Bacterial profile of high vaginal swabs in patients with preterm prelabor rupture of membranes at the Queen Elizabeth Hospital, Barbados and implications for antibiotic management

Aims: The aim of this study was to identify the bacterial organisms found in patients with preterm prelabor rupture of membranes (PPROM) at Queen Elizabeth Hospital (QEH). Hypothesis: “Escherichia coli (E. coli) is the most commonly isolated bacterial organism from high vaginal swabs in patients with PPROM at the Queen Elizabeth Hospital.” Preterm prelabor rupture of membranes refers to membrane rupture before the onset of uterine contractions occurring before 37+0 weeks of gestation. Genital tract infection is an important risk factor of PPROM. Identification of organisms associated with PPROM allows for targeted antibiotic therapy. Methods: A retrospective cohort analysis was done using data from January 2024–December 2024 (12 months), to characterize the microorganisms identified in the high vaginal swabs (HVS) done in women admitted to QEH with a diagnosis of PPROM. A total of 31 women were included in the study. Under aseptic conditions, sterile high vaginal swabs were taken from the posterior fornix of the vagina of each patient. Fisherbrand modified amies charcoal transport medium was used. Swabs were transported to the laboratory within 24 hours of collection and stored at incubation temperatures of 35–37 °C. The samples were cultured on blood agar, Sabouraud Dextrose Agar (SDA), MacConkey agar, and Thayer–Martin agar for microbial isolation. The presence of creamy to white colonies on SDA was used to identify yeast. Gray colonies on blood agar confirmed bacterial vaginosis associated Gardnerella vaginalis. Data were collected from the antenatal ward admissions books and results of HVS were obtained from Schuynet (a web-based laboratory information system used at QEH). Results: Of the 31 women, the results of 29 samples were obtained. Culture growth was present in the high vaginal swabs of 13 women (44.82%; 95% CI: 28.4–62.5%). Three different types of pathogens were identified: yeast in 10 women 34.48% (95% CI: 19.9–52.7%), bacterial vaginosis in 3 women; 10.34% (95% CI: 3.58–26.4%) and Group B Streptococcus in 3 women; 10.34% (95% CI: 3.58–26.4%). Conclusion: Identifying these bacterial patterns is essential for selecting effective antibiotics. These data lead to the question of whether PPROM patients are receiving correctly targeted antibiotic treatment.