MICROBIOLOGICAL PROFILE OF HIGH VAGINAL SWABS AND ANTIBIOTIC SUSCEPTIBILITY PATTERNS IN CASES OF PRETERM PREMATURE RUPTURE OF MEMBRANES AT A TERTIARY CARE CENTER IN SOUTH INDIA
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Keywords
PPROM, preterm birth, high vaginal swab, antibiotic susceptibility, maternal morbidity, neonatal outcomes, antimicrobial resistance, expectant management
Abstract
Introduction:
Prelabour rupture of membranes (PROM) refers to the spontaneous rupture of foetal membranes before labour begins, irrespective of gestational age. If this occurs prior to 37 weeks, it is termed preterm premature rupture of membranes (PPROM), affecting approximately 3% of pregnancies and contributing to 30–35% of preterm births. Maternal infection remains a significant etiological factor in PPROM, impacting both maternal and neonatal outcomes.
Objective:
To assess the clinical and microbiological profile of high vaginal swab (HVS) samples and evaluate antibiotic susceptibility patterns in patients with PPROM at a tertiary care center, along with analysing associated maternal and foetal outcomes.
Methodology:
Hospital-based, prospective observational study was conducted over one year following ethical approval. The study included 68 antenatal women admitted with PPROM between 24 and 36+6 weeks of gestation. Relevant clinical and laboratory data, including HVS cultures and neonatal outcomes, were analysed.
Results:
HVS cultures were positive in 16.2% of cases. The organisms isolated included Escherichia coli (45.5%), Candida albicans (27.3%), Enterococcus faecalis (18.2%), and Klebsiella pneumoniae (9.1%). All gram-negative isolates exhibited resistance to Ampicillin and third-generation cephalosporins but were sensitive to Piperacillin-Tazobactam, Cefoperazone-Sulbactam, Cefepime, and Meropenem. One Enterococcus faecalis isolate was sensitive to Ampicillin and high-level Gentamicin; both were susceptible to Vancomycin and Linezolid. Among neonates, 10.3% of mothers developed chorioamnionitis and 36.8% of infants required neonatal resuscitation.
Conclusion:
PPROM represents a significant risk for preterm birth and associated maternal morbidity such as chorioamnionitis. Early identification of causative organisms and their antibiotic susceptibility patterns is essential for optimizing management and improving maternal-neonatal outcomes. Empirical therapy should be guided by local resistance patterns, with a focus on timely administration of corticosteroids, magnesium sulphate, and appropriate antibiotics.
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Dr. Soumya Baby
Senior Resident, Govt.T.D. Medical College, Alappuzha
Dr Rachel Alexander
Professor (CAP) Government T.D. Medical College Alappuzha
Dr DEEPTHI.P.S
Associate professor (CAP) Government T.D. Medical College Alappuzha