MICROBIOLOGICAL PATTERN IN CASES OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES (PPROM): A CASE-CONTROL STUDY

Abstract

BACKGROUND: Preterm premature rupture of fetal membranes (PPROM) is a significant contributor to adverse 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. Empirical antibiotic prescription is often based on the common pathogens and sensitivity pattern from studies done in developed countries and it is very likely that these pathogens would be different from those in our environment.

OBJECTIVE: To determine the pattern of micro – organisms implicated in cases of preterm premature rupture of fetal membranes and the antimicrobial sensitivity pattern at Obafemi Awolwo University Teaching Hospitals Complex, Ile – Ife.

METHOD: This was a case-control study of 56 cases of PPROM between 24 weeks and 36 weeks gestation versus controls matched for age, gestation age and parity. Endocervical swab and high viginal swab were taken from both cases and control and sent for microscopy, culture and sensitivity.

RESULT: The overall incidence of PPROM was 5.7%. The cases of PPROM had significantly more positive cultures than controls (83.9% versus 8.9% P = 0.001). The common pathogens include klebsiella (32.1%), Escherichia coli (19.6%), Proteus (14.3%), and Staphylococcus aureus (10.7%). Others which are also isolated in the controls were Streptococcus pyogenes (7.1%), Coagulase negative Staphylococcus (3.6%), Bacteriodes (5.4%) and β haemolytic Streptococcus (3.6%). The organisms showed very good sensitivity to Ciprofloxacin (96.3%), Ceftriaxone (92.6%), Amoxiclav (94.4%), Cefuroxime (90.7%), Erythromycin (88.9%), Gentamicin(70.4%) and Chloramphenicol (63%). Cloxacillin only showed moderate sensitivity (50%) while Ampicillin, Co-trimoxazole and Amoxicillin all had low sensitivity. Low socioeconomic class was associated with PPROM (P < 0.001).
CONCLUSION: Positive cultures are present in most cases of PPROM and Klebsiella is the commonest pathogen identified.

MICROBIOLOGICAL PATTERN IN CASES OF PRETERM PREMATURE RUPTURE OF FETAL MEMBRANES (PPROM): A CASE-CONTROL STUDY