Maternal recto vaginal colonization in term and preterm deliveries

Authors

  • Zahra Akbarian Rad MD., Neonatal-pediatric Disease, Faculty Member, Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

Keywords:

Sepsis; Recto-vaginal colonization; Preterm delivery

Abstract

Background and aim: Maternal recto-vaginal organisms are the main cause of early-onset sepsis in neonates. The aim of this study was to determine the most common organisms and compare maternal recto-vaginal colonization in term and preterm delivery.

Methods: This cross-sectional study was done from October 2014 through October 2016 among participants referred to Ayatollah Rouhani Hospital in Babol, Northern Iran. All pregnant women within gestational age (GA) ≥ 26 weeks and labor pain were included in this study. By a cotton applicator, culture from the lower third of the vagina and another one from the rectum were taken and transported by Stuart media to the laboratory, and were cultured on main Medias within 24 hours. Then microorganisms in preterm and term delivery were compared together. Data were analyzed using SPSS 16. The variables were compared between two groups by chi-squared test, Fisher′s exact test and logistic regression. P<0.05 was statistically considered significant.

Results: Among 511 mothers with successful culturing, 417 delivered at term and 94 fewer than 37 weeks. Staphylococcus epidermidis and Escherichia coli (E. coli) were the most abundant organisms. The frequency of E. coli in term and preterm delivery was 52.5% and 68.1% respectively (p=0.006). Group B strep was more frequent in term delivery (13.7% vs. 3.2%, p=0.004).

Conclusion: Based on our findings, the frequency E. coli and other gram-negative bacteria were higher in preterm delivery groups which indicates the need to assess the efficacy of chemoprophylaxis in situations such as prolonged rupture of membrane, and preterm delivery.

References

Iams JD. Prevention of preterm parturition. N Engl J Med. 2014; 370(3): 254-61. doi:

1056/NEJMc1402822. PMID: 24806178.

Romero R, Dey SK, Fisher SJ. Preterm labor: one syndrome, many causes. Science. 2014; 345(6198): 760- 5. doi: 10.1126/science.1251816. PMID: 25124429.

Murthy V, Kennea NL. Antenatal infection/inflammation and fetal tissue injury. Best Pract Res Clin Obstet

Gynaecol. 2007; 21(3): 479-89. doi: 10.1016/j.bpobgyn.2007.01.010. PMID: 17363332.

Kliegman RM, Stanton B, St.Geme J, Schor NF, Behrman RF. Nelson text book of pediatrics. 19th ed.

: 2470.

Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-Onset Neonatal Sepsis. Clin Microbiol

Rev. 2014; 27(1): 21-47. doi: 10.1128/CMR.00031-13. PMID: 24396135.

Scholl J, Nasioudis D, Boester A, Speleotes M, Grunebaum A, Witkin SS. Group B streptococcus alters

properties of vaginal epithelial cells in pregnant women. Am J Obstet Gynecol. 2016; 214(3): 383. e1-5.

doi: 10.1016/j.ajog.2015.12.053. PMID: 26928153.

Kerur BM, Bhat BV, Harish B, Habeebullah S, Kumar CU. Maternal genital bacteria and surface

colonization in early neonatal sepsis. Indian J Pediatr. 2006; 73(1): 29-32. doi: 10.1007/BF02758256.

PMID: 16444057.

Afsharpaiman S, Torkaman M, Saburi A, Farzaampur A, Amirsalari S, Kavehmanesh Z. Trends in

incidence of neonatal sepsis and antibiotic susceptibility of causative agents in two neonatal intensive care

units in Tehran, IR Iran. J clin neonatol. 2012; 1(3): 124. doi: 10.4103/2249-4847.101692. PMID:

, PMCID: PMC3762027.

Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal

sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011; 127(5): 817-26.

doi: 10.1542/peds.2010-2217. PMID: 21518717.

Koenig JM, Keenan WJ. Group B. Streptococcus and early-onset sepsis in the era of maternal prophylaxis.

Pediatr Clin North Am. 2009; 56(3): 689-708. doi: 10.1016/j.pcl.2009.04.003. PMID: 19501699.

Pararas M, Skevaki C, Kafetzis D. Preterm birth due to maternal infection: causative pathogens and modes

of prevention. Eur J Clin Microbiol Infect Dis. 2006; 25(9): 562-9. doi: 10.1007/s10096-006-0190-3.

PMID: 16953371.

Mukhopadhyay S, Puopolo KM. Risk assessment in neonatal early onsetsepsis. Seminars in perinatology.

Elsevier; 2012.

Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Changing patterns in neonatal Escherichia coli

sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics. 2008; 121(4):

-96. doi: 10.1542/peds.2007-2171. PMID: 18381532.

Metsvaht T, Ilmoja ML, Parm Ü, Maipuu L, Merila M, Lutsar I. Comparison of ampicillin plus gentamicin

vs. penicillin plus gentamicin in empiric treatment of neonates at risk of early onset sepsis. Acta Paediatr.

; 99(5): 665-72. doi: 10.1111/j.1651-2227.2010.01687.x. PMID: 20096030.

Tita AT, Andrews WW. Diagnosis and Management of Clinical Chorioamnionitis. Clin Perinatol. 2010;

(2): 339-54. doi: 10.1016/j.clp.2010.02.003. PMID: 20569811.

Singh S, Swain S, Das L, Das PC, Sahoo S. Isolation and characterization of organisms in high vaginal

swab culture in preterm pregnancy (28-37 week). Int J Reprod Contracept Obstet Gynecol . 2016; 5(11):

-8. doi: 10.18203/2320-1770.ijrcog20163853.

Karambin M, Zarkesh M. Entrobacter, the Most Common Pathogen of Neonatal Septicemia in Rasht, Iran.

Iran J Pediatr. 2011; 21(1): 83-7. PMID: 23056769.

Jean-Baptiste N, Benjamin DK, Cohen-Wolkowiez M, Fowler VG, Laughon M, Clark RH, et al.

Coagulase-negative staphylococcal infections in the neonatal intensive care unit. Infect Control Hosp

Epidemiol. 2011; 32(7): 679-86. doi: 10.1086/660361. PMID: 21666399. 19) Marchant EA, Boyce GK, Sadarangani M, Lavoie PM. Neonatal sepsis due to coagulase-negative

staphylococci. Clin Dev Immunol. 2013; 2013: 586076. doi: 10.1155/2013/586076. PMID: 23762094,

PMCID: PMC3674645.

Martius JA, Roos T, Gora B, Oehler MK, Schrod L, Papadopoulos T, et al. Risk factors associated with

early-onset sepsis in premature infants. Eur J Obstet Gynecol Reprod Biol. 1999; 85(2): 151-8. PMID:

Lin FY, Weisman LE, Troendle J, Adams K. Prematurity is the major risk factor for late-onset group B

streptococcus disease. J infect dis. 2003: 15; 188(2): 267-71. doi: 10.1086/376457. PMID: 12854082.

Downey LC, Smith PB, Benjamin DK. Risk Factors and Prevention of Late Onset Sepsis in Premature

Infants. Early hum dev. 2010; 86(Suppl 1): 7-12. doi: 10.1016/j.earlhumdev.2010.01.012. PMID:

Published

2022-02-12