Observational studyAntimicrobial resistance and infection control2021
Colonization with multidrug-resistant Enterobacteriaceae among infants: an observational study in southern Sri Lanka.
Observational study in Antimicrobial resistance and infection control, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 3 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 3 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- Phenotypic and genotypic landscape of antibiotic resistance through One Health approach in Sri Lanka: A systematic review.Tropical medicine & international health : TM & IH · 2025Pooled it
- Neonatal Colonization With Antibiotic-Resistant Pathogens in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.JAMA network open · 2024Pooled it
- Comprehensive analysis of antimicrobial resistance in the Southwest Indian Ocean: focus on WHO critical and high priority pathogens.Frontiers in public health · 2024Pooled it
- Gender and equity within antimicrobial resistance: a scoping review of evidence and policy in Bangladesh and Sri Lanka.BMC public health · 2026Article
- Antimicrobial Resistance and Infant Mortality in Sri Lanka: A Retrospective Cohort Study.Journal of paediatrics and child health · 2026Article
- Colonization of selected antibiotic-resistant bacteria among pregnant women: a cross-sectional study at a tertiary care hospital in the Eastern Province of Sri Lanka.BMC microbiology · 2026Article
- Molecular Relatedness of Maternal and Neonatal Multidrug-Resistant Gram-Negative Colonization Isolates in Low- and Middle-Income Countries: A Systematic Review.Open forum infectious diseases · 2026Review
- Academic global health collaboration: the Ruhuna-Duke partnership.Global health action · 2025Article
- Maternal Colonization Versus Nosocomial Transmission as the Source of Drug-Resistant Bloodstream Infection in an Indian Neonatal Intensive Care Unit: A Prospective Cohort Study.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
- Clonal Spread of Hospital-Acquired NDM-1-ProducingAntibiotics (Basel, Switzerland) · 2023Article
- The Dynamics of Antimicrobial Resistance among Enterobacteriaceae Isolates in Russia: Results of the 2012-2018 INFORM and ATLAS International Program Studies.Antibiotics (Basel, Switzerland) · 2022Article
- Prevalence and Molecular Typing of Carbapenemase-Producing Enterobacterales among Newborn Patients in Italy.Antibiotics (Basel, Switzerland) · 2022Article
Corrections and comments
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Authors and funding
17 authors at 7 institutions in 3 countries.
Funding
Abstract
backgroundThe timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among infants in southern Sri Lanka.
methodsWomen and their newborn children were enrolled within 48 h after delivery in southern Sri Lanka. Rectal swabs were collected from women and infants at enrollment and 4-6 weeks later. Enterobacteriaceae were isolated and identified as MDRE (positive for extended-spectrum β-lactamases or carbapenem resistant) using standard microbiologic procedures. We used exact methods (Fisher's exact and Kruskal-Wallis tests) and multivariable logistic regression to identify sociodemographic and clinical features associated with MDRE intestinal colonization. Whole-genome sequencing was performed on selected MDRE isolates to identify phylogroups and antibiotic resistance-encoding genes were identified with NCBI's AMRfinder tool.
resultsOverall, 199 post-partum women and 199 infants were enrolled; 148/199 (74.4%) women and 151/199 (75.9%) infants were reassessed later in the community. Twenty-four/199 (12.1%) women and 3/199 (1.5%) infants displayed intestinal colonization with MDRE at enrollment, while 26/148 (17.6%) women and 24/151 (15.9%) infants displayed intestinal colonization with MDRE at the reassessment. While there were no risk factors associated with infant colonization at enrollment, multivariable analysis indicated that risk factors for infant colonization at reassessment included mother colonized at enrollment (aOR = 3.62) or reassessment (aOR = 4.44), delivery by Cesarean section (aOR = 2.91), and low birth weight (aOR = 5.39). Of the 20 MDRE isolates from infants that were sequenced, multilocus sequence typing revealed that 6/20 (30%) were clustered on the same branch as MDRE isolates found in the respective mothers. All sequenced isolates for mothers (47) and infants (20) had at least one ESBL-producing gene. Genes encoding fosfomycin resistance were found in 33/47 (70%) of mothers' isolates and 16/20 (80%) of infants' isolates and genes encoding resistance to colistin were found in one (2%) mother's isolate.
conclusionsOur results suggest that a substantial proportion of infants undergo MDRE intestinal colonization within 6 weeks of birth, potentially due to postnatal rather than intranatal transmission.
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