Maternal Recto-Vaginal Organisms and Surface Skin Colonization in Infants

Early-onset sepsis is a common cause of neonatal mortality and mainly occurs due to the colonized microorganisms in the maternal recto-vaginal area. The present study aimed to evaluate the effects of maternal risk factors on recto-vaginal colonization and transmission rate of micro-flora from mothers to infants.
Upon admission, two samples were obtained from the distal third of vagina and rectum of mothers using sterile cotton swabs. Six hours after birth, sterile swab samples were collected from the external ear canal, nose, groin, and umbilicus of the infants. The samples were transferred to the laboratory on Stuart transport medium. Afterwards, the samples were transferred to standard culture media within 24 hours. Transmission rate of organisms was calculated based on the maternal and neonatal findings.
In total, 13 bacterial and fungal species were detected in the samples. Escherichia coli was the most frequent gram-negative organism in the rectal and vaginal cultures (29.34%) with the transmission rate of 49.4% to the infants. Infants of the mothers with premature rupture of membranes (PROM) had significant Enterobacter cloacaecolonization. In addition, frequency of Candida albicans was higher in the mothers with gestational hypertension (21.4%) compared to non-hypertensive women (4.9%). Infants requiring advanced cardiopulmonary resuscitation (CPR) had significantly higher E. coli colonization (45.1%) compared to those not needing CPR (27.6%).
According to the results, gram-negative bacteria (E. coli and Enterobacteriaceae ) were the most frequent organisms in the maternal recto-vaginal area and body surface of the neonates in our clinical setting. Therefore, chemoprophylaxis is recommended for these organisms in prolonged PROM.