Antibiotic Susceptibility and Risk Factors for Listeriosis in Women with Spontaneous Abortion in Ugandan Tertiary Hospitals: A cross-sectional study

doi:10.21203/rs.3.rs-4701410/v1

Download PDF

Research Article

Antibiotic Susceptibility and Risk Factors for Listeriosis in Women with Spontaneous Abortion in Ugandan Tertiary Hospitals: A cross-sectional study

https://doi.org/10.21203/rs.3.rs-4701410/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Background

Listeriosis, caused by Listeria monocytogenes, poses significant health risks globally, particularly among pregnant women. Despite its established impact in other regions, its prevalence and antibiotic susceptibility patterns in Uganda, especially among women experiencing spontaneous abortion, remain understudied.

Objective

This cross-sectional study aimed to determine the prevalence, antibiotic susceptibility, and associated risk factors of listeriosis among women admitted with spontaneous abortion in Ugandan tertiary hospitals.

Methods

A total of 384 women from Jinja and Kayunga Regional Referral Hospitals were included. Data on socio-demographic characteristics, obstetric history, and dietary habits were collected using structured interviews and high vaginal swab cultures. Antibiotic susceptibility testing was performed, and logistic regression analysis was used to assess risk factors.

Results

The prevalence of listeriosis among participants was 11.2%. L. monocytogenes showed high susceptibility to Vancomycin (88.37%) and Clindamycin (81.40%), but significant resistance to Ampicillin (81.40%) and Amoxicillin (76.74%). Risk factors significantly associated with listeriosis included lack of formal education (adjusted odds ratio [aOR] = 7.0, 95% CI: 1.779–27.655), multiple abortions (aOR = 3.3, 95% CI: 1.486–7.427), and consumption of soft cheese, ice cream, yogurt, or ghee (aOR = 4.3, 95% CI: 1.331–14.082).

Conclusion

This study provides critical insights into the prevalence, antibiotic resistance patterns, and risk factors for listeriosis among Ugandan women with spontaneous abortion. Findings underscore the need for targeted public health interventions and antibiotic stewardship to mitigate the impact of this infection.

Listeriosis

Listeria monocytogenes

antibiotic susceptibility

risk factors

spontaneous abortion

Uganda

Listeriosis is an infection caused by Listeria monocytogenes, a Gram-positive, facultative anaerobic bacterium capable of thriving in both intracellular and extracellular environments. This pathogen is primarily transmitted to humans through the consumption of contaminated food, including soft cheeses, dairy products, ready-to-eat meats, smoked fish, and raw vegetables. Notably, L. monocytogenes can survive and even grow under refrigeration, making it a significant concern in food safety (1–3).

Despite being rarely diagnosed, listeriosis is an extremely deadly infection that can have devastating effects on both the mother and the fetus in pregnant women worldwide. Pregnant women are 20 times more likely to contract listeriosis than the general population (4). The condition is associated with high hospitalization rates and fatality rates of up to 20–50% (5). It significantly contributes to poor obstetric outcomes and is linked to 20% of spontaneous abortions or stillbirths globally (6). In Africa, the disease has primarily affected animals rather than people. Although listeriosis infection in pregnant women typically presents with nonspecific symptoms or is asymptomatic, it remains a significant factor in various pregnancy complications, including abortion, premature delivery, and fetal mortality. Notably, 20% of listeriosis-related pregnancies result in spontaneous abortion or stillbirth (6).

In Uganda, the majority of individuals with spontaneous abortion are treated and discharged without specific investigations to determine the cause. This highlights the importance of identifying the etiologies behind spontaneous abortions, including listeriosis. Given that 20% of listeriosis-related pregnancies result in spontaneous abortion or stillbirth (6), understanding the prevalence and impact of listeriosis at this institution could inspire further investigation. Identifying contributing factors and establishing appropriate antibiotics for isolated Listeria monocytogenes will guide future prevention initiatives and treatment protocols for listeriosis infection in JRRH's antenatal care.

The significance of this study lies in addressing the substantial gaps in knowledge regarding listeriosis in Uganda, particularly its impact on pregnant women experiencing spontaneous abortion. While listeriosis is well-documented in regions such as Europe and North America, with established public health measures to control its spread, data from African countries, including Uganda, remain sparse (7). This study aims to fill this critical gap by determining the prevalence, antibiotic susceptibility patterns, and associated risk factors of listeriosis among women admitted to Ugandan tertiary hospitals with spontaneous abortion.

Globally, listeriosis is a notable zoonotic disease with significant public health implications. In Europe, the prevalence ranges from 0.1 to 11.3 cases per million people, with pregnant women being 13 to 20 times more likely to contract the infection compared to the general population (8). The disease's burden is even more pronounced in Africa, where limited healthcare infrastructure and rising antibiotic resistance exacerbate the impact. Studies in sub-Saharan Africa report a pooled prevalence of listeriosis at 20.1% among pregnant women, significantly contributing to abortion-related cases (9). In Ethiopia, the prevalence of Listeria monocytogenes in various sources, including meat and dairy products, highlights the widespread risk of infection (10).

In Uganda, the prevalence and impact of listeriosis among pregnant women remain largely undocumented. The identification of Listeria monocytogenes in Ugandan soils and foods suggests a potential public health threat, especially for vulnerable populations such as pregnant women (11). Despite this, there is a significant knowledge gap regarding the burden of listeriosis and its antibiotic susceptibility patterns in the region. Addressing this gap is crucial for developing targeted interventions and treatment protocols to mitigate the impact of this infection (12).

This study is imperative as it provides foundational data on the prevalence of listeriosis, identifies antibiotic resistance patterns, and elucidates the socio-demographic, obstetrical, medical, and environmental risk factors associated with the infection (13). These findings will inform public health strategies and clinical practices, ultimately aiming to reduce the incidence of listeriosis-related complications among pregnant women in Uganda (14). Identifying the contributing factors to this infection will guide future prevention initiatives and the establishment of appropriate antibiotics for the isolated Listeria monocytogenes, enhancing treatment protocols for listeriosis at JRRH.

2.1 Study design: A cross-sectional study.

2.2 Study site: This study was conducted at Jinja and Kayunga Regional Referral Hospitals in Uganda, which serve as major healthcare facilities for multiple districts in the eastern and central regions of the country. These hospitals report high rates of spontaneous abortions, making them critical sites for investigating the prevalence and factors associated with listeriosis among pregnant women.

2.3 Sample size calculation: The sample size for this study was determined using the formula proposed by Kish Leslie in 1965. This formula, represented as \(\:n=\frac{{Z}^{2}PQ}{{D}^{2}}\), where \(\:n\) is the desired sample size, \(\:Z\) is the standard normal deviation at the 95% confidence level (here, \(\:Z\) = 1.96), \(\:P\:\)the estimated proportion of the target population with Listeriosis (assumed as 0.5 due to lack of known prevalence). \(\:Q\:\)is the proportion of the population without Listeriosis \(\:Q\) = \(\:1-P\), and \(\:D\) denotes the desired level of accuracy, set at 5%.

Substituting the given values into the formula yields\(\:\:n\:=\frac{{1.96}^{2}\:\text{X}0.5\text{X}0.5}{0.05\text{X}0.05}=\:384\), resulting in a calculated sample size of 384 participants.

2.4 Inclusion and exclusion criteria

2.4.1 Inclusion criteria: Women admitted to the gynecology wards of Jinja and Kayunga Regional Referral Hospitals with confirmed diagnoses of spontaneous abortion, verified by Obstetric/Gynecologic Ultrasound Scan. Participants were required to provide written informed consent, be aged 18 years and above, and be admitted during the study period.

2.4.2 Exclusion criteria: Women who were on antibiotics for at least 72 hours prior to admission.

2.5 Study procedure: The data collection for the study was carried out by the principal investigator (PI) and trained research assistants, who approached women admitted to the gynecology ward of Jinja and Kayunga Regional Referral Hospitals with spontaneous abortion during the study period to determine eligibility. Before starting the interviews, the nature of the study was explained to each eligible participant, and written informed consent was obtained. Participants were assured of the confidentiality, privacy, and anonymity of their information using an approved Informed Consent form from Bishop Stuart University Research and Ethics Committee (REC). The community engagement plans involved educating, counseling, and sensitizing community members, hospital administration, research assistants, and laboratory technologists about the study's needs, benefits, and outcomes. Village Health Teams in the catchment population were sensitized prior to the commencement of data collection and on a daily basis. Study outcomes were communicated directly to individual participants while maintaining their privacy and confidentiality.

2.6 Data collection procedure:

A structured, pre-tested interviewer-administered questionnaire was used to gather information on socio-demographic, obstetrical, medical, and environmental factors associated with listeriosis among the participants. The questionnaire was pre-tested at the hospitals by randomly selecting 10% of the sample size to ensure its reliability and validity, resulting in necessary adjustments before the final data collection. Reliability of the data collection tool was confirmed with a Cronbach’s coefficient alpha test score of 88%, and the validity was ensured through precise and consistent instrumentation.

For sample collection, high vaginal swabs were taken from each consenting participant for culture and determining antibiotic susceptibility patterns of listeriosis infection. Participants were asked to lie comfortably in a lithotomy position, and aseptic techniques were strictly observed during the procedure. The collected samples were then analyzed by trained and licensed medical microbiologists at Jinja Regional Referral Hospital.

2.7 Study variables: The primary focus of this study is the dependent variable, Listeriosis infection, which was assessed among women experiencing spontaneous abortion diagnosed through culture and sensitivity testing for antibiotic susceptibility.

Several independent variables are considered in this study to explore their associations with Listeriosis infection. These variables include maternal age (< 25, 25–34, ≥ 35), education level (No Formal education, Primary, Secondary, Tertiary), gestational age (weeks) (< 12, ≥ 12), number of abortions (< 2, ≥ 2), HIV status, presence of diabetes, consumption of soft cheeses, ice cream, yoghurt, consumption of half-cooked or smoked meat, consumption of smoked seafood (fish), consumption of unboiled or half-boiled milk, consumption of ready-to-eat raw vegetables or half-cooked vegetables (cabbages, tomatoes), and history of contact with domestic animals (cats, dogs, pigeons, cattle, pigs).

2.8 Data quality control: The inclusion and exclusion criteria were strictly adhered to. Prior to data collection, thorough checks were conducted on all questionnaires to ensure completeness and validity of the data obtained. Research assistants received extensive training and continuous supervision from the principal investigator to ensure precise utilization of data collection instruments and adherence to ethical guidelines. Endocervical swab (high vaginal swab) samples were collected using sterile high vaginal swab collecting kits and transported to the laboratory following standardized procedures. Each sample was meticulously labeled with the participants' numerical codes to facilitate easy identification. Daily reviews of all stored data copies were conducted to detect any inconsistencies, which were promptly addressed. Laboratory analysis of the samples adhered strictly to established standards, with regular checks on the validity of the collecting kits, including verification of expiry dates. To further validate the accuracy of the results, 10% of the samples were independently tested at an accredited laboratory at Masaka Regional Referral Hospital, yielding consistent findings.

2.9 Data analysis: Data analysis for this study was performed using STATA software version 14.2, structured to address three primary objectives.

Objective One: Prevalence of Listeriosis

To determine the prevalence of Listeriosis among women with spontaneous abortion, the number of women who tested positive for the infection was divided by the total number of women tested. The results were then visually represented using a pie chart, illustrating the proportion of Listeriosis cases within the study population.

Objective Two: Antibiotic Susceptibility Patterns

The second objective involved describing the antibiotic susceptibility patterns of Listeria monocytogenes. This was accomplished through the use of descriptive statistics and frequency tables. These methods provided a detailed account of the effectiveness of various antibiotics against the infection, highlighting the most and least effective treatments and offering insights into resistance patterns.

Objective Three: Risk Factors for Listeriosis

The third objective focused on analyzing the risk factors associated with Listeriosis using binary logistic regression at both bivariate and multivariate levels, maintaining a 95% confidence level. Initially, unadjusted odds ratios with their corresponding 95% confidence intervals and p-values were reported. Factors with a p-value ≤ 0.2 were included in the multivariate analysis to control for potential confounders. The final multivariate analysis reported adjusted odds ratios, 95% confidence intervals, and p-values, with a variable considered statistically significant if it had a p-value ≤ 0.05. The results for this objective were presented in tabular form, providing a comprehensive view of the factors significantly associated with Listeriosis in the study population.

2.10 Ethical considerations: Ethical approval for the study was obtained from the Research and Ethics Committee of Bishop Stuart University (BSU-REC-2023-119) and registered with the Uganda National Council for Science and Technology. Privacy and confidentiality were ensured by individually assessing participants, anonymizing questionnaires with number codes, and securely storing data. Written informed consent was obtained after thoroughly explaining the study details to participants, with signatures or fingerprints collected.

3.1 Data collection flow chart: In Fig. 1 below, the flow of data collection is illustrated.

Figure 1 Data collection flow chart.

3.2 Descriptive characteristics of study participants

Table 1

Socio-demographic, obstetric and Environmental characteristics of the study participants (N = 384).
Variable	Category	Frequency(n)	Percentage (%)
Socio-demographic characteristics
Age	< 25	142	36.98
Age	25–34	130	33.85
	≥ 35	112	29.17
Level of education	No Formal education	38	9.90
	Primary	48	12.50
	Secondary	198	51.56
	Tertiary	100	26.04
Gestation age (weeks)	< 12	146	38.02
	≥ 12	238	61.98
Number of abortions	< 2	279	72.66
	≥ 2	105	27.34
HIV status	Yes	32	8.33
	No	352	91.67
Diabetes	Yes	36	9.38
	No	348	90.62
Consumption of Soft Cheese, Ice cream, Yoghurt	Yes	254	66.15
	No	130	33.85
Consumption of Half Cooked/Smoked meat	Yes	245	63.80
	No	139	36.20
Consumption of smoked sea food (Fish)	Yes	234	60.94
	No	150	39.06
Consumption of unboiled/half boiled milk	Yes	235	61.20
	No	149	38.80
Consumption of ready to eat raw vegetables/half cooked (cabbages, Tomatoes,)	Yes	238	61.98
	No	146	38.02
History of contact with domestic animals (Cats, Dogs, Pigeons,Cattle, Pigs)	Yes	236	61.46
	No	148	38.54

The study participants exhibited diverse socio-demographic characteristics. The majority were under 25 years old (36.98%) or between 25–34 years old (33.85%). Over half had secondary education (51.56%), with fewer having tertiary (26.04%), primary (12.50%), or no formal education (9.90%). Most participants were in gestation week ≥ 12 (61.98%) and had fewer than two abortions (72.66%). Almost all participants were HIV-negative (91.67%) and non-diabetic (90.62%). Dietary habits showed that the majority consumed soft cheese, ice cream, and yogurt (66.15%), half-cooked or smoked meat (63.80%), smoked seafood (60.94%), unboiled or half-boiled milk (61.20%), and ready-to-eat raw or half-cooked vegetables (61.98%). Additionally, a significant portion had contact with domestic animals (61.46%) (Table 1).

3.3 Prevalence of Listeriosis among women with spontaneous abortion.

Out of 384 pregnant women tested, 43 were positive for Listeriosis, resulting in an overall prevalence of 11.2% (Fig. 2).

Figure 2: Pie-chart showing the prevalence of Listeriosis among women with spontaneous abortion admitted at JRRH and KRRH.

3.4 Identification of antibiotics susceptibility patterns of listeriosis among women with spontaneous abortion admitted at Jinja and Kayunga Regional Referral Hospitals.

Table 2

Susceptibility patterns characteristics of the of antibiotics (N = 384).
Variable	Category	Frequency(n)	Percentage (%)
Vancomycin	Susceptible	38	88.37
	Resistance	5	11.63
Clindamycin	Susceptible	35	81.40
	Resistance	8	18.60
Gentamycin	Susceptible	27	62.79
Gentamycin	Resistance	16	37.21
Ceftriaxone	Susceptible	20	46.51
Ceftriaxone	Resistance	23	53.49
Coamoxiclav	Susceptible	16	37.21
Coamoxiclav	Resistance	27	62.79
Amoxicillin	Susceptible	10	23.26
	Resistance	33	76.74
Ampicillin	Susceptible	8	18.60
Ampicillin	Resistance	35	81.40

The study assessed the antibiotic susceptibility patterns of Listeria monocytogenes. The majority of isolates were susceptible to Vancomycin (88.37%) and Clindamycin (81.40%), while a notable proportion were susceptible to Gentamycin (62.79%). However, susceptibility to Ceftriaxone (46.51%) and Coamoxiclav (37.21%) was less frequent. Alarmingly, the majority of isolates were resistant to Amoxicillin (76.74%) and Ampicillin (81.40%), highlighting significant resistance issues for these commonly used antibiotics (Table 2).

3.5 Description of factors associated with Listeriosis among women with spontaneous abortion

Table 3

Analysis of factors associated with listeriosis among women with spontaneous abortion admitted at Jinja and Kayunga Regional Referral Hospitals (N = 384)
Variable	Category	Test results from Culture		cOR (95%CI)	P	aOR (95%CI)	P
Variable	Category	Negative (%) (n = 341)	Positive (%) (n = 43)	cOR (95%CI)	P	aOR (95%CI)	P
Age	< 25	125(88.03)	17(11.97)	1.00
	25–34	119(91.54)	11(8.46)	0.7(0.306–1.511)	0.343
	≥ 35	97(86.61)	15(13.39)	1.1(0.541–2.391)	0.735
Level of education	Tertiary	33(89.19)	4(10.81)	1.00		1.00
	No Formal education	53(74.65)	18(45.35)	2.8(0.872–9.004)	0.084	7.0(1.779–27.655)	0.005**
	Primary	146(91.82)	13(8.18)	0.7(0.225–2.397)	0.609	1.1(0.302–4.158)	0.865
	Secondary	109(93.16)	8(684)	0.6(0.171–2.139)	0.436	0.9(0.218–3.613)	0.634
Gestation age	< 13 WOA	139(95.21)	7(4.79)	1.00		1.00
Gestation age	≥ 13 WOA	202(84.87)	36(15.13)	3.5(1.531–8.181)	0.003*	1.4(0.485–3.876)	0.551
Number of abortions	< 2	256(91.76)	23(8.24)	1.00		1.00
Number of abortions	≥ 2	85(80.95)	20(19.05)	2.6(1.371–5.004)	0.004*	3.3(1.486–7.427)	0.003**
HIV status	No	318(90.34)	34(9.66)	1.00		1.00
HIV status	Yes	23(71.88)	9(28.13)	3.7(1.568–8.545)	0.003*	4.1(1.446–11.633)	0.008**
Diabetes	Yes	30(83.33)	6(16.67)	1.00
Diabetes	No	311(89.37)	37(10.63)	0.6(0.232–1.524)	0.279
Consumption of Soft Cheese, Ice cream, Yoghurt, Ghee	No	125(96.15)	5(3.85)	1.00		1.00
Consumption of Soft Cheese, Ice cream, Yoghurt, Ghee	Yes	216(85.04)	38(14.96)	4.4(1.687–11.464)	0.002*	4.3(1.331–14.082)	0.015**
Consumption of Half Cooked/Smoked meat	No	128(92.09)	11(7.91)	1.00		1.00
Consumption of Half Cooked/Smoked meat	Yes	213(86.94)	32(13.06)	1.7(0.852–3.589)	0.128	0.8(0.342–2.087)	0.715
Consumption of smoked sea food (Fish)	No	144(96.00)	6(4.00)	1.00		1.00
Consumption of smoked sea food (Fish)	Yes	197(84.19)	37(15.81)	4.5(1.853–10.965)	0.001*	4.2(1.531–11.366)	0.005**
Consumption of unboiled/half boiled milk	No	144(96.64)	5(3.36)	1.00		1.00
Consumption of unboiled/half boiled milk	Yes	197(83.83)	38(16.17)	5.6(2.134–14.463)	0.001*	4.4(1.402–13.789)	0.011**
Consumption of ready to eat raw vegetables/half cooked (cabbages, Tomatoes, Onions, Nakati,)	No	141(96.58)	5(3.42)	1.00		1.00
	Yes	200(84.03)	38(15.97)	5.4(2.058–13.951)	0.001*	3.1(1.065–8.903)	0.038**
History of contact with domestic animals (Cats, Dogs, Pigeons,Cattle, Pigs)	No	140(94.59)	8(5.41)	1.00		1.00
	Yes	201(85.17)	35(14.83)	3.0(1.372–6.767)	0.006*	1.9(0.691–5.079)	0.217

cOR: Crude Odds Ratio, CI: Confidence Interval, P*: represents p values ≤ 0.2 before aOR P**: ≤0.05 aOR: adjusted Odds Ratio.

Participants with no formal education were significantly more likely to contract Listeriosis compared to those with tertiary education, with an adjusted odds ratio (aOR) of 7.0 (95% CI: 1.779–27.655). Women who had experienced two or more abortions had a 3.3 times higher likelihood of Listeriosis (aOR = 3.3, 95% CI: 1.486–7.427) compared to those with fewer abortions. Consumption of soft cheese, ice cream, yogurt, or ghee was associated with 4.3 times increased odds of Listeriosis (aOR = 4.3, 95% CI: 1.331–14.082). Similarly, consumption of smoked seafood (aOR = 4.2, 95% CI: 1.531–11.366), unboiled or half-boiled milk (aOR = 4.4, 95% CI: 1.402–13.789), and ready-to-eat raw vegetables (aOR = 3.1, 95% CI: 1.065–8.903) significantly elevated the risk of contracting Listeriosis (Table 3).

4.1 Prevalence of Listeriosis among women with spontaneous abortion.

In this study, the prevalence of Listeriosis among women experiencing spontaneous abortion was 11.2%. This finding closely aligns with studies conducted in Italy (11.7% by Pesavento et al., 2010) (15), Iraq (13.82% by Al-dorri, 2018) (16), and Egypt (14.4% by Aziz & Mohamed, 2020) (17). However, our study's overall prevalence was lower than that reported in other studies, such as 20.83% in Iran (18), 31.1% in Iraq (19), 33.5% (20), 39.53% (21), 20.1% in Sub-Saharan Africa (Dufailu et al., 2021), and 28.44% in Ethiopia (22). Conversely, our study found a higher prevalence compared to studies in Iran (5.5% by Heidarzadehs and colleagues (23) and 3.66% by Ahmadi and colleagues (24)), 2.7% (25) in another meta-analysis study in Africa (5.17% by Geteneh and colleagues (26)), and 5.4% in Ethiopia (27). The variations in prevalence could be attributed to differences in study methodologies, including the use of high vaginal swabs for culture and sensitivity in our study versus ELISA and PCR methods used in other studies with higher prevalence. Additionally, differences in sample sizes and study durations may have contributed to these discrepancies. Geographic location and lifestyle factors could also have influenced the varying prevalence rates observed across different studies

4.2 Susceptibility patterns of Listeria infection among women with spontaneous abortion.

Among women with spontaneous abortion admitted at JRRH and KRRH, susceptibility patterns of Listeria infection revealed that most isolates were susceptible to Vancomycin (88.37%) and Clindamycin (81.40%). This aligns with findings from a study in Ethiopia, where high resistance rates of 66.7% for clindamycin, amoxicillin, and vancomycin were reported (6).

In contrast, Listeria infection in our study showed resistance primarily to Ampicillin (81.40%), Amoxicillin (76.74%), and Ceftriaxone (53.49%), consistent with the resistance patterns observed in other studies such as that by Ishola and colleagues (28), which noted widespread resistance to these antibiotics. Studies from Iraq indicated that all strains were susceptible to meropenem, with varying susceptibility rates to cotrimoxazole (92.3%), ampicillin (84.6%), erythromycin (84.6%), and penicillin (69.2%) (19) suggesting regional differences in resistance profiles.

Furthermore, our study found that 46.51% of isolates were resistant to more than three drugs, comparable to findings by Gebremedhin and colleagues (22) in Ethiopia, where 100% of Listeria monocytogenes isolates showed resistance to two or more drugs, and 95% were multidrug-resistant. This highlights the challenge of multidrug resistance in treating Listeria infections, exacerbated by the misuse and over-the-counter availability of antibiotics.

4.3 Factors associated with Listeriosis among women with spontaneous abortion admitted at JRRH and KRRH.

It was found that the education level was significantly linked with listeriosis in this study, as also noted in a study conducted in a group of 144 women in the teaching and referral hospitals in Ethiopia, with a positive association between the level of education and listeriosis (24). Educated individuals often exhibit better food hygiene practices compared to their less educated counterparts. HIV status was also significantly associated with listeriosis, consistent with findings from research conducted among pregnant women with listeriosis in Johannesburg, South Africa, where HIV positivity correlated with increased susceptibility to listeriosis, especially among immunocompromised patients (29, 30). Consumption of soft cheeses, ice cream, yogurt, and ghee showed a significant association with listeriosis, aligning with previous studies by Pesavento et al. (15) and Goebel et al. (31), highlighting these dairy products as potential sources of Listeria contamination. Similarly, consumption of smoked seafood (fish) and unboiled/half-boiled milk were significantly associated with listeriosis, corroborating findings by Zahedi Bialvaei et al. (29) and Lemma et al. (27). Consumption of ready-to-eat raw vegetables/half-cooked vegetables also remained significantly associated with listeriosis, consistent with studies by Lemma et al. (27) and Zahedi Bialvaei et al. (29). These findings underscore the risks associated with these food items in the transmission of Listeria infections, particularly in settings where hygiene practices may be inadequate.

Prevalence of Listeriosis

The study found a high prevalence of Listeriosis (11.2%) among women with spontaneous abortion, highlighting significant regional disparities and methodological influences on reported prevalence rates.

Susceptibility Patterns

High susceptibility to Vancomycin and Clindamycin contrasts with significant resistance to Ampicillin, Amoxicillin, and Ceftriaxone, emphasizing the need for tailored antibiotic treatment strategies in Listeria infections.

Factors Associated with Listeriosis

Education level, HIV status, and dietary habits were identified as significant factors influencing Listeriosis risk, emphasizing the importance of education and targeted interventions to mitigate infection risks effectively.

Abbreviation	Meaning
JRRH	Jinja Regional Referral Hospital
KRRH	Kayunga Regional Referral Hospital
CDC	Centers for Disease Control and Prevention
FDA	Food and Drug Administration
WHO	World Health Organization
REC	Research and Ethics Committee
HIV	Human Immunodeficiency Virus
cOR	Crude Odds Ratio
aOR	Adjusted Odds Ratio
CI	Confidence Interval

6. Study limitations: This study explored associations rather than causation.

7. Study Strength: Conducted across two tertiary hospitals, this study provides a broadly representative insight into associated factors across Uganda.

8. Further area of study: Investigate the genetic diversity and antimicrobial resistance mechanisms of Listeria monocytogenes strains isolated from women with spontaneous abortion in Uganda. This research could provide insights into strain virulence and resistance profiles, informing targeted treatment strategies and public health interventions.

9. Recommendations:

i. Public Health Authorities: Initiate systematic screening protocols for Listeriosis among women with recurrent spontaneous abortions to enhance early detection and management.

ii. Healthcare Providers: Advocate for routine culture and sensitivity testing to tailor antibiotic treatment for women presenting with suspected Listeriosis, ensuring effective management and reducing antibiotic resistance.

iii. Community Health Education: Launch comprehensive awareness campaigns to educate the public about Listeriosis risk factors and prevention strategies. Focus on educating food handlers to improve food safety practices and minimize Listeria contamination.

10.1 Consent for publications: Not applicable to this study.

10.2 Availability of data and material: The datasets utilized in this study can be obtained from the corresponding author upon request. Please contact Emmanuel Ssentongo via email at [email protected]

10.3 Conflict of interest: There are no conflicts of interest related to this study.

10.4 Funding: This study did not receive any grants or funding.

10.5 Author contributions: ES served as the principal investigator, contributing to the study design, data collection, analysis, and initial manuscript drafting. MK, RM, JCK, RB, MK and SB contributed to the discussion and interpretation of study findings. RSE, and EO supervised the study.

10.6 Acknowledgment: We extend our gratitude to all the patients who participated in this study.

CDC. Listeria (Listeriosis) [Internet]. 2023 [cited 2024 Jul 7]. https://www.cdc.gov/listeria/index.html.
FDA. Listeria (Listeriosis) [Internet]. 2024 [cited 2024 Jul 7]. https://www.fda.gov/food/foodborne-pathogens/listeria-listeriosis.
Koopmans MM, Brouwer MC, Vázquez-Boland JA, van de Beek D. Human Listeriosis. Clin Microbiol Rev [Internet]. 2023;36(1). https://journals.asm.org/doi/10.1128/cmr.00060-19.
Chukwu EE, Nwaokorie FO. Listeriosis Knowledge and Attitude among Pregnant Women Attending a Tertiary Health Institution, South Western Nigeria. Adv Infect Dis [Internet]. 2020;10(02):64–75. https://www.scirp.org/journal/doi.aspx?doi=10.4236/aid.2020.102006.
Wang Z, Tao X, Liu S, Zhao Y, Yang X. An Update Review on Listeria Infection in Pregnancy. Infect Drug Resist [Internet]. 2021;14:1967–78. http://www.ncbi.nlm.nih.gov/pubmed/34079306.
Welekidan LN, Bahta YW, Teklehaimanot MG, Abay GK, Wasihun AG, Dejene TA, et al. Prevalence and drug resistance pattern of Listeria monocytogenes among pregnant women in Tigray region, Northern Ethiopia: A cross-sectional study. BMC Res Notes. 2019;12(1):1–6.
Lungu B, O’Bryan CA, Muthaiyan A, Milillo SR, Johnson MG, Crandall PG et al. Listeria monocytogenes: Antibiotic Resistance in Food Production. Foodborne Pathog Dis [Internet]. 2011;8(5):569–78. http://www.liebertpub.com/doi/10.1089/fpd.2010.0718.
WHO. World Health Organization. 2018 [cited 2024 Jul 7]. Listeriosis. https://www.who.int/news-room/fact-sheets/detail/listeriosis.
Dufailu OA, Yaqub MO, Owusu-Kwarteng J, Addy F. Prevalence and characteristics of Listeria species from selected African countries. Trop Dis Travel Med Vaccines [Internet]. 2021;7(1):26. https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-021-00151-5.
Gebretsadik S, Kassa T, Alemayehu H, Huruy K, Kebede N. Isolation and characterization of Listeria monocytogenes and other Listeria species in foods of animal origin in Addis Ababa, Ethiopia. J Infect Public Health [Internet]. 2011;4(1):22–9. https://linkinghub.elsevier.com/retrieve/pii/S1876034110000808.
Vivant AL, Garmyn D, Piveteau P. Listeria monocytogenes, a down-to-earth pathogen. Front Cell Infect Microbiol [Internet]. 2013;3. http://journal.frontiersin.org/article/10.3389/fcimb.2013.00087/abstract.
Radoshevich L, Cossart P. Listeria monocytogenes: towards a complete picture of its physiology and pathogenesis. Nat Rev Microbiol [Internet]. 2018;16(1):32–46. https://www.nature.com/articles/nrmicro.2017.126.
Montero D, Bodero M, Riveros G, Lapierre L, Gaggero A, Vidal RM et al. Molecular epidemiology and genetic diversity of Listeria monocytogenes isolates from a wide variety of ready-to-eat foods and their relationship to clinical strains from listeriosis outbreaks in Chile. Front Microbiol [Internet]. 2015;6. http://journal.frontiersin.org/article/10.3389/fmicb.2015.00384/abstract.
Schlech WF. Epidemiology and Clinical Manifestations of Listeria monocytogenes Infection. Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA, Braunstein M, Rood JI, editors. Microbiol Spectr [Internet]. 2019;7(3). https://journals.asm.org/doi/10.1128/microbiolspec.GPP3-0014-2018.
Pesavento G, Ducci B, Nieri D, Comodo N, Lo Nostro A. Prevalence and antibiotic susceptibility of Listeria spp. isolated from raw meat and retail foods. Food Control. 2010;21(5):708–13.
Al-dorri AZR. Study of bacteria Listeria monocytogenes in spontaneous aborted women in Salah Al-deen province. Tikrit J Pure Sci. 2018;21(3):12–7.
Aziz SAAA, Mohamed MBED. Prevalence, virulence genes, and antimicrobial resistance profile of Listeria monocytogenes isolated from retail poultry shops in Beni-Suef city, Egypt. J Adv Vet Anim Res. 2020;7(4):710–7.
Ohadi E, Goudarzi H, Kalani BS, Taherpour A, Shivaee A, Eslami G. Serotyping of Listeria monocytogenes Isolates from Women with Spontaneous Abortion Using Polymerase Chain Reaction Method. J Med Bacteriol. 2019;8(3/4):8–17.
Abd Al-Mayahi FS, Jaber SM. Multiple drug resistance of Listeria monocytogenes isolated from aborted women by using serological and molecular techniques in Diwaniyah city/Iraq. Iran J Microbiol. 2020;12(4):305–12.
Hiba HH, Ghaima KK, Qader DS. Isolation and Characterization of Listeria Monocytogenes From Some Iraqi Miscarriage Women. Iraqi J Agric Sci. 2024;55(1):322–8.
Mohamed AH, Yaseen SS, Azeez AA, Abass KS. The annual incidence of Listeria monocytogenes infection among pregnant women with abortion and premature birth effects in Kirkuk city, Iraq. Rev Latinoam Hipertens. 2022;17(1).
Gebremedhin EZ, Hirpa G, Borana BM, Sarba EJ, Marami LM, Tadese ND et al. Detection of Listeria species, factors associated, and antibiogram of Listeria monocytogenes in beef at abattoirs, butchers, and restaurants of Ambo and Holeta Towns. Ethiopia ResearchSquare. 2020.
Heidarzadeh S, Dallal MMS, Pourmand MR, Pirjani R, Foroushani AR, Noori M, et al. Prevalence, antimicrobial susceptibility, serotyping and virulence genes screening of Listeria monocytogenes strains at a tertiary care hospital in Tehran, Iran. Iran J Microbiol. 2018;10(5):307–13.
Ahmadi A, Ramazanzadeh R, Derakhshan S, Khodabandehloo M, Farhadifar F, Roshani D, et al. Prevalence of Listeria monocytogenes infection in women with spontaneous abortion, normal delivery, fertile and infertile. BMC Pregnancy Childbirth. 2022;22(1):1–6.
Bayat A, Doudi M, Ahadi AM, Tehrani HG. Isolation and Characterization of Streptococcus agalactiae and its Capsular Antigen, Along with Mycoplasma hominis and Listeria monocytogenes, as Abundant Infections in Women with Abortion in Iran. Jundishapur J Microbiol. 2023;16(10).
Geteneh A, Biset S, Tadesse S, Admas A, Seid A, Belay DM. A vigilant observation to pregnancy associated listeriosis in Africa: Systematic review and meta-analysis. PLOS Glob public Heal [Internet]. 2022;2(10):e0001023. http://www.ncbi.nlm.nih.gov/pubmed/36962624.
Ishola OO, Mosugu JI, Adesokan HK. Prevalence and antibiotic susceptibility profiles of Listeria monocytogenes contamination of chicken flocks and meat in Oyo State, south-western Nigeria: Public health implications. J Prev Med Hyg. 2016;57(3):E157–63.
Zahedi Bialvaei A, Sheikhalizadeh V, Mojtahedi A, Irajian G. Epidemiological burden of Listeria monocytogenes in Iran. Iran J Basic Med Sci. 2018;21(8):770–80.
Mateus T, Silva J, Maia RL, Teixeira P. Listeriosis during Pregnancy: A Public Health Concern. ISRN Obstet Gynecol. 2013;2013:1–6.
Goebel W, Gonza B, Domi G, Patoge G, De. Listeria Pathogenesis Mol Virulence Determinants. 2001;14(3):584–640.

No competing interests reported.

Download PDF

Editorial decision: Revision requested
15 Jul, 2024
Editor assigned by journal
09 Jul, 2024
Submission checks completed at journal
09 Jul, 2024
First submitted to journal
07 Jul, 2024

You are reading this latest preprint version

Antibiotic Susceptibility and Risk Factors for Listeriosis in Women with Spontaneous Abortion in Ugandan Tertiary Hospitals: A cross-sectional study

Status:

Version 1

Abstract

Background

Objective

Methods

Results

Conclusion

Figures

1. Introduction

2. Materials and Methods

2.4 Inclusion and exclusion criteria

2.4.2 Exclusion criteria: Women who were on antibiotics for at least 72 hours prior to admission.

3. Results

3.1 Data collection flow chart: In Fig. 1 below, the flow of data collection is illustrated.

3.2 Descriptive characteristics of study participants

3.3 Prevalence of Listeriosis among women with spontaneous abortion.

3.5 Description of factors associated with Listeriosis among women with spontaneous abortion

4. Discussion

4.1 Prevalence of Listeriosis among women with spontaneous abortion.

4.2 Susceptibility patterns of Listeria infection among women with spontaneous abortion.

4.3 Factors associated with Listeriosis among women with spontaneous abortion admitted at JRRH and KRRH.

5. Conclusions

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1