Rectovaginal Colonization With Pathogenic Escherichia coli During Pregnancy And Neonatal Outcomes

Figures & data

Figure 1 Patient flow diagram for E. coli screening among pregnant women.

Notes: ^aElective abortion because of severe ventriculomegaly of the fetus. ^bMajor anomaly of two neonates due to (1) right lung aplasia and (2) hypoplastic left heart syndrome.

Table 1 Maternal Characteristics Of The Pregnant Women Included In This Study

Characteristics	Colonization With Pathogenic E. coli (n = 49)	Non-Colonization With Pathogenic E. coli (n = 88)	OR (95% CI)
Age (years)	32.2 (4.0)	32.9 (4.3)	0.96(0.885~1.045)
Educational level
University degree or above	35 (71)	67 (76)	0.78 (0.356~1.727)
College degree or below	14 (29)	21 (24)	1.28 (0.579~2.813)
Use of probiotics^a
No use of probiotics	31 (63)	45 (51)	1.65 (0.805~3.366)
1~27 days	13 (27)	26 (30)	0.86 (0.394~1.883)
>28 days	5 (10)	17 (19)	0.48 (0.163~1.378)
Use of antimicrobials^a
No use of antimicrobials	37 (76)	71 (81)	0.74 (0.319~1.708)
Systemic antimicrobials	5 (10)	6 (7)	1.55 (0.449~5.378)
Vaginal suppository	7 (14)	10 (11)	1.30 (0.461~3.664)
Systemic antimicrobials and vaginal suppository	0 (0)	1 (1)	NA
Pets at home^b
Yes	11 (22)	24 (27)	0.77 (0.340~1.751)
No	38 (78)	64 (73)	1.30 (0.571~2.938)
GBS screening result
Negative	28 (57)	48 (55)	1.11 (0.549~2.247)
Positive	12 (25)	24 (27)	0.87 (0.388~1.930)
No screening before delivery	9 (18)	16 (18)	1.01 (0.410~2.499)
Mode of delivery
Vaginal delivery	28 (57)	50 (57)	1.01 (0.500~2.052)
Cesarean delivery	21 (43)	38 (43)	0.99 (0.487~1.999)

Notes: All data presented as n (%), except age, which is presented as mean (standard deviation). ^aUse of probiotic/antimicrobial was defined as using probiotic/antimicrobial within past 3 months before sampling. ^bPets were defined as dog or cat.

Abbreviations: E. coli, Escherichia coli; OR, odds ratio; CI, confidence interval; GBS, group B Streptococcus; NA, not applicable.

Table 2 Descriptive Analysis Of 137 Neonates With Maternal Colonization Of Pathogenic E. coli At Kaohsiung Veterans General Hospital Between March 2016 And June 2017

Characteristics	Maternal Colonization With Pathogenic E. coli (n = 49)	Maternal Non-Colonization With Pathogenic E. coli (n = 88)	OR (95% CI)
Prematurity	7 (14)	9 (10)	1.46 (0.51~4.21)
Low birth weight	7 (14)	5 (6)	2.77 (0.83~9.24)
Small for gestational age	5 (10)	8 (9)	1.14 (0.35~3.69)
Hospitalization	9 (18)	5 (6)	3.74 (1.18~11.87)
Use of antimicrobials	15 (31)	18 (21)	1.72 (0.77~3.81)
Use of ventilator	6 (12)	3 (3)	3.95 (0.94~16.58)
Clinical symptoms
Neonatal fever	2 (4)	2 (2)	1.83 (0.25~13.41)
Perinatal infection	12(25)	12(14)	2.05 (0.84~5.01)
RDS	3 (6)	0 (0)	NA
Transient tachypnea of newborn	4 (8)	3 (3)	2.52 (0.54~11.75)
MAS	1 (2)	3 (3)	0.59 (0.06~5.83)
Hyperbilirubinemia	17 (35)	14 (16)	2.81 (1.24~6.38)
Respiratory symptoms	11(23)	10 (11)	2.26 (0.88~5.78)
Gastrointestinal symptoms	8(16)	3(3)	5.53 (1.39~21.94)

Note: All data are presented as n (%).

Abbreviations: E. coli, Escherichia coli; OR, odds ratio; CI, confidence interval; RDS, respiratory distress syndrome; MAS, meconium aspiration syndrome; NA, not applicable.

Table 3 Neonatal Morbidities According To Maternal Colonization With Each Pathotype Of E. coli Among 137 Pregnant Women

Characteristics	ExPEC (n = 41)	Non-ExPEC (n = 96)	P	ETEC (n = 17)	Non-ETEC (n = 120)	P	EIEC (n = 10)	Non-EIEC (n = 127)	P (Adjusted P)^a
Neonatal fever	2 (5)	2 (2)	0.58	0 (0)	4 (3)	1.00	0 (0)	4 (3)	1.00
Perinatal infection	11 (27)	13(14)	0.06	5 (29)	19 (16)	0.18	1 (10)	23 (18)	1.00
RDS	3 (7)	0 (0)	0.03	1 (6)	2 (2)	0.33	0 (0)	3 (2)	1.00
Transient tachypnea of newborn	4 (10)	3 (3)	0.20	1 (6)	6 (5)	1.00	1 (10)	6 (5)	0.42
MAS	1 (2)	3 (3)	1.00	0 (0)	4 (3)	1.00	0 (0)	4 (3)	1.00
Hyperbilirubinemia	14 (34)	17 (18)	0.04	4 (24)	27 (23)	1.00	7 (70)	24 (19)	0.001 (aP= 0.024)
Respiratory symptoms	10 (24)	11 (12)	0.05	4 (24)	17 (14)	0.3	2 (20)	19 (15)	0.65
Gastrointestinal symptoms	5 (12)	6 (6)	0.3	4 (24)	7 (6)	0.03	1 (10)	10 (8)	0.58

Notes: All data presented as n (%). ^aBenjamini–Hochberg (BH) adjustment was applied for multiple comparison in the whole table, and there was only one significance after correction. aP= 0.024.

Abbreviations: E. coli, Escherichia coli; ExPEC, extraintestinal pathogenic E. coli; ETEC, enterotoxigenic E. coli; EIEC, enteroinvasive E. coli; RDS, respiratory distress syndrome; MAS, meconium aspiration syndrome.

Table 4 Risk Factors For Hyperbilirubinemia Among 137 Singleton Neonates

Evaluated Risk Factor	Hyperbilirubinemia n = 31	Non-Hyperbilirubinemia n = 106	P, Unadjusted (Adjusted P)^c
Neonate-related
GA < 34 weeks	2 (7)	0(0)	0.05
GA 34–36 weeks	6 (19)	8(8)	0.09
GA > 37 weeks	23 (74)	98(93)	0.01
5-min Apgar score < 6	0 (0)	0(0)	NA
Maternal-related
Age (years)	33.1 (4.1)	32.5 (4.3)	0.54
Vaginal delivery	17 (55)	61 (58)	0.79
Clinical chorioamnionitis	0 (0)	0 (0)	NA
Prolonged ROM > 18 hrs	2 (6)	3 (3)	0.32
E. coli at rectoanal site	19 (61)	37 (35)	0.01
E. coli at vaginal site	5 (16)	13 (12)	0.56
E. coli at rectovaginal site	20 (65)	42 (40)	0.01
Pathogenic E. coli at rectoanal site	16 (52)	25 (24)	0.003 (aP= 0.048)
Pathogenic E. coli at vaginal site	5 (16)	11 (10)	0.36
Pathogenic E. coli at rectovaginal site	17 (55)	32 (30)	0.01
ExPEC at rectovaginal site	14 (45)	27 (26)	0.04
Pathogenic E. coli in first trimester^a	0 (0)	3 (3)	1.00
Pathogenic E. coli in second trimester^a,b	7 (23)	7 (7)	0.02
Pathogenic E. coli in third trimester^b	14 (45)	25 (24)	0.02

Notes: All data are presented as n (%), except age, which is presented as mean (standard deviation). ^aOne case of pathogenic E. coli carrier was collected during the first and second trimesters. ^bSix cases of pathogenic E. coli carriers were collected during the second and third trimesters. ^cBenjamini–Hochberg (BH) adjustment was applied for multiple comparison in the whole table, and there was only one significance after correction. aP= 0.048.

Abbreviations: GA, gestational age; ROM, rupture of membranes; E. coli, Escherichia coli; ExPEC, extraintestinal pathogenic E. coli; NA, not applicable.

Figure 2 Antimicrobial susceptibility rate among pathogenic E. coli and non-pathogenic E. coli groups.

Abbreviations: AMS, ampicillin/sulbactam; PI, piperacillin; PTZ, piperacillin/tazobactam; CZ, cefazolin; CX, cefoxitin; CFM, cefixime; CAZ, ceftazidime; CRO, ceftriaxone; GM, gentamicin; CIP, ciprofloxacin; MINO, minocycline; TMP/SMX, trimethoprim/sulfamethoxazole.