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- Title
Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin.
- Authors
Brown, Richard G.; Marchesi, Julian R.; Lee, Yun S.; Smith, Ann; Lehne, Benjamin; Kindinger, Lindsay M.; Terzidou, Vasso; Holmes, Elaine; Nicholson, Jeremy K.; Bennett, Phillip R.; MacIntyre, David A.
- Abstract
<bold>Background: </bold>Preterm prelabour rupture of the fetal membranes (PPROM) precedes 30% of preterm births and is a risk factor for early onset neonatal sepsis. As PPROM is strongly associated with ascending vaginal infection, prophylactic antibiotics are widely used. The evolution of vaginal microbiota compositions associated with PPROM and the impact of antibiotics on bacterial compositions are unknown.<bold>Methods: </bold>We prospectively assessed vaginal microbiota prior to and following PPROM using MiSeq-based sequencing of 16S rRNA gene amplicons and examined the impact of erythromycin prophylaxis on bacterial load and community structures.<bold>Results: </bold>In contrast to pregnancies delivering at term, vaginal dysbiosis characterised by Lactobacillus spp. depletion was present prior to the rupture of fetal membranes in approximately a third of cases (0% vs. 27%, P = 0.026) and persisted following membrane rupture (31%, P = 0.005). Vaginal dysbiosis was exacerbated by erythromycin treatment (47%, P = 0.00009) particularly in women initially colonised by Lactobacillus spp. Lactobacillus depletion and increased relative abundance of Sneathia spp. were associated with subsequent funisitis and early onset neonatal sepsis.<bold>Conclusions: </bold>Our data show that vaginal microbiota composition is a risk factor for subsequent PPROM and is associated with adverse short-term maternal and neonatal outcomes. This highlights vaginal microbiota as a potentially modifiable antenatal risk factor for PPROM and suggests that routine use of erythromycin for PPROM be re-examined.
- Subjects
PREMATURE labor; FETAL membranes; NEONATAL sepsis; ANTIBIOTICS; ERYTHROMYCIN; THERAPEUTICS; RNA analysis; COMPARATIVE studies; DEGENERATION (Pathology); PREMATURE infants; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; PREGNANCY complications; PRENATAL care; RESEARCH; RESEARCH funding; VAGINA; EVALUATION research; DISEASE progression; ANTIBIOTIC prophylaxis; DISEASE complications
- Publication
BMC Medicine, 2018, Vol 16, Issue 1, p1
- ISSN
1741-7015
- Publication type
journal article
- DOI
10.1186/s12916-017-0999-x