Antibiotic susceptibility of genital tract isolates in pregnant women with premature pre-labour rupture of membranes (PPROM) in a low-resource setting

Abstract

Premature pre - labour rupture of membranes (PPROM) is a significant obstetric complication that contributes to preterm births, maternal infections, and neonatal morbidity. The role of genital tract infections in the etiology of PPROM is well established, yet data on microbial isolates and antibiotic susceptibility patterns in resource-limited settings remain scarce. This study aimed to determine the microbial profile and antibiotic resistance patterns among women with PPROM in Sudan. A hospital-based case–control study was conducted at Omdurman Maternity Hospital, Sudan, from June to December 2022. A total of 140 participants were enrolled, including 70 women with PPROM and 70 gestational age–matched controls without PPROM. Endocervical swabs were collected under sterile conditions and cultured for microbial identification. Antibiotic susceptibility testing was performed using the disk diffusion method following CLSI 2021 guidelines. Data were analysed using SPSS version 25, and associations were assessed using odds ratios (OR) with 95% confidence intervals (CI); p < 0.05 was considered statistically significant. Positive cultures were significantly more frequent among PPROM patients (60.0%) than controls (27.1%) (OR = 4.03; 95% CI: 1.98–8.20; p < 0.001). The predominant isolates in PPROM cases were Staphylococcus aureus (34.3%; OR = 11.47; 95% CI: 3.20–62.94; p < 0.001), Enterobacter spp. (12.9%; OR = 4.97; 95% CI: 0.97–49.00; p = 0.055), and Escherichia coli (11.4%). In contrast, Candida albicans was more common in controls (12.9%; OR = 0.10; 95% CI: 0.002–0.75; p = 0.017). Antibiotic susceptibility testing showed high resistance to amoxicillin and amoxiclav, while cefotaxime (95.8% susceptibility for S. aureus ) and erythromycin (87.5% for E. coli ) were the most effective agents. Genital tract infections play a significant role in PPROM, with Staphylococcus aureus , E. coli , and Enterobacter spp. being the predominant isolates. The high prevalence of in vitro resistance, particularly to penicillins, supports the need for continuous antimicrobial surveillance and periodic review of empirical regimens. As pregnancy and neonatal outcomes were not assessed, these findings should be interpreted as microbiological observations that may help inform, but do not by themselves establish, screening or treatment policies in low-resource settings.