Prevalence, Spectrum and Antibiotic Susceptibility of Bacterial and Candida Colonization between the 21st and 33rd Week of Gestation in Women with PPROM – 5 Yearsʼ Experience in 1 Perinatal Center

Abstract

Objective: The aim of this study was to evaluate the prevalence, spectrum and antibiotic susceptibility of bacterial and Candida colonization of the vagina between the 21st and the 33rd week of gestation in women who had preterm premature rupture of membranes (PPROM). Study design: High vaginal swabs from 245 subjects with PPROM were analyzed in a retrospective cohort study using cultivation-dependent methods. Patients were additionally divided into two groups: women with PPROM between the 21st and 27th week of gestation (group A) and women with PPROM between the 28th and 33rd week of gestation (group B). A subgroup analysis comparing the two groups was done. Results: The prevalence of pathological bacterial colonization was similar in both study groups (40.8 vs. 41.4 %; p > 0.05), however, a difference in antibiotic susceptibility was noted, which did not reach statistical significance (resistance to ampicillin 71.4 vs. 52.5 %; cefuroxime 9.5 vs. 11.7 %; gentamicin 28.6 vs. 16.4 %; ciprofloxacin 5.0 vs. 5.4 %). In group A there was a statistically significant lower rate of Candida colonization (11.1 vs. 24.3 %; p = 0.04). Conclusion: In patients with early PPROM, the rate of Candida colonization (group A) is lower and there are indications of a difference in antibiotic susceptibility of the colonizing bacteria depending on gestational age. Larger study groups are required to confirm these preliminary results.

Zusammenfassung

Einleitung: Ziel dieser Studie ist die Untersuchung von Prävalenz, Spektrum und Antibiotikaresistenz der Bakterien- und Candida-Kolonisation der Scheide nach vorzeitigem Blasensprung in der 21. bis zum Abschluss der 34. Schwangerschaftswoche. Material und Methode: Hohe vaginale Abstriche von 245 Schwangeren mit vorzeitigem Blasensprung wurden retrospektiv mit Kultivierung analysiert. Eine Subgruppe von Schwangeren in der 21. bis zum Abschluss der 27. Schwangerschaftswoche (Gruppe A) wurde mit Schwangeren in der 28. bis zum Abschluss der 33. Schwangerschaftswoche verglichen. Ergebnisse: Die Prävalenz bakterieller Kolonisation war in beiden Gruppen in vergleichbarer Häufigkeit vorhanden (40,8 vs. 41,4 %, p > 0,05). Es zeigte sich jedoch eine unterschiedliche Antibiotikaresistenz in beiden Gruppen; der Unterschied war statistisch nicht signifikant (Resistenz gegen: Ampicillin 71,4 vs. 52,5 %; Cefuroxim 9,5 vs. 11,7 %; Gentamicin 28,6 vs. 16,4 %; Ciprofloxacin 5,0 vs. 5,4 %). In Gruppe A zeigte sich eine statistisch signifikant niedrigere Candida-Kolonisation (11,1 vs. 24,3 %; p = 0,04). Schlussfolgerung: Schwangere mit sehr frühem vorzeitigem Blasensprung haben eine niedrigere Candida-Kolonisation und möglicherweise eine andere Antibiotikaresistenz abhängig vom Schwangerschaftsalter. Größere Studien sind notwendig, um diese vorläufigen Ergebnisse zu bestätigen.

Key words

preterm premature rupture of membrane - antibiotic susceptibility - bacterial and Candida colonization - prevalence

Schlüsselwörter

vorzeitiger Blasensprung - Antibiotikaresistenz - Bacteria- und Candida-Kolonisation - Prävalenz

• References

• 1 Goldenberg RL, Culhane JF, Iams JD et al. Epidemiology and causes of preterm birth. Lancet 2008; 371: 75-84
• 2 Marlow N, Wolke D, Bracewell MA. EPICure Study Group. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 2005; 352: 9-19
• 3 Melamed N, Klinger G, Tenenbaum-Gavish K et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol 2009; 114: 253-260
• 4 DiGiulio DB, Romero R, Kusanovic JP et al. Prevalence and diversity of microbes in the amniotic fluid, the fetal inflammatory response, and pregnancy outcome in women with preterm pre-labor rupture of membranes. Am J Reprod Immunol 2010; 64: 38-57
• 5 DiGiulio DB, Gervasi MT, Romero R et al. Microbial invasion of the amniotic cavity in pregnancies with small-for-gestational-age foetuses. J Perinat Med 2010; 38: 495-502
• 6 DiGiulio DB, Gervasi MT, Romero R et al. Microbial invasion of the amniotic cavity in preeclampsia as assessed by cultivation and sequence-based methods. J Perinat Med 2010; 38: 503-513
• 7 Romero R, Baumann P, Gomez R et al. The relationship between spontaneous rupture of membranes, labor, and microbial invasion of the amniotic cavity and amniotic fluid concentrations of prostaglandins and thromboxane B2 in term pregnancy. Am J Obstet Gynecol 1993; 168: 1654-1664
• 8 Mercer BM, Goldenberg RL, Das AF et al. What we have learned regarding antibiotic therapy for the reduction of infant morbidity after preterm premature rupture of the membranes. Semin Perinatol 2003; 27: 217-230
• 9 Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol 2003; 1101: 178-193
• 10 Kenyon S, Pike K, Jones DR et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE I trial. Lancet 2008; 372: 1310-1318
• 11 Kenyon S, Pike K, Jones DR et al. Childhood outcomes after prescription of antibiotics to pregnant women with preterm rupture of the membranes: 7-year follow-up of the ORACLE II trial. Lancet 2008; 372: 1319-1327
• 12 Kenyon S, Brockelhurst P, Jones D et al. MRC ORACLE Children Study. Long term outcomes following prescription of antibiotics to pregnant women with either spontaneous preterm labour or preterm rupture of the membranes. BMC Pregnancy Childbirth 2008; 8: 14
• 13 Yudin MH, van Schalkwyk J, van Eyk N et al. Antibiotic therapy in preterm premature rupture of the membranes. SOGC Clinical Practice Guideline 2009. http://www.sogc.org/guidelines/documents/gui233CPG0909.pdf last access: 8.1.2013
• 14 Kenyon S, Boulvain M, Neilson JP. Antibiotics for preterm rupture of membranes. Cochrane Database Syst Rev 2010; (8) CD001058
• 15 Kenyon SL, Taylor DJ, Tarnow-Mordi W. ORACLE Collaborative Group. Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE I randomised trial. Lancet 2001; 357: 979-988
• 16 Kenyon SL, Taylor DJ, Tarnow-Mordi W. ORACLE Collaborative Group. Broad-spectrum antibiotics for spontaneous preterm labour: the ORACLE II randomised trial. Lancet 2001; 357: 989-994
• 17 Versalovic J, Carroll KC, Funke G et al. Manual of clinical Microbiology. 10th edition. Washington: American Society of Microbiology; 2011
• 18 Cockerill FR. Performance standards for antimicrobial susceptibility testing. http://www.clsi.org last access: 8.1.2013
• 19 Reinhard J, Heinrich TM, Reichenbach L et al. Prevalence, spectrum and sensitivity of bacterial and fungal infection at 21st to 33rd weeks gestational age with preterm rupture of membrane – 5 years of experience in 1 perinatal centre. Z Geburtshilfe Neonatol 2011; 215: PO05_05
• 20 Wild J, Küssel L, Zeisler H. Der frühe vorzeitige Blasensprung. Geburtsh Frauenheilk 2010; 70: P38
• 21 Kuhn P, Dheu C, Bolender C et al. Incidence and distribution of pathogens in early-onset neonatal sepsis in the era of antenatal antibiotics. Paediatr Perinat Epidemiol 2010; 24: 479-487
• 22 Salah RM, Allam AM, Magdy AM et al. Bacterial vaginosis and infertility: cause or association?. Eur J Obstet Gynecol Reprod Biol 2012; DOI: 10.1016/j.ejogrb.2012.10.031.
• 23 Mendling W, Schnell JD. Antepartal vaginal yeast contamination today. Mykosen 1984; 27: 573-578
• 24 Czeizel AE, Fladung B, Vargha P. Preterm birth reduction after clotrimazole treatment during pregnancy. Eur J Obstet Gynecol Reprod Biol 2004; 116: 157-163
• 25 Kiss H, Petricevic L, Husslein P. Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery. BMJ 2004; 329: 371
• 26 Kagan KO, Hoopmann M, Kozlowski P. Assessment of foetal DNA in maternal blood – a useful tool in the hands of prenatal specialists. Geburtsh Frauenheilk 2012; 72: 998-1003
• 27 Beckmann MW, Bader W, Bechtold I et al. Finanzierung und finanzielle Probleme von Leistungen und Strukturen im Fachgebiet Gynäkologie und Geburtshilfe im Jahr 2011 – allgemeine Aspekte und geburtshilfliche Versorgung. II. Artikel der Finanzierungskommission der DGGG e. V. – Teil I. Geburtsh Frauenheilk 2011; 71: 367-380