Maternal Vaginal Colonization Research Articles

In silico and experimental analysis of the repeated domains in BvaP, a protein important for GBS vaginal colonization.

Streptococcus agalactiae (group B strep, GBS) infections in neonates are often fatal and strongly associated with maternal GBS vaginal colonization. Previously, we highlighted the importance of a formerly uncharacterized protein, BvaP, in GBS vaginal colonization. BvaP is highly conserved across GBS and is made up of repeated domains, with a variable number of repeats between strains. Here, we evaluate the prevalence of BvaP repeated domains and their relevance in phenotypes previously associated with vaginal colonization. Using in silico analysis, we found that the number of repeats in the BvaP protein does not generally appear to be associated with serotype, isolation site, or host. Using BvaP truncations in GBS strain A909, we determined that a smaller number of repeats was correlated with decreased bacterial chain length, but adherence to vaginal epithelial cells was complemented using BvaP containing one, two, three, or five repeats. Future research will be geared toward understanding the host immune response to BvaP in vivo and whether vaginal carriage or host response is dependent on the BvaP repeated domains.

PREVALANCE OF FUNGAL SEPSIS IN LOW BIRTH WEIGHT AND VERY LOW BIRTH WEIGHT NEONATES AND ITS CORRELATION WITH HIGH RISK FACTORS IN A TERTIARY CARE CENTRE IN INDIA

BACKGROUND: Candidemia refers to the isolation of pathogenic species of Candida from a blood culture specimen. Candidemia in hospitalized patients especially in ICU patients is emerging as a signicant problem worldwide. Isolation of an organism from a blood culture of a neonate with clinical symptoms of infection constitutes the common denition of sepsis. The change in epidemiology and pattern of antifungal susceptibility of Candida infection has made identication of aetiological agent compulsory along with its antifungal susceptibility. MATERIALS AND METHODS: This retrospective cross - sectional study was carried out in the neonatal intensive care unit of tertiary health care centre, Lata Mangeshkar Hospital, Nagpur during the period of March 2021 to September 2021 with the primary objective to determine the incidence of fungal sepsis in very low birth weight neonates in neonatal intensive care unit (NICU) setup and secondary objective to study the correlation with the risk factors in a tertiary care center in India. RESULTS: In the present study, between march 2021 to September 2021, out of total 47 very low birth neonates, 18 very low birth weight neonates were blood culture positive for candida species . Hence, the incidence of candidemia in Very Low Birth Weight neonates in this study was 36%. DISCUSSION: The increase in resistance to antifungal agents among Candida isolates has resulted in increased mortality and morbidity. Prevention of risk factors in Candidemia patients with early removal of central line, timely fungal culture, Candida speciation and antifungal susceptibility are necessary for appropriate treatment and better outcome. CONCLUSION: Neonatal Candida colonization is the rst step that predisposes to invasive candidiasis. Pregnancies complicated by preterm labor or possible delivery should be considered for screening and treatment of maternal vaginal colonization to decrease the occurrence of neonatal colonization and its sequences

Molecular Epidemiology of Group B Streptococcus Colonization in Egyptian Women.

(1) Background: Streptococcus agalactiae or Group B Streptococcus (GBS) causes severe neonatal infections with a high burden of disease, especially in Africa. Maternal vaginal colonization and perinatal transmissions represent the common mode of acquiring the infection. Development of an effective maternal vaccine against GBS relies on molecular surveillance of the maternal GBS population to better understand the global distribution of GBS clones and serotypes. (2) Methods: Here, we present genomic data from a collection of colonizing GBS strains from Ismailia, Egypt that were sequenced and characterized within the global JUNO project. (3) Results: A large proportion of serotype VI, ST14 strains was discovered, a serotype which is rarely found in strain collections from the US and Europe and typically not included in the current vaccine formulations. (4) Conclusions: The molecular epidemiology of these strains clearly points to the African origin with the detection of several sequence types (STs) that have only been observed in Africa. Our data underline the importance of continuous molecular surveillance of the GBS population for future vaccine implementations.

A Novel Conserved Protein in Streptococcus agalactiae, BvaP, Is Important for Vaginal Colonization and Biofilm Formation.

Streptococcus agalactiae (group B streptococcus [GBS]) infections in neonates are often fatal and strongly associated with maternal GBS vaginal colonization. Here, we investigated the role of an uncharacterized protein, BvaP, in GBS vaginal colonization. bvaP was previously identified as the most highly upregulated gene in the GBS A909 transcriptome when comparing vaginal colonization to growth in liquid culture. We found that the absence of BvaP affects the ability of GBS to adhere to extracellular matrix components and human vaginal epithelial cells, and the ability of a ΔbvaP mutant to colonize the murine vaginal tract was significantly decreased. Cellular morphological alterations such as changes in cell shape, chain length, and clumping were also observed in a knockout mutant strain. Given its high expression level in vivo, high degree of conservation among GBS strains, and role in vaginal colonization, BvaP may be an eligible target for GBS vaccination and/or drug therapy. IMPORTANCE Neonatal GBS disease is a major cause of morbidity and mortality, and maternal vaginal colonization is the leading risk factor for the disease. Colonization prevention would greatly impact the rates of disease transmission, but vaccine development has stalled as capsular polysaccharide vaccines have low immunogenicity in vivo. While these vaccines are still in development, the addition of a protein conjugate may prove fruitful in increasing immunogenicity and strain coverage across GBS serotypes. Previous research identified sak_1753 as a highly upregulated gene during murine vaginal colonization. This study reveals that Sak_1753 is required to maintain proper GBS cellular morphology and colonization phenotypes and is required for full in vivo vaginal colonization in a murine model. We have renamed Sak_1753 group B streptococcus vaginal adherence protein (BvaP). The findings of this study indicate that BvaP is important for GBS colonization of the vaginal tract and, given its high expression level in vivo and strain conservation, may be a candidate for vaccine development.

Maternal Ureaplasma/Mycoplasma colonization during pregnancy and neurodevelopmental outcomes for preterm infants.

IntroductionUreaplasma (U.) and Mycoplasma (M.) species have been related to pregnancy complications (including preterm birth) and worse neonatal outcomes. The aim of our work is to evaluate neurodevelopmental outcomes in preterm infants born to mothers with Ureaplasma/Mycoplasma colonization during pregnancy.MethodsPreterm infants with gestational age (GA) of ≤ 30 weeks were included in a retrospective follow-up study. To evaluate the effects of maternal vaginal colonization, we divided preterm infants into two groups: exposed and unexposed infants. All infants were assessed at 24 ± 3 months of age using Griffith’s Mental Developmental Scales (GMDS).ResultsAmong 254 preterm infants, only 32 infants (12.6%) were exposed to U. /M. colonization during pregnancy. Exposed infants and unexposed ones had a similar Griffith′s Developmental Quotient (106 ± 27.2 vs. 108.9 ± 19.5, respectively), without significant differences (p = 0.46). However, exposed infants had a significantly poorer outcome than their unexposed peers in terms of locomotor abilities (100.7 ± 28.3 exposed vs. 111.5 ± 26.1 unexposed, p = 0.03).ConclusionFor visual and hearing impairment, exposed and unexposed infants had similar incidences of cognitive and motor impairment. However, exposed infants had significantly lower locomotor scores than unexposed peers.

MANIFESTATION OF MATERNAL VAGINAL COLONIZATION OF GROUP B STREPTOCOCCUS IN PRETERM PREMATURE RUPTURE OF MEMBRANES

Objectives: To look at the manifestation of maternal vaginal colonization of Group B Streptococcus in pre-term premature rupture of membranes.Methods and materials: This cross sectional study was conducted at Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from November 02 ,2020 to May 02, 2021. By using chi square test, Group B streptococcus (GBS ) was stratifi ed among age, gravidy, parity, BMI and booking status to see the eff ect modifi cation value ≤ 0.05 was taken as significant. Those co comorbidities that aff ect the results were excluded. All data was entered, processed, and analyzed on SPSS version 21.0.Results: Out of total 126 patients, mostly in 15-25 Years of age [04(3.17%),P value,0.889] were reported as compare to 26-35 Years of age 03(2.38%) and 0.79% years among 36-45 Years. Simailrly the frequency of Group B streptococcus (GBS) was prevalent among 15-20 kg/m2 category [04(3.17%),P value,0.083] as compare to 21-25 kg/m2 02(01.58%) and 26-30 kg/m2 having 02(01.58%)Conclusion: The gastrointentinal and vaginal epithelium of healthy women colonized by Group B Streptococcus(GBS) pose a greater risk of serious pathologies in the susceptible infant by a transmission during parturition or ascending intrauterine infection. The incidence of early-onset GBS sepsis has decreased as a result of universal screening and intra partum antibiotic prophylaxis.

Growing threat of extended-spectrum β-lactamase-producingEnterobacteriaceae colonisation in high-risk pregnancies: A cross-sectional study.

To investigate the epidemiological changes in extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) vaginal colonisation in pregnant women deemed at high risk, and to identify independent risk factors. Further, the differences in perinatal outcomes according to maternal ESBL-E vaginal colonisation were analysed. Cross-sectional study. Republic of Korea. A cohort of 1460 women admitted to our high-risk pregnancy unit between 14+0 and 36+6 weeks of gestation. The trend of changes in the association of ESBL-E vaginal colonisation from January 2010 to December 2020 was analysed. The main outcomes were analysed over the study period and ESBL-E vaginal colonisation. Rate of ESBL-E vaginal colonisation, risk factors for ESBL-E vaginal colonisation and perinatal outcomes. The ESBL-E vaginal colonisation rate has tended to increase over the past 11 years, which was attributed to a significantly higher proportion of ESBL-producing Escherichia coli. Cerclage (RR3.7, 95%CI 2.19-6.40) and prior antibiotic treatment (RR4.0, 95%CI 2.44-6.54) were found as independent risk factors for ESBL-E vaginal colonisation. Earlier gestational age at delivery and higher proven early-onset neonatal sepsis (EONS) rate were observed in the ESBL-E-positive group. The ESBL-E vaginal colonisation rate in pregnant patients at high risk has increased over the past decade, and the independent risk factors for colonisation are cerclage and prior antibiotic treatment. Additionally, maternal ESBL-E vaginal colonisation is associated with higher rates of proven EONS.

Invasive candidiasis in a neonatal intensive care unit in Fukuoka.

Invasive candidiasis (IC) is a leading cause of morbidity and mortality in preterm infants. The objective of this study was to determine the prevalence of IC infection in newborns in the neonatal intensive care unit (NICU) of a tertiary hospital in Japan, and to identify specific predisposing factors for IC. We retrospectively collected data on demographics, clinical characteristics, and outcomes of infants with IC, who were discharged from a tertiary NICU in Japan between January 2009 and December 2020. We compared predisposing factors associated with the occurrence of early-onset IC (EOIC < 72 h) and late-onset IC (LOIC ≥72 h) with those of early-onset and late-onset bacterial sepsis. Between January 2009 and December 2020, 3,549 infants were admitted to the NICU, including 344 extremely-low birthweight (ELBW) infants. Eleven infants (including nine ELBW infants) had IC (incidence 0.31%), and the mortality rate of IC was 0%. Four (36%) infants had EOIC and seven (64%) had LOIC. All those with EOIC presented with skin lesions and 86% with LOIC had thrombocytopenia. Maternal vaginal Candida colonization was a more specific predisposing factor for EOIC, while gestational age <26 weeks, broad-spectrum antibiotic use, prior bacterial infection, prior gastrointestinal (GI) surgery, and GI diseases were more specific predisposing factors for LOIC. The findings suggest that maternal vaginal Candida colonization and skin lesions in ELBW infants may contribute to early recognition of EOIC. LOIC should be suspected if ELBW infants with several predisposing factors of LOIC have thrombocytopenia.

Differential impact of abnormal vaginal colonization on perinatal outcome and association with early-onset neonatal sepsis: preterm labor vs. preterm premature rupture of membrane

Objective The purpose of this study was to check whether the impact of abnormal vaginal colonization on perinatal outcomes would be different in patients with preterm labor (PTL) and premature membrane rupture (PPROM). We also sought to determine the concordance rate of microorganisms isolated from the maternal vagina and neonatal blood in cases of early-onset neonatal sepsis (EONS) in PTL and PPROM. Methods This retrospective study included 996 singleton pregnancies who were admitted to the high risk care unit of our institution due to PTL (n = 519) or PPROM (n = 477) and underwent vaginal culture examination at admission between January 2005 and April 2019. Abnormal vaginal colonization was defined upon isolation of aerobic microorganisms. The maternal baseline characteristics, delivery, and neonatal outcomes were compared according to the presence or absence of abnormal vaginal flora, both in PTL and PPROM. Results The rate of abnormal vaginal colonization in PTL and PPROM was 17.0 and 21.4%, respectively. Both in PTL and PPROM, the gestational age at admission was lower in the abnormal vaginal colonization group (PTL, 27.2 ± 3.5 vs. 28.2 ± 3.5 weeks, p = .024; PPROM, 26.1 ± 5.3 vs. 27.5 ± 4.5 weeks, p = .007). Multivariable analysis demonstrated that the group with abnormal bacteria in PPROM but not in PTL had a significantly higher rate of EONS than the group without abnormal bacteria after adjustment for confounders including gestational age at admission (PPROM, odds ratio, OR [95% confidence interval, CI]: 4.172 [1.426–12.206]; PTL, OR [95% CI]: 0.661 [0.079–5.505]). Concordance analysis showed that the maternal vaginal bacteria colonization by Escherichia coli (5.9 vs. 0.5%, p = .033) and Staphylococcus aureus (14.3 vs. 0.2%, p = .032) in PPROM was significantly correlated with the microorganisms from the neonatal blood culture EONS cases. In PTL, no specific microorganisms showed concordance between maternal vaginal bacteria and microorganisms causing EONS. Conclusion Our data showed that maternal vaginal colonization in PPROM, but not in PTL, is an independent risk factor for EONS.

Vertical transmission of methicillin-resistant Staphylococcus aureus at delivery and its clinical impact: An observational, prospective cohort study.

Methicillin-resistant Staphylococcus aureus (MRSA) infection has a significant clinical impact on both pregnant women and neonates. The aim of this study was to assess accurately the vertical transmission rate of MRSA and its clinical impacts on both pregnant mothers and neonates. We conducted a prospective observational cohort study of 898 pregnant women who were admitted to our department and 905 neonates from August 2016 to December 2017. MRSA was cultured from nasal and vaginal samples taken from the mothers at enrollment and from nasal and umbilical surface swabs taken from neonates at the time of delivery. We examined the vertical transmission rate of MRSA in mother-neonate pairs. We used multivariable logistic regression to identify risk factors for maternal MRSA colonization and maternal/neonatal adverse outcomes associated with maternal MRSA colonization. The prevalence of maternal MRSA colonization was 6.1% (55 of 898) at enrollment. The independent risk factors were multiparity and occupation (healthcare provider) (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.25-4.42 and OR 2.58, 95% CI 1.39-4.79, respectively). The prevalence of neonatal MRSA colonization at birth was 12.7% (7 of 55mother-neonate pairs) in the maternal MRSA-positive group, whereas it was only 0.12% (one of 843 pairs) in the maternal MRSA-negative group (OR 121, 95% CI 14.6-1000). When maternal vaginal samples were MRSA-positive, vertical transmission was observed in four of nine cases (44.4%) in this study. Skin and soft tissue infections developed more frequently in neonates in the maternal MRSA-positive group than in the MRSA-negative group (OR 7.47, 95% CI 2.50-22.3). The prevalence of MRSA in pregnant women was approximately 6%. Vertical transmission caused by maternal vaginal MRSA colonization was observed in four of nine cases (44.4%). Although our study includes a limited number of maternal MRSA positive cases, the vertical transmission of MRSA may occur in up to 44% of neonates of mothers with vaginal MRSA colonization. Maternal MRSA colonization may be associated with increased development of skin and soft tissue infections in neonates via vertical transmission.

Maternal Vaginal Ureaplasma spp. Colonization in Early Pregnancy Is Associated with Adverse Short- and Long-Term Outcome of Very Preterm Infants.

Vaginal colonization with Ureaplasma (U.) spp. has been shown to be associated with adverse pregnancy outcome; however, data on neonatal outcome are scarce. The aim of the study was to investigate whether maternal vaginal colonization with U. spp. in early pregnancy represents a risk factor for adverse short- or long-term outcome of preterm infants. Previously, 4330 pregnant women were enrolled in an observational multicenter study, analyzing the association between vaginal U. spp. colonization and spontaneous preterm birth. U. spp. colonization was diagnosed via PCR analysis from vaginal swabs. For this study, data on short-term outcome were collected from medical records and long-term outcome was examined via Bayley Scales of Infant Development at 24 months adjusted age. Two-hundred-and-thirty-eight children were born <33 weeks gestational age. After exclusion due to asphyxia, malformations, and lost-to-follow-up, data on short-term and long-term outcome were available from 222 and 92 infants, respectively. Results show a significant association between vaginal U. spp. colonization and severe intraventricular hemorrhage (10.4% vs. 2.6%, p = 0.03), retinopathy of prematurity (21.7% vs. 10.3%, p = 0.03), and adverse psychomotor outcome (24.3% vs. 1.8%, OR 13.154, 95%CI 1.6,110.2, p = 0.005). The data suggest an association between vaginal U. spp. colonization in early pregnancy and adverse short- and long-term outcome of very preterm infants.

Early-onset neonatal sepsis due to Streptococcus Pneumoniae: A rare causative organism in neonates

Streptococcus pneumoniae (pneumococcus) is a common respiratory tract pathogen in children causing otitis media, sinusitis, bacteremia, and meningitis. Although comparatively rare, this pathogen can also cause early-onset neonatal sepsis (EONS) as well as late-onset neonatal sepsis and can mimic Group B streptococcal sepsis-like illness in neonates. S. pneumoniae can be transmitted vertically from maternal vaginal tract colonization or from the placenta through hematogenous spread. Two consecutive case reports of EONS are reported. Vaccination of the mother with pneumococcal polysaccharide vaccine during the third trimester may provide protection to infants by enhancing the transplacental transfer of active immunoglobulin (IgG) to the fetus, as well as improving the availability of secretory antibodies for the fetus through mother's milk. Immunization of the mother may also prevent genital colonization through resulting high levels of IgG plus mucosal CD17 lymphocytes.

Предупреждение неонатальной инфекции, обусловленной стрептококками группы В

Objective. To evaluate the prevalence of vaginal carriage of Streptococcus agalactiae among pregnant women at 35–37 weeks of gestation and assess the efficacy of intrapartum antibiotic prophylaxis (IAP) for group B streptococcus (GBS) infection in newborns. Patients and methods. We examined 800 pregnant women at 35–37 weeks of gestation (bacteriological examination of vaginal microbiota with biomaterial collected from the posterior vaginal fornix). Identified carriers of S. agalactiae who had vaginal delivery (n = 50) received antibiotic prophylaxis to prevent infection in newborns. We also evaluated the frequency of vertical transmission of streptococci in all infants during the first hour of life (bacteriological examination of pharyngeal swabs and meconium). Identification of microorganisms was performed by direct protein profiling using MALDI-TOF mass spectrometry (FLEX series, Bruker Daltonic GmbH, Germany). Results. Maternal vaginal colonization with S. agalactiae in the third trimester was observed in 13.5% of patients tested (n = 108). Fifty women had vaginal delivery and received antibiotic prophylaxis to prevent infection in newborns. Postpartum samples of only 1 newborn gave scanty growth of S. agalactiae at bacteriological examination (1 × 101 CFU/mL in meconium and 1 × 103 CFU/mL in the pharyngeal sample), while the remaining 49 newborns had sterile samples. Thus, the frequency of S. agalactiae vertical transmission with intrapartum antibiotic prophylaxis was 2% (n = 1). Of note, infection in the newborn caused no inflammation. Conclusion. Relatively low prevalence of vaginal carriage of S. agalactiae among pregnant women gives no sufficient grounds for the inclusion of such bacteriological examination into compulsory screening for infections in pregnant women in the Russian Federation. However, intrapartum antibiotic prophylaxis is an effective method to prevent streptococcal infection in newborns; it should be used in women at risk of GBS infections. Kew words: vaginal carriage of bacteria, intrapartum antibiotic prophylaxis, neonatal sepsis, Streptococcus agalactiae, intrauterine infection, screening for infections

In-vitro effect of vaginal lactobacilli against group B Streptococcus

Streptococcus agalactiae(GBS) is a leading cause of infection during pregnancy, preterm birth and neonatal infection, with a significant clinical and socio-economic impact. To prevent maternal GBS vaginal colonization, new antibiotic-free approaches, based on lactobacilli probiotics, are advisable.The aim of this study was to assess the anti-GBS activity of 14 vaginal Lactobacillus strains, belonging to different species (L. crispatus, L. gasseri, L. vaginalis), isolated from healthy pre-menopausal women. In particular, we performed ‘inhibition’ experiments, evaluating the ability of both Lactobacillus cells and culture supernatants in reducing Streptococcus viability, after 60 min contact time.First, we demonstrated that the acidic milieu, produced by vaginal lactobacilli metabolism, is crucial in counteracting GBS growth in a pH-dependent manner. Experiments with organic/inorganic acid solutions confirmed the strict correlation between pH levels and the anti-GBS activity. GBS was more sensitive to lactic acid than to hydrochloric acid, indicating that the presence of H+ ions is necessary but not sufficient for the inhibitory activity. Moreover, experiments with Lactobacillus pH-adjusted supernatants led to exclude a direct role in the anti-GBS activity by other bioactive molecules.Second, we found that only a few Lactobacillus strains were able to reduce Streptococcus viability by means of cell pellets. The anti-GBS effect displayed by Lactobacillus cells was related to the their ability to interact and aggregate with Streptococcus cells. We found that the anti-GBS activity was retained after methanol/proteinase K treatment, but lost after lysozyme exposure of Lactobacillus cells. Therefore, we supposed that non-proteinaceous components of Lactobacillus cell wall could be responsible for the anti-GBS activity.In conclusion, we identified specific Lactobacillus strains able to interfere with GBS viability by multiple strategies and we elucidated some of the mechanisms of action. These strains could serve as probiotic formulations for the prevention of GBS vaginal colonization.

Group B Streptococcus colonization induces Prevotella and Megasphaera abundance-featured vaginal microbiome compositional change in non-pregnant women.

BackgroundPrevious studies have indicated that variations in the vaginal microbiome result in symptomatic conditions. Group B Streptococcus (GBS) is a significant neonatal pathogen and maternal vaginal colonization has been recognized as an important risk factor for neonatal disease. Therefore, it is important to discover the relationship between the composition of the vaginal microbiome and GBS colonization. This study explores the potential relationship between the composition of the vaginal microbiome and GBS colonization in non-pregnant Chinese women.MethodsA total of 22 GBS-positive, non-pregnant women and 44 matched GBS-negative women were recruited for the current study. The composition of the vaginal microbiome was profiled by sequencing the 16S rRNA genes. The microbiome diversity and variation were then evaluated.ResultsThe vaginal microbiome of the 66 subjects enrolled in the current study were compared and the results showed that GBS-positive women exhibited significant vaginal microbial differences compared with the GBS-negative women based on the analysis of similarities (r = 0.306, p < 0.01). The relative abundance of the bacterial genus Lactobacillus (p < 0.01) was significantly lower in the GBS-positive group, while the abundances of the bacterial genera Prevotella (p < 0.01), Megasphaera (p < 0.01), and Streptococcus (p < 0.01) were significantly higher in the GBS-positive group.DiscussionThe current study addressed significant variations across the communities of the vaginal microbiome in GBS-positive and GBS-negative women in a Chinese cohort, which paves the way for a larger cohort-based clinical validation study and the development of therapeutic probiotics in the future.

P15.09: Association of abnormal vaginal colonisation and preterm delivery: effect of cervical length

The exact relationship between abnormal vaginal colonisation and adverse pregnancy outcome in preterm labour remains unclear. Therefore, we hypothesised that women with shorter cervical length (CL) are predisposed to ascending infection in women with preterm labour (PTL) or short CL. We aimed to examine abnormal vaginal colonisation rate according to cervical shortening and to compare the association between abnormal vaginal colonisation and spontaneous preterm delivery (SPTD) before 34 weeks according to CL in women with PTL or short CL. This study included 580 patients who admitted to our high-risk unit due to PTL or short CL and underwent vaginal culture and measurement of CL at admission between 2005 and 2015. Maternal age, parity, parity, body mass index and CL at admission, vaginal culture result, birth weight of neonates, and SPTD before 34 weeks were retrospectively reviewed. The study population was divided three groups according to the degree of cervical shortening; CL < 0.5cm (n=113), 0.5cm to 1.5cm (n=145), ≥ 1.5cm (n=322). There was no difference in abnormal vaginal colonisation rate according to the CL shortening (17.7%, 17.9%, 13.7% in group with CL < 0.5cm, 0.5cm to 1.5cm, ≥ 1.5cm, respectively, p=0.22). Overall, the rate of SPTD was not different according to the presence or absence of abnormal vaginal colonisation in three groups (93.3% vs 68.3%, p=0.06 in group with CL < 0.5cm; 40.9% vs 55.7% p=0.21 in group with 0.5cm to 1.5cm, 42.4% vs 33.2% p=0.30 in group with CL ≥ 1.5cm). However, in group with CL < 0.5cm, the presence of gram negative bacteria (but not gram positive) was significantly associated with higher SPTD (100% vs 68.6%, p=0.03). In other two groups, there was no difference in the rate of SPTD according to either the presence of gram positive or negative bacteria. Our data showed that maternal vaginal colonisation by gram-negative bacteria in advanced cervical shortening in PTL or short CL is associated with SPTD before 34 weeks. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Risk Factors for Vaginal Colonization and Relationship between Bacterial Vaginal Colonization and In-Hospital Outcomes in Women with Obstructed Labor in a Ugandan Regional Referral Hospital.

Introduction The proportion of women with severe maternal morbidity from obstructed labor is between 2 and 12% in resource-limited settings. Maternal vaginal colonization with group B streptococcus (GBS), Escherichia coli, and Enterococcus spp. is associated with maternal and neonatal morbidity. It is unknown if vaginal colonization with these organisms in obstructed labor women is associated with poor outcomes. Objectives To determine whether vaginal colonization with GBS, E. coli, or Enterococcus is associated with increased morbidity among women with obstructed labor and to determine the risk factors for colonization and antibiotic susceptibility patterns. Methods We screened all women presenting in labor to Uganda's Mbarara Regional Referral Hospital maternity ward from April to October 2015 for obstructed labor. Those meeting criteria had vaginal swabs collected prior to Cesarean delivery and surgical antibiotic prophylaxis. Swabs were inoculated onto sterile media for routine bacterial culture and antimicrobial susceptibility testing. Results Overall, 2,168 women were screened and 276 (13%) women met criteria for obstructed labor. Vaginal swabs were collected from 272 women (99%), and 170 (64%) were colonized with a potential pathogen: 49% with E. coli, 5% with GBS, and 8% with Enterococcus. There was no difference in maternal and fetal clinical outcomes between those colonized and not colonized. The number of hours in labor was a significant independent risk factor for vaginal colonization (aOR 1.02, 95% CI 1.00–1.03, P=0.04). Overall, 38% of GBS was resistant to penicillin; 61% of E. coli was resistant to ampicillin, 4% to gentamicin, and 5% to ceftriaxone and cefepime. All enterococci were ampicillin and vancomycin susceptible. Conclusion There was no difference in maternal or neonatal morbidity between women with vaginal colonization with E. coli, GBS, and Enterococcus and those who were not colonized. Duration of labor was associated with increased risk of vaginal colonization in women with obstructed labor.

Maternal vaginal colonization with selected potential pathogens of neonatal sepsis in the era of antimicrobial resistance, a single center experience from Sri Lanka

BackgroundMaternal vaginal colonization with antibiotic resistant organisms is a growing concern in countries with high antibiotic resistance rates.MethodsA low vaginal swab was collected from mothers on admission, on discharge and a peri-rectal swab was collected from the neonates born to these mothers on discharge. Routine microbiological methods were used to identify the colonization rates for Escherichia coli, Klebsiella spp. and Streptococcus agalactiae.ResultsThe pre-delivery colonization rate among the 250 participants for total Enterobacteriaceae was 18.8%. The colonization rates for Klebsiella spp., E. coli and S. agalactiae were, 12.4, 5.6 and 14.8% respectively. Two Klebsiella spp. and two E. coli isolates were confirmed to be exentend spectrum β lactamase (ESBL) producers with the commonest resistant determinant being blaCTX-M. Post-delivery swabs were collected from 130 participants and the colonization rates were 41.5% for Enterobacteriaceae, 25.4% for Klebsiella spp., 10.8% for E. coli, and 10.8% for S. agalacteiae. Three Klebsiella isolates and one E. coli isolate were confirmed to be ESBL producers with the commonest resistant determinant being blaCTX-M. Considering the 130 participants with both samples, there was a significant increase in the colonization with any Enterobacteriaceae and Klebsiella spp. (p < 0.05). Peri-rectal swabs were collected from neonates in 159 instances. The isolation rates for Enterobacteriaceae was 34%. The genus specific isolation rate for Klebsiella was 21.4% while the rates for E. coli and S.agalactiae were 10.1 and 5.7% respectively. Two of the E. coli were confirmed to be ESBL producers while none of the klebsiellae were identified to be so. Considering these 159 instances where both the mother and baby were sampled, random amplification of polymorphic DNA (RAPD) analysis revealed that Enterbacteriaceae with same strain type was present in 6.9% of the instances, indicating possible transfer between the mother and neonate. The transfer rate for ESBL producers were 0.6%.ConclusionsThe lower level of antimicrobial resistance among these potentially community acquired isolates is encouraging. However, in view of the increasing level of resistance reported elsewhere in the region, regular monitoring is warranted.

Coassociation between Group B Streptococcus and Candida albicans Promotes Interactions with Vaginal Epithelium.

Group B Streptococcus (GBS) is a leading cause of neonatal sepsis, pneumonia, and meningitis worldwide. In the majority of cases, GBS is transmitted vertically from mother to neonate, making maternal vaginal colonization a key risk factor for neonatal disease. The fungus Candida albicans is an opportunistic pathogen of the female genitourinary tract and the causative agent of vaginal thrush. Carriage of C. albicans has been shown to be an independent risk factor for vaginal colonization by GBS. However, the nature of interactions between these two microbes is poorly understood. This study provides evidence of a reciprocal, synergistic interplay between GBS and C. albicans that may serve to promote their cocolonization of the vaginal mucosa. GBS strains NEM316 (serotype III) and 515 (serotype Ia) are shown to physically interact with C. albicans, with the bacteria exhibiting tropism for candidal hyphal filaments. This interaction enhances association levels of both microbes with the vaginal epithelial cell line VK2/E6E7. The ability of GBS to coassociate with C. albicans is dependent upon expression of the hypha-specific adhesin Als3. In turn, expression of GBS antigen I/II family adhesins (Bsp polypeptides) facilitates this coassociation and confers upon surrogate Lactococcus lactis the capacity to exhibit enhanced interactions with C. albicans on vaginal epithelium. As genitourinary tract colonization is an essential first step in the pathogenesis of GBS and C. albicans, the coassociation mechanism reported here may have important implications for the risk of disease involving both of these pathogens.

Maternal vaginal flora during labor and its effect on gestational age and birthweight of neonates

Background: Identification of the abnormal colonization of the genital tract by a culture based approach has been recommended by the CDC 2000. This will definitely aid in the early recognition of mothers who need to be effectively treated which in turn will prevent newborn infections. Objectives were to study the pattern of maternal vaginal flora in labor and to study the outcome in the neonate.Methods: This study was conducted on 250 mothers in labor and their babies followed up till discharge in the departments of OBG and neonatology in a tertiary care medical college hospital, Deliveries by caesarean section were excluded.Results: Of the 250 babies, 70 were small for gestational age (SGA) and of these 60 (85.71%) were born to colonized mothers; whereas among the appropriate for gestation (AGA) babies, 110 (61.11%) were those born to non-colonised mothers. A statistically significant association was found between SGA babies and maternal colonization. Whereas relation between maternal colonization and gestational age did not show a statistically significant difference.Conclusions: This study shows us that maternal vaginal colonisation in labor significantly impacted the baby's weight with increase in small for gestational age babies being more among the colonised mothers. Hence, finding the organism in the maternal vaginal flora and treating it as per sensitivity might result in lesser incidence of SGA babies.