah Rabenandrasana, Norohasina Fanja Randriamanga, Sandrine Bernabeu, Aina Harimanana, Rindra Vatosoa Randremanana, Perlinot Herindrainy, Jean-Marc Collard, Long Pring, Navin Sreng, Sokleaph Cheng, Laurence Borand, Elsa Kermorvant-Duchemin, Tania Crucitti, Didier Guillemot and Bich-Tram Huynh
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Anne-Lise Beaumont: UVSQ, CESP, Anti-infective Evasion and Pharmacoepidemiology team, Université Paris-Saclay
Agathe de Lauzanne: Institut Pasteur du Cambodge, Clinical Research Group, Epidemiology and Public Health Unit
Alexis Criscuolo: Biological Resource Center of Institut Pasteur, Institut Pasteur, Université Paris Cité, GIPhy ‒ Genome Informatics and Phylogenetics
Laetitia Fabre: Unité des Bactéries Pathogènes Entériques, Institut Pasteur, Université Paris Cité
Mamitina Alain Noah Rabenandrasana: Institut Pasteur de Madagascar, Experimental Bacteriology Unit
Norohasina Fanja Randriamanga: Institut Pasteur de Madagascar, Experimental Bacteriology Unit
Sandrine Bernabeu: Assistance Publique - Hôpitaux de Paris, Department of Bacteriology-Hygiene, Bicêtre Hospital
Aina Harimanana: Institut Pasteur de Madagascar, Epidemiology and Clinical Research Unit
Rindra Vatosoa Randremanana: Institut Pasteur de Madagascar, Epidemiology and Clinical Research Unit
Perlinot Herindrainy: Institut Pasteur de Madagascar, Epidemiology and Clinical Research Unit
Jean-Marc Collard: Unité des Bactéries Pathogènes Entériques, Institut Pasteur, Université Paris Cité
Long Pring: Institut Pasteur du Cambodge, Clinical Research Group, Epidemiology and Public Health Unit
Navin Sreng: Institut Pasteur du Cambodge, Medical Biology Laboratory
Sokleaph Cheng: Institut Pasteur du Cambodge, Medical Biology Laboratory
Laurence Borand: Institut Pasteur du Cambodge, Clinical Research Group, Epidemiology and Public Health Unit
Elsa Kermorvant-Duchemin: Department of Neonatal Medicine, Université Paris Cité, AP-HP, Hôpital Necker-Enfants malades
Tania Crucitti: Institut Pasteur de Madagascar, Experimental Bacteriology Unit
Didier Guillemot: UVSQ, CESP, Anti-infective Evasion and Pharmacoepidemiology team, Université Paris-Saclay
Bich-Tram Huynh: UVSQ, CESP, Anti-infective Evasion and Pharmacoepidemiology team, Université Paris-Saclay

Nature Communications, 2025, vol. 16, issue 1, 1-13

Abstract: Abstract Early neonatal infections caused by extended-spectrum-beta-lactamase-producing Enterobacterales (ESBL-PE) are prevalent in low- and middle-income countries, posing significant treatment challenges. This study investigates ESBL-PE colonization in 499 mother-neonate pairs from Madagascar and Cambodia, with stool samples collected at delivery and from neonates during the first three days of life. Using short- and long-read sequencing, identical isolates or plasmids are detected within each pair to assess neonatal acquisition from maternal source. Associated risk factors are identified through multinomial regression. Maternal gut carriage accounts for only 16.5% of neonatal ESBL-PE acquisition, suggesting that most cases originate from other sources. Primiparity and the wet season are associated with an increased risk of acquisition from the mother, while cesarean delivery, neonatal resuscitation, and wet season are associated with acquisition from other sources. These findings challenge the paradigm that maternal carriage is the primary source of early neonatal ESBL-PE colonization, highlighting the need for further research into alternative sources to inform targeted interventions.

Date: 2025
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DOI: 10.1038/s41467-025-65352-4

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