Vaginal colonisation of women in labour with potentially pathogenic bacteria: a cross sectional study at three primary health care facilities in Central Uganda

Abstract

Background: Potentially pathogenic bacteria that colonise the lower genital tract of women in labour can be passed to the baby during birth. While many babies become colonised with these bacteria after delivery, a few develop neonatal infections. The lower genital tract is a reservoir for potential pathogens and a source of infection for neonates. We determined the prevalence of vaginal colonisation of potentially pathogenic bacteria among women in labour in Central Uganda and identified potential risk factors associated with this colonisation. Methods: We conducted a cross sectional study at three primary health care facilities and collected vaginal swabs from HIV-1 negative women in labour. Specimens were cultured on different selective microbiological media, and biochemical tests were used to classify bacterial isolates on the species level. Multivariable logistic regression analyses were used to estimate the association between relevant exposures and colonisation with potentially pathogenic bacteria. Results: We recruited 1472 women in labour whose mean age was 24.6 years (standard deviation [SD] 4.9). Of these, 955 (64.9%; 95% Confidence Interval [CI] 62.4, 67%) were vaginally colonised with at least one potentially pathogenic bacterial species. The most commonly isolated species were Escherichia coli (n = 508; 34.5%), Klebsiella pneumoniae (n = 144; 9.8%) and Staphylococcus aureus (n = 121; 8.2%). Results from exploratory multivariable regression analyses indicated that having had ≥5 previous pregnancies (adjusted odds ratio [aOR] 0.59; 95% CI 0.35, 0.97) or being ≥30 years old (aOR 1.52; 95% CI 1.03, 2.23) could be associated with vaginal colonisation with any potentially pathogenic bacteria, as well as with vaginal colonisation with S. aureus (aOR 0.33; 95% CI 0.12, 0.88, and aOR 2.17; 95% CI 1.17, 4.00, respectively). Possession of domestic animals in a household (aOR 0.57; 95% CI 0.35, 0.92) could be associated with vaginal colonisation with E. coli. Conclusions: Two-thirds of HIV-1 negative women in labour were vaginally colonised by potentially pathogenic bacteria, mainly E. coli, K. pneumoniae, and S. aureus.

Bacterial Colonization of Vagina in Indian Women During Labor and Its Association With Puerperal and Neonatal Sepsis: A Tertiary Hospital Study

“…The objective was to find out any increased risk of complications like puerperal sepsis and EONS in these subsets of low-risk pregnant women. In the study, CoNS (gram-positive organism) was the most common single isolated organism whereas various studies have reported gram-negative bacteria predominantly [ 8 , 12 ]. The rate of vaginal colonization with maternal age was not found to be different in different age groups (p=0.141).…”

“…The rate of vaginal colonization with maternal age was not found to be different in different age groups (p=0.141). But few studies have reported increased colonization with age, predominantly in >30 years of age [ 8 , 12 ] and some in <20 years of age [ 13 - 14 ]. We did not find any relation between vaginal colonization and BMI (p=0.986) whereas others had found a higher BMI to be a significant risk factor for GBS colonization [ 15 - 17 ].…”

Vaginal colonization with antimicrobial-resistant bacteria among women in labor in central Uganda: prevalence and associated factors

“…We conducted a cross-sectional study between July 2016 and July 2018 at three primary health care facilities in and close to Kampala in central Uganda: Mukono General Hospital (formerly Mukono Health Centre IV), Kawaala Health Centre III, and Kitebi Health Centre III [ 15 ]. This study was nested within the Chlorhexidine Trial, which is a randomized controlled assessing whether a single application of 4% chlorhexidine solution on the umbilical cord stump immediately after birth reduces the risk of omphalitis and severe illness [ 16 ].…”

Colonization Rate of Potential Neonatal Disease-Causing Bacteria, Associated Factors, and Antimicrobial Susceptibility Profile Among Pregnant Women Attending Government Hospitals in Hawassa, Ethiopia

“…our study, a higher proportion of E. coli was reported from South Africa (45.1%), 13 Iran 56.3%), 8 and Uganda (34.5%). 25 On the other hand, the prevalence of E. coli we identified (29.9%) was higher than the prevalence reported from Nigeria (5%), 12 North-eastern India (16.3%), 26 India (19.6%), 17 Sudan (6%), 9 Spain (13%), 27 Sri Lanka (5.6%), 23 and Indonesia (3.3%). 16 The difference could be due to socioeconomic background and contamination during sample collection.…”

“…24 On the other hand, our finding was lower than the prevalence reported from Uganda (55%). 25 The discrepancies could be due to the fact that the current study considered four bacterial species as a potential pathogen for neonatal disease while the other studies considered different types and numbers of bacteria. The variations could also be due to gestational age and laboratory methods used.…”