Cervical amniotic fluid bacterial colonization, antibiotic susceptibility and associated factors among women with premature rupture of membranes at Mbarara Regional Referral Hospital, Southwestern Uganda

Abstract

Background: Bacterial colonization is a recognized cause of premature rupture of membranes (PROM), a predictor of poor maternal and fetal outcomes. Despite routine use of antibiotics in women with PROM, data on antibiotic susceptibility patterns in Uganda are limited. We determined the prevalence and associated factors of cervical amniotic fluid bacterial colonization, and described the bacterial isolates and antibiotic susceptibility patterns among women seeking care at Mbarara Regional Referral Hospital (MRRH) in Southwestern Uganda. Methods: We conducted a cross-sectional study at MRRH from December 21, 2020 to June 12, 2021. We consecutively enrolled women with PROM at ≥ 24 weeks of gestation, and aseptically picked two endocervical swabs irrespective of prior antibiotic use. Aerobic cultures were performed on blood, chocolate, MacConkey agars and incubated at 35–37◦C for 24–72 hours. Polymerase chain reaction (PCR) was performed on culture-negative samples. Antibiotic susceptibility was performed via Kirby-Bauer disk diffusion and dilution method. Interviewer-administered questionnaires were used to obtain participants’ characteristics. We performed multivariable logistic regression to determine factors associated with bacterial colonization. Results: We enrolled 144 participants with mean age of 26.5 ± 6.2 years. Prevalence of cervical amniotic bacterial colonisation was 35.4% (n = 51; 95%CI: 28.0–43.7). Six bacteria were isolated: Klebsiella pneumoniae (n = 15; 34.1%), Staphylococcus aureus (n = 11; 25.0%), Enterobacter agglomerans (n = 10; 22.7%), Escherichia coli (n = 3; 6.8%), Streptococcus spp (n = 3; 6.8%), and Enterococcus faecalis (n = 2; 4.6%). Ciprofloxacin exhibited the highest sensitivity (88.6%), followed by cefuroxime (75%), while all isolated bacteria demonstrated resistance to ampicillin. Factors independently associated with cervical amniotic fluid bacterial colonisation were prime gravidity (aOR = 2.69; 95%CI: 1.07–6.71, p = 0.035), obesity (aOR = 3.15; 95%CI: 1.10–9.11, p = 0.024) and being referred-in (aOR = 2.37; 95% CI: 1.04–5.3, p = 0.038). Conclusion: Approximately one-third of the women had cervical amniotic fluid bacterial colonization, with all the bacterial isolates being resistant to ampicillin —the recommended first line of treatment for PROM by the Ministry of Health. There is a need to review the guidelines for the prophylactic use of ampicillin in PROM in our setting. Revising treatment protocols and considering alternative antibiotics based on local resistance patterns could improve patient outcomes and prevent complications associated with ineffective antibiotic therapy in the context of PROM.