Microbiome Diversity in Vaginal Fluid and Sensitivity Patterns in Preterm Premature Rupture of Membrane Cases

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Abstract
Introduction: Preterm premature rupture of membranes (PPROM) is spontaneous rupture of the fetal membranes before 37 completed weeks and before the onset of labor. PPROM occurs in 3% of all pregnancies and is responsible for approximately one-third of all preterm deliveries. It leads to increase in perinatal morbidity and mortality. Aim: The present study aimed to characterize the microbiome of vaginal fluid, which will be helpful in the selection of empiric antimicrobial therapy. Materials and Method: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Pradyumna Bal Memorial Hospital, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar during the period of October 2019 to June 2021 to characterize the microorganisms in the vaginal fluid and their antimicrobial sensitivity patterns found in antenatal women presenting with PPROM. A total of 160 antenatal women diagnosed with PPROM, gestational age between 28 weeks to 36 weeks and 6 days were included in the study. High vaginal swabs were collected for microbial culture and sensitivity. Results: Out of 160 samples, the growth of organisms was observed in 134 (85.09%) samples. Out of them, 133 were monomicrobial, one was polymicrobial. Common isolated infections included Enterococcus faecalis (17.39%), followed by Staphylococcus aureus (14.29%), Escherichia coli (11.18%), and Staphylococcus haemolyticus (6.21%). Most of them were sensitive to ampicillin followed by linezolid and vancomycin. S. aureus was most sensitive to linezolid followed by gentamicin and vancomycin. Most isolates were multidrug-resistant. Conclusion: The empirical antimicrobial treatment started for PPROM management should be based on the established changing microbiological pattern and sensitivities with due consideration of geographical and demographic variations.

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