1. Extended-Spectrum-β-Lactamase producing Enterobacteriaceae in neonates and association with maternal urine cultures. Alex Guri 1, Natalie Flaks-Manov 2, Adi Ghilai 2, Moshe Hoshen 2, Ariel Benis 2, Orna Flidel 3, Pnina Ciobotaru 4, Oren Zimhony 4 1.Division of Pediatrics, Kaplan Medical Centre, Rehovot, Israel 2.Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv 3.Neonatology Department, Kaplan Medical Centre, Rehovot, Israel 4.Infectious Diseases Unit, Kaplan Medical Centre, Rehovot, Israel

2. Disclosure Company Name Honoraria/ Expenses Consulting/ Advisory Board Funded Research Royalties/ Patent Stock Options Ownership/ Equity Position Employee Other (please specify) XNo, nothing to disclose Yes, please specify:

3. Background Community acquired Extended Spectrum β-Lactamase producing Enterobacteriaceae (ESBL-PE) pandemics, 1990s-today Enterobacteriaceae (EB) cause early and late onset neonatal sepsis The burden of EB sepsis is especially high in Neonatal Intensive Care Units (NICU) 3

4. 4 Woerther, P. L., (2013). Trends in human fecal carriage of extended-spectrum β- lactamases in the community: toward the globalization of CTX-M. Clinical microbiology reviews, 26(4), 744-758.

5. 5 ESBL-PE carriage in the community according to their geographical and temporal distribution

6. Background Routine urinary cultures are taken during pregnancy Treatment of asymptomatic bacteriuria in pregnancy prevents pyelonephritis and premature labour No data about the significance of these cultures for vertical transmission to neonates 6

7. Objectives Primary - to find out association between the presence of ESBL-PE in gestational urine cultures and ESBL-PE in the corresponding neonates' cultures Secondary - to analyze the effect of ESBL-PE on neonatal morbidity and mortality 7

8. Methods Retrospective cohort study of neonates born during the years 2009-2013 whose mothers had performed urinary cultures within one year prior to delivery Data were obtained from the centralized Clalit Health Services warehouse The cohort included only neonates who had any type of positive EB culture during the first three months after birth 8

9. Results 9 137,580 neonates born in 2009-2013 to mothers who performed urinary culture 31,921 (23.2%) neonates performed any type of culture 2,647 (8,3%) neonates with positive cultures 290 (11.0%) ESBL-PE positive cultures 29,274 neonates with negative cultures (excluded) 105,659 did not perform any culture in the 3 months after delivery (excluded) Flowchart of the Study Population

10. 10

11. Trends for ESBL-PE proportion in the EB positive neonatal cultures (n=2,647) 11 Total rate for 5 years cohort = 11%

12. 12 Primary Objective

13. Neonates length of hospital stay during the 3 months after birth 13 Secondary Objective 1

14. 14 Secondary Objective 2

15. 15 Association between neonatal positive ESBL-PE and 6 months neonatal mortality - univariate analysis

16. Conclusions ESBL-PE in maternal urinary culture during pregnancy is an independent risk for neonatal ESBL-PE Neonatal ESBL-PE are associated with increased hospital stay and mortality Comprehensive infection control policy in NICU should take in consideration the results of maternal urinary cultures 16