Contribution of vaginal culture to predict early onset neonatal infection in preterm prelabor rupture of membranes

      Highlights

      • In PPROM before 34 WG, potential pathogens were cultured from vaginal swabs in 16.9 % at rupture and 24.5 % at delivery.
      • Vaginal swab culture positivity was not associated with the risk of early onset neonatal infection (EONI).
      • Lack of lactobacilli was a major risk factor for EONI.
      • Clinical intra uterine infection was highly predictive of EONI.

      Abstract

      Background

      Preterm prelabor rupture of membranes (PPROM) is a major cause of morbidity and mortality for both the mother and the newborn. The vaginal germ profile in PPROM is poorly known, particularly regarding the risk of early-onset neonatal infection (EONI).

      Objective

      To determine microbiological risk factors for EONI in case of PPROM before 34 weeks of gestation (WG).

      Study Design

      A retrospective single-center cohort of patients with PPROM before 34 W G from 2008 to 2016. Vaginal swabs were obtained at admission and at delivery as per usual care and were analyzed by Gram stain and culture for vaginal dysbiosisi.e lactobacilli depletion and/or presence of potential pathogens.

      Results

      Among 268 cases of PPROM, 39 neonates had EONI 14.55 %; (95 %CI 0.11 - 0.19) Overall, vaginal samples culture was positive in 16.67 % (95 %CI 11.95 %–22.32 %) at the time of rupture and 24.76 % (95 %CI 19.02 %–31.23 %) at delivery, with no significant differences between EONI and no-EONI groups (p = 0.797 and 0.486, respectively), including for Group B Streptococci (GBS) and Escherichia coli. EONI was significantly associated with dysbiosis at the time of rupture (23.94 % versus 10.35 % in the absence of dysbiosis, p = 0.009) and at delivery (19.70 % versus 3.90 % if no dysbiosis, p < 0.001). Clinical intra-uterine infection was present in 78.5 % (n = 31) of the EONI group versus 37.2 % (n = 85) in the non-EONI group (p < 0.001) and chorioamnionitis and/or funisitis were found in 97.3 % and 91.9 %, respectively in the EONI group, versus 56.11 % and 53.96 %, respectively, in the non-EONI group (p < 0.001).

      Conclusion

      Dysbiosis following rupture and at delivery, but not the presence of pathogens in the VS culture, was associated with the risk of EONI in case of PPROM.

      Keywords

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