Delineating the risk factors, sources of acquisition and clinical outcomes in neonates colonised with multidrug-resistant bacteria: The NeoCol study

Antimicrobial resistance contributes to neonatal mortality globally. Delineating transmission pathways resulting in neonatal colonisation with multidrug-resistant (MDR) bacteria is necessary to reduce this burden. We conducted a prospective cohort study of 189 mother-infant dyads to delineate the risk factors associated with transmission of MDR bacteria, revealing a high prevalence of maternal colonisation with ESBL-producing bacteria at delivery (55%, 104/189) and in neonates by hospital discharge (61%, 115/189). Compared to non-colonised neonates, those colonised with MDR bacteria were more likely to have been exposed to antibiotics prior to colonisation (63%, vs 24%, p<0.001), require a longer hospital stay (16 days vs 2 days, p<0.001) and have episodes of sepsis following colonisation (62% vs 24%, p<0.001). However, most culture-positive neonatal infections (91%, 10/11) were not caused by previously identified colonising bacteria. Our study reveals poor clinical outcomes associated with MDR neonatal colonisation and suggests improved antibiotic stewardship programs may reduce this burden.