Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Neonatal Care

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae pose a significant threat to neonates, particularly those in intensive care settings. These bacteria—most commonly Escherichia coli and Klebsiella pneumoniae—are capable of hydrolysing penicillins, cephalosporins and aztreonam, rendering standard therapies ineffective. Colonisation often precedes infection, with gut, skin and environmental reservoirs contributing to transmission. Low birth weight, prematurity and invasive procedures such as central line placement increase vulnerability. In low- and middle-income countries, overcrowding, limited water and sanitation infrastructure and unregulated antibiotic use exacerbate the burden, while in high-income settings, outbreaks in neonatal intensive care units (NICUs) underline lapses in infection control. Molecular surveillance, including whole-genome sequencing, has revealed both clonal spread and diverse strain introductions, emphasising the need for universal screening, cohorting, antimicrobial stewardship and environmental decontamination. Early identification of colonised infants, combined with targeted prophylaxis and rigorous hygiene measures, can reduce sepsis incidence, length of stay and healthcare costs. Global collaboration to harmonise surveillance definitions and share epidemiological data is essential to curb the spread of ESBL-producing Enterobacteriaceae in this vulnerable population.

Research from Nature Portfolio

Recent studies have employed genomic and metagenomic approaches to characterise ESBL and other resistance genes in neonatal and maternal microbiota. One investigation in a West African referral hospital demonstrated that nearly half of neonates under 2 kg acquired multidrug-resistant Gram-negative bacilli, including ESBL-producers, within the first week of life. Whole-genome sequencing revealed heterogeneous strain diversity, minimal mother-to-neonate transmission and the predominance of CTX-M-15 and TEM variants. Another large multicountry analysis examined the rectal microbiota of thousands of mothers and neonates, identifying high carriage rates of blaCTX-M-15, blaNDM and blaOXA-48-like genes in both groups. This work linked specific healthcare factors—such as duration of hospital stay and antibiotic exposure—to gene carriage, and correlated resistance gene presence with adverse neonatal outcomes and sepsis risk, thereby highlighting targets for surveillance and intervention.

Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in Neonatal Care publication trend

The graph below shows the total number of articles in epidemiology of extended-spectrum beta-lactamase-producing enterobacteriaceae in neonatal care across all publications each year (not limited to Nature Index journals).

Technical terms

Extended-spectrum beta-lactamases (ESBL): Enzymes that inactivate a wide range of beta-lactam antibiotics, including third-generation cephalosporins.

Enterobacteriaceae: A family of Gram-negative bacteria, encompassing species such as Escherichia coli and Klebsiella pneumoniae, often implicated in neonatal sepsis.

Colonisation: Presence and multiplication of bacteria on or within a host without causing overt disease symptoms.

Carbapenemases: Beta-lactamase enzymes capable of degrading carbapenem antibiotics, leading to resistance against last-resort agents.

Whole-genome sequencing: Laboratory method for determining the complete DNA sequence of an organism’s genome, used to assess strain relatedness and transmission.

References

1. Acquisition and carriage of genetically diverse multi-drug resistant gram-negative bacilli in hospitalised newborns in The Gambia. Communications Medicine (2023).
2. Antibiotic resistance genes in the gut microbiota of mothers and linked neonates with or without sepsis from low- and middle-income countries. Nature Microbiology (2022).
3. Perinatal colonization with extended-spectrum beta-lactamase-producing and carbapenem-resistant Gram-negative bacteria: a hospital-based cohort study. Antimicrobial Resistance & Infection Control (2024).
4. 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 (2023).
5. Monocentric observational cohort study to investigate the transmission of third-generation cephalosporin-resistant Enterobacterales in a neonatal intensive care unit in Heidelberg, Germany. Microbiology Spectrum (2023).