MICROBIOLOGICAL PATTERN IN CASES OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES (PPROM)

Abstract

Preterm premature rupture of fetal membranes(PPROM) is a significant contributor to
poor obstetric outcome. The need for a continuous search for the aetiological factors to enable its
prevention and proper management if it occurs cannot be overemphasized.
This was a case control study (73 cases versus 73 controls with on going pregnancy
without rupture of membranes) aimed at determining the microbiological pattern of of PPROM
in our environment. Endocervical culture of cases and controls were compared. The cases of
PPROM had significantly more positive cultures than controls( 97.3% versus 5.5% ; p <0.001).
Escherischia coli(32.8%) was the commonest organism isolated. Other organisms of statistical
significance isolated include Proteus(21.9%), Bacteroides(15.1%), and Klebsiella(9.6%). These
organisms showed very good sensitivity to Ciprofloxacin(90.4%), Ceftriaxone(89%),
Ceftazidime(86.3%), Co-amoxiclav(80.8%), Erythromycin(73.9%), Cefuroxime(73.9%) and
Gentamicin(65.8%). Clindamycin(45.2%) only showed moderate sensitivity but Co-trimoxazole
Ampicillin, Amoxicillin and Cloxacillin all had low sensitivity.
A significant number of PPROM(58.9%) occurred at 31 – 33 weeks gestation(P. value
0.014). Low level of education or low socioeconomic class was significantly associated with
PPROM(82.2%, P <0.001)
A combination of Cefuroxime and Erythromycin given intravenously for the first 48
hours followed by oral combination of these two drugs for a further 5 days is suggested based on
the sensitivity pattern of the isolated organisms in this study. It is recommended that
prophylactic use of antibiotics in the management PPROM should be based on the microbiological pattern and their sensitivity in any environment.

MICROBIOLOGICAL PATTERN IN CASES OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES (PPROM)