Vancomycin-Resistant Enterococci and Extended-Spectrum β-Lactamase-Producing Bacterial Colonization of the Cervix after Emergency Cerclage: Is It Safe?

Won-Kyu Jang,Jin-Gon Bae

doi:10.3390/antibiotics10080933

Abstract

Antimicrobial resistance is currently becoming a global threat to human health. We performed a retrospective study on patients who underwent emergency cerclage between January 2016 and December 2018 at the Dongsan Medical Center. Cervical culture was first performed before surgery to confirm that there was no infection and was repeated on days 1, 4, and 7 after surgery. A total of 85 pregnant women underwent emergency cerclage. Among them, six patients had vancomycin-resistant enterococci (VRE) colonization in the cervix after cerclage, and 23 patients developed extended-spectrum β-lactamase (ESBL)-producing bacterial colonization in the cervix. The average gestational age at delivery was lower in the VRE group. Neonatal death was also significantly higher in the VRE group. The rate of occurrence of early-onset sepsis was also higher in the VRE group, and both VRE and ESBL-producing bacterial colonization cases in which early-onset sepsis occurred resulted in neonatal death. The prognosis of cervical VRE colonization after cervical surgery was poor, whereas the prognosis of ESBL-producing bacterial colonization in the cervix did not differ significantly from that of the control group. However, careful neonatal treatment is required considering that early-onset sepsis is fatal to the newborn.

Highlights

Preterm birth is highly associated with perinatal morbidity [1]
The average gestational age at delivery was lower in the vancomycin-resistant enterococci (VRE) group, and the interval from surgery to delivery was shorter; there was no significant difference between the ESBL-producing bacteria group and the control group
The present study aimed to investigate the effect of cervical colonization by VRE or ESBL-producing bacteria after cerclage on the clinical features of pregnancy and neonatal outcomes

Summary

Introduction

Cervical insufficiency is a risk factor for miscarriage or premature birth in the second trimester [4]. Cervical cerclage is a surgical procedure performed for pregnant women who currently have or have had cervical insufficiency, and it is performed as a very effective and general treatment to prevent preterm birth [5,6]. Enterococcus species is a component of the human gut flora and is found naturally in the birth canal of women. Vancomycin-resistant enterococci (VRE) are more resistant to treatment than their susceptible counterparts. In addition to the development of enterococci with high levels of resistance to penicillin and aminoglycosides, the emergence of vancomycin resistance in enterococci poses serious challenges and difficulties for physicians treating patients infected with these microbes [8]. Bacteria that produce ESBL are resistant to certain types of antibiotics, such as penicillin, cephalosporin, and monobactam.

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