179
IRUS Total
Downloads

Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin

File Description SizeFormat 
s12916-017-0999-x.pdfPublished version5.79 MBAdobe PDFView/Open
Title: Vaginal dysbiosis increases risk of preterm fetal membrane rupture, neonatal sepsis and is exacerbated by erythromycin
Authors: MacIntyre, DA
Brown, R
Marchesi, J
Lee, Y
Smith, A
Lehne, B
Kindinger, L
Terzidou, V
Holmes, E
Nicholson, J
Bennett, P
Item Type: Journal Article
Abstract: Background: 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 composition associated with PPROM and the impact of antibiotics on bacterial composition is unknown. Methods: 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. Results: 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% versus 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 species. Lactobacillus depletion and increased relative abundance of Sneathia spp. was associated with subsequent funisitis and early onset neonatal sepsis. Conclusions: 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.
Issue Date: 24-Jan-2018
Date of Acceptance: 20-Dec-2017
URI: http://hdl.handle.net/10044/1/55525
DOI: 10.1186/s12916-017-0999-x
ISSN: 1741-7015
Publisher: BioMed Central
Journal / Book Title: BMC Medicine
Volume: 16
Copyright Statement: © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
Biotechnology and Biological Sciences Research Council (BBSRC)
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
Kristian Gerhard Jebsen Foundation
Bowel & Cancer Research
National Institute for Health Research
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Seattle ChildrensHospital Research Foundation
The Academy of Medical Sciences
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial College Healthcare NHS Trust- BRC Funding
Imperial Health Charity
Medical Research Council
Medical Research Council (MRC)
Imperial College London
St Stephen's Aids Trust
National Institute for Health Research
Funder's Grant Number: MR/L009226/1
MR/L009226/1
RDD03 79560
BB/L020858/1
BH124127
RDA01 79560
None Given
N/A
EME/13/121/07
RDA05 79560
RDB04
N/A
Springboard
RDA27
RDA27
RDA27
RDA27
RDA02
RF17/1011
MR/R00875/1
MR/R000875/1
SSAT054
EME/13/121/07
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Vaginal microbiota
Preterm birth
Preterm prelabour rupture of membranes
Antibiotics
Erythromycin
Neonatal sepsis
Pregnancy
PREMATURE RUPTURE
BACTERIAL-VAGINOSIS
ANTIMICROBIAL SUSCEPTIBILITY
INTRAAMNIOTIC INFLAMMATION
CHILDHOOD OUTCOMES
ANTIBIOTIC-THERAPY
PRELABOR RUPTURE
MICROBIOTA
BIRTH
CHORIOAMNIONITIS
Antibiotics
Erythromycin
Neonatal sepsis
Pregnancy
Preterm birth
Preterm prelabour rupture of membranes
Vaginal microbiota
Adult
Antibiotic Prophylaxis
Cohort Studies
Disease Progression
Dysbiosis
Erythromycin
Female
Fetal Membranes, Premature Rupture
Humans
Infant, Newborn
Microbiota
Neonatal Sepsis
Pregnancy
Premature Birth
Prenatal Care
RNA, Bacterial
RNA, Ribosomal, 16S
Risk Factors
Vagina
Vagina
Humans
Fetal Membranes, Premature Rupture
Premature Birth
Disease Progression
Erythromycin
RNA, Bacterial
RNA, Ribosomal, 16S
Antibiotic Prophylaxis
Prenatal Care
Risk Factors
Cohort Studies
Pregnancy
Adult
Infant, Newborn
Female
Microbiota
Dysbiosis
Neonatal Sepsis
11 Medical and Health Sciences
General & Internal Medicine
Publication Status: Published
Article Number: 9
Online Publication Date: 2018-01-24
Appears in Collections:Department of Metabolism, Digestion and Reproduction
Faculty of Medicine
School of Public Health