Bottom line: Maternal ESBL colonization in preterm delivery is uncommon but carries a notable transmission risk and worse neonatal profiles, though current evidence is insufficient to change screening or empiric antibiotic practices.
This prospective cohort study from Thailand (1) found a 6.4% rate of maternal ESBL-E colonization in preterm deliveries, with a 20% vertical transmission rate and one case of neonatal ESBL sepsis. Colonization was associated with earlier gestational age, lower birth weight, and longer hospital stay, though these findings are likely confounded by prematurity rather than a direct causal effect. The small sample size and lack of adjustment for key confounders limit interpretation, making the results hypothesis-generating rather than practice-changing. Similarly, recent data support maternal–infant transmission of resistant Enterobacterales while highlighting that neonatal colonization is influenced by multiple maternal and environmental factors (2).
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