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

Imane Ben M'Barek; Luce Landraud; Luc Desfrere; Kankoé Sallah; Camille Couffignal; Marion Schneider; Laurent Mandelbrot

doi:10.1016/j.ejogrb.2021.04.016

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

Eur J Obstet Gynecol Reprod Biol. 2021 Jun:261:78-84. doi: 10.1016/j.ejogrb.2021.04.016. Epub 2021 Apr 16.

Authors

Imane Ben M'Barek¹, Luce Landraud², Luc Desfrere³, Kankoé Sallah⁴, Camille Couffignal⁵, Marion Schneider⁴, Laurent Mandelbrot⁶

Affiliations

¹ Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, F-75006, Paris, France.
² Université de Paris, F-75006, Paris, France; INSERM, IAME, F-75018, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service Microbiologie, Colombes, France.
³ Assistance Publique-Hôpitaux de Paris, Service de Néonatalogie, Hôpital Louis Mourier, Colombes, France.
⁴ Assistance Publique-Hôpitaux de Paris, URC PNVS, CIC1 1425, INSERM P7, Hôpital Bichat, Paris, France.
⁵ Université de Paris, F-75006, Paris, France; INSERM, IAME, F-75018, Paris, France; Assistance Publique-Hôpitaux de Paris, URC PNVS, CIC1 1425, INSERM P7, Hôpital Bichat, Paris, France.
⁶ Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, F-75006, Paris, France; INSERM, IAME, F-75018, Paris, France. Electronic address: laurent.mandelbrot@aphp.fr.

PMID: 33901775
DOI: 10.1016/j.ejogrb.2021.04.016

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: Bacterial vaginosis; Early onset neonatal infection; Intra uterine infection; Preterm delivery; Preterm prelabor rupture of membrane; Vaginal dysbiosis; Vaginal swab.

MeSH terms

Chorioamnionitis* / diagnosis
Chorioamnionitis* / epidemiology
Dysbiosis / diagnosis
Female
Fetal Membranes, Premature Rupture*
Gestational Age
Humans
Infant, Newborn
Pregnancy
Retrospective Studies