Prevalence of colonisation with multi-drug-resistant Gram-negative organisms in pregnant and postpartum women and people in low- and middle-income countries: A protocol for a systematic review.

<ns3:p>Background Maternal infections are a significant cause of mortality and morbidity in LMICs, and the rise of antimicrobial resistance (AMR) poses a growing threat to global maternal health. Multi-drug resistant Gram negative bacteria (MDR-GNB), including extended-spectrum β-lactamase (ESBL) and carbapenemase-producing organisms, in particular, are critical threats due to limited treatment options, particularly in resource-constrained settings. Objective This systematic review will assess the prevalence of, and risk factors for, maternal colonisation with MDR-GNB in pregnant and postpartum women and people across LMICs. It also characterises resistance phenotypes and genotypes, assesses evidence of nosocomial acquisition, and evaluates the quality of data reporting. Methods PRISMA-P guidelines, we will search the following databases from 2000 onwards: PubMed/MEDLINE, Scopus, Web of Science, ProQuest, Global Health, CINAHL, and the WHO Global Index Medicus. Grey literature will be identified through Google Scholar, preprint servers and websites of ministries of health and international agencies. Eligible studies must report on MDR-GNB colonisation among pregnant or postpartum individuals in LMICs. Two reviewers will independently screen articles, extract data, and assess risk of bias using validated tools. Data synthesis will include descriptive and quantitative analyses, including meta-analysis if appropriate. The certainty of evidence will be evaluated using the GRADE framework. Expected outcomes This review will synthesise current knowledge on maternal colonisation with MDR-GNB in LMICs, identify gaps in the literature, and support efforts to strengthen microbiological surveillance, inform clinical guidance, and reduce AMR-related maternal mortality. Registration CRD420250639803 Available at <ns3:ext-link xmlns:ns4="http://www.w3.org/1999/xlink" ext-link-type="uri" ns4:href="https://www.crd.york.ac.uk/PROSPERO/view/CRD420250639803">https://www.crd.york.ac.uk/PROSPERO/view/CRD420250639803</ns3:ext-link></ns3:p>