Vaginal dysbiosis increases risk of PPROM, neonatal sepsis and is exacerbated by erythromycin

To understand the dynamics of vaginal microbiota compositions associated with PPROM and the impact by antibiotics, the study 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: vaginal dysbiosis characterised by Lactobacillus spp. depletion was present prior to the rupture of fetal membranes in approximately a third of cases and persisted following membrane rupture. Vaginal dysbiosis was exacerbated by erythromycin treatment particularly in women initially colonised by Lactobacillus spp. Lactobacillus depletion and increased relative abundance of Sneathia spp. were associated with subsequent funisitis and early onset neonatal sepsis. 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.