Antimicrobial resistance patterns in pregnancy and their relationship to early onset Neonatal infection in tertiary level hospitals in Rwanda

Abstract Introduction Bacterial infections during pregnancy pose significant risks to both mothers and newborns, particularly in low-income settings where access to appropriate healthcare may be limited. This study aimed to investigate the prevalence and antimicrobial resistance patterns of bacterial pathogens isolated from pregnant women admitted in tertiary level hospitals in Rwanda. Understanding these patterns is crucial for guiding effective treatment and improving maternal and neonatal outcomes. Objective The main objective of this study was to determine the antimicrobial resistance patterns in pregnancy and their relationship to early onset Neonatal infection in tertiary level hospitals in Rwanda. Materials and methods Observational longitudinal study at Rwandan tertiary hospitals enrolled 271 pregnant women with infection symptoms, collecting clinical data and performing microscopy, culture, and antibiotic susceptibility tests. Neonates were monitored for early infections, with symptomatic cases undergoing hemoculture. Antimicrobial resistance of isolated pathogens was evaluated through standard microbiological methods. Results The study showed a 38.0% positive culture rate among pregnant women, with Candida albicans (53.2%), Escherichia coli (18.4%), and Klebsiella pneumoniae (7.1%) being the most common pathogens. High antibiotic resistance was observed, notably in Klebsiella pneumoniae, resistant to antibiotics like Ceftriaxone, Cefotaxime, Cefixime, Ampicillin but sensitive to Amikacin,Imipenem, and Piperacillin/Tazobactam. Escherichia coli showed resistance to Penicillin G and Ampicillin but remained sensitive to certain cephalosporins and Amikacin. Among sick newborns tested, 15.5% had positive cultures, predominantly Klebsiella pneumoniae (88.9%), displaying high resistance to cephalosporins and penicillins. Notably, 55.6% of these cases matched maternal strains. Conclusion This study reveals high antimicrobial resistance in bacterial pathogens among pregnant women in Rwanda, particularly Gram-negative bacteria, underscoring the need for better antimicrobial stewardship and effective antibiotics. Routine screening, susceptibility testing, education, and early detection are essential to improving maternal and neonatal Health outcomes in low-income settings