Mother-infant colonization and neonatal sepsis in prelabor rupture of membranes

OBJECTIVE: This study aims to determine the incidence of prelabor rupture of membranes (PROM) in a tertiary care institution, the bacterial pathogens involved in maternal and neonatal colonization, and the major bacterial pathogens of neonatal sepsis in PROM.

METHODS: This prospective study was conducted over 2 years from March 1999 to February 2001 in Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia. Consecutive admissions of infant-and-mother pairs with PROM constitute the subjects of this survey. Every mother had endocervical swab taken before delivery, and their infants had surface swabs and sepsis screening before starting antibiotic therapy.

RESULTS: The incidence of PROM was 12.6 per 1000 live births. Premature delivery rate was 54.6% while, the overall prematurity rate was 7.2%. The major microorganisms involved in genital colonization of the mothers were coagulase negative Staphylococcus (CONS) (24%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (11.3%) and Enterococcus species (11.3%). The infants were colonized largely with CONS (31%), Klebsiella pneumoniae (18%) and Escherichia coli (E.coli) (17%). Fourteen percent of the infants were infected but in only 6% was septicemia documented (Staphylococcus aureus, 3 cases and 1 case each with CONS, group B Streptococci (GBS) and E.coli). In contrast to Western experience, the incidence of GBS was uncommon in both mothers and infants. The bacterial pattern suggests vancomycin and cefotaxime or aminoglycoside combination as empirical antibiotic therapy for both infected infants and selected contaminated mothers with PROM.

CONCLUSION: Generally, it appears wasteful to routinely admit, screen and empirically treat all infants born after PROM; only ill infants, febrile mothers, or either, with associated chorioamnionitis deserve antibiotic treatment.