Maternal and neonatal rectal carriage of beta-lactamases from low- and middle-income countries: prevalence, risk factors and genomes (part of the BARNARDS study).

BARNARDS was a network of clinical centres aiming to assess the burden of antimicrobial resistance (AMR) in neonates <60 days old from low-middle income countries across Africa and South-Asia. From 36,348 neonates and 35,040 mothers recruited, socio-demographic and clinical data were collected. Gram-Negative bacteria from carbapenemase PCR positive samples were identified by MALDI-TOF MS and we found a high diversity of species carrying the carbapenemase genes (57 distinct species/genera) and exhibited resistance to the majority of antibiotics tested. Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae/E. cloacae complex, the most commonly found species, were characterised by whole-genome sequencing (WGS), Through this characterisation we unveiled close relationships between isolates from different samples suggesting transmission of bacteria between neonates, neonates and mothers, and within the same neonate. Risk factor for carriage of these genes were identified and AMR genes carriage were predictors of neonatal sepsis and adverse birth outcomes.