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Original Research
Alarming resistance to third-generation cephalosporins and carbapenems among Enterobacterales colonising pregnant women and neonates in eastern DRC
Submitted: 01 September 2025 | Published: 01 September 2026
About the author(s)
Théophile Mitima Kashosi, Section Techniques de Laboratoire, Institut Supérieur des Techniques Médicales de Bukavu, Bukavu, Democratic Republic of the Congo; and, Department of Microbiology and Virology, Doctoral School of Health Sciences and Technological Innovation, Evangelical University of Cameroon, Bandjoun, Cameroon; and, Department of Experimental Medicine, Laboratory of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Rome Tor Vergata, Rome, ItalyAntonella Minutolo, Department of Experimental Medicine, Laboratory of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
Carlotta Fiorilla, Department of Experimental Medicine, Laboratory of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
Marialaura Fanelli, Department of Experimental Medicine, Laboratory of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
Daniella Ashuza Kagayo, Section Techniques de Laboratoire, Institut Supérieur des Techniques Médicales de Bukavu, Bukavu, Democratic Republic of the Congo
Jean-Baptiste Kajiramugabi, Section Techniques de Laboratoire, Institut Supérieur des Techniques Médicales de Bukavu, Bukavu, Democratic Republic of the Congo
Alfred Cubaka Kabagale, Laboratoire de Microbiologie, Faculté des Sciences, Université Officielle de Bukavu, Bukavu, Democratic Republic of the Congo
Sandro Grelli, Department of Experimental Medicine, Laboratory of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy; and, Virology Unit, Faculty of Medicine and Surgery, Policlinic of Tor Vergata, Rome, Italy
Francesca Pica, Department of Experimental Medicine, Laboratory of Microbiology and Clinical Microbiology, Faculty of Medicine, University of Rome Tor Vergata, Rome, Italy
Vittorio Colizzi, Department of Microbiology and Virology, Doctoral School of Health Sciences and Technological Innovation, Evangelical University of Cameroon, Bandjoun, Cameroon; and, Faculty of Medicine, Teaching Hospital ‘Good Samaritan’, N’Djamena, Chad
Abstract
Background: Extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) and carbapenem-resistant Enterobacteriaceae (CRE) pose a growing threat to maternal and neonatal health, particularly in low-resource settings. In eastern Democratic Republic of the Congo (DRC), data on antimicrobial resistance in these populations are scarce.
Objective: To determine resistance profiles of ESCR-E and CRE among pregnant women, postpartum mothers, and their newborns in South Kivu, eastern DRC.
Methods: A cross-sectional multicentre study was conducted from April 2023 to October 2024 in urban and rural health facilities. Rectal swabs or stool samples were collected. Bacterial identification was performed using conventional biochemical galleries, and antimicrobial susceptibility testing was performed by the standard disk diffusion (Kirby–Bauer) method.
Results: High rates of ESCR-E and CRE colonisation were found across all groups. Over 90% of ESCR-E isolates were resistant to third-generation cephalosporins and showed multidrug resistance, including to aminoglycosides and fluoroquinolones. Carbapenem-resistant Enterobacteriaceae isolates were resistant to penicillin and cephalosporins but remained susceptible to ceftazidime–tazobactam. These resistance profiles severely limit treatment options in maternal and neonatal care.
Conclusion: The high prevalence of multidrug-resistant ESCR-E and CRE in mothers and newborns highlights an urgent need for improved antimicrobial stewardship, resistance surveillance, and infection prevention strategies. The potential use of probiotics to restore gut microbiota and reduce colonisation should also be explored.
What this study adds: This study provides the first comprehensive data on ESCR-E and CRE colonisation in mothers and newborns in eastern DRC, revealing alarming multidrug resistance patterns and highlighting the urgent need for targeted stewardship, surveillance, and Infection Prevention and Control strategies in maternal and neonatal care settings.
Keywords
Sustainable Development Goal
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