Abstract

Background: Premature rupture of membrane (PROM) contributes to approximately one-third of premature birth and 10% perinatal mortality worldwide. Here, we report the patterns of facultative pathogenic bacteria colonizing the vagina of pregnant women to guide prophylactic antibiotic treatment in the management of PROM.

Methods: This comparative cross-sectional study was conducted between August 2015 and March 2016. High vaginal swabs were collected and processed to detect the presence of facultative pathogenic bacteria. Isolate identification and antibiotic susceptibility testing was conducted using MALDI-TOF MS and VITEK-2 system, respectively. Data were analyzed using STATA version 13.

Results: A total of 175 pregnant women with PROM and 175 without PROM were investigated. The median age of the pregnant women with PROM was significantly higher than that of pregnant women without PROM: 27 [21-32] vs. 25[21-29], p=0.026. Pregnant women with PROM were significantly more likely to be colonized with facultative pathogenic bacteria 59/175 (33.7%), 95% CI; 26.7-40.7 than pregnant women without PROM; 27/175 (15.4%), 95% CI; 10.1-20.7, P<0.001. Escherichia coli were significantly more isolated from pregnant women with PROM than those without PROM: 36 (73.5%) vs. 13(26.5%), p<0.001. The proportion of resistance among pathogenic isolates from women with PROM to ampicillin, trimethoprim/sulfamethoxazole and cefotaxime were 100%, 66.7% and 40%, respectively.

Conclusions: The vagina of pregnant women with PROM is significantly more colonized by multi-resistant facultative pathogenic bacteria than that of pregnant women without PROM. Further studies should be done to elucidate the impact of these bacteria in relation to PROM and the pregnancy outcome.