Maternal Recto-Vaginal Organisms and Surface Skin Colonization in Infants


1 Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, Iran

2 Infertility and Health Reproductive Research Center, Babol University of Medical Sciences, Babol, Iran

3 Clinical Research Development Unit of Rohani Hospital, Babol University of Medical Sciences, Babol, Iran

4 Babol University of Medical Sciences, Babol, Iran

5 6Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran 7 Department of Statistic and Epidemiology, Babol University of Medical Sciences, Babol, Iran.


Background: 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.
Methods: 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.
Results: 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%).
Conclusion: 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.


1. Neu J, Rushing J. Cesarean versus vaginal delivery: long-term infant outcomes and the hygiene hypothesis. Clin Perinatol. 2011; 38(2):321-31.
2. Shah BA, Padbury JF. Neonatal sepsis: an old problem with new insights. Virulence. 2014; 5(1):170-8.
3. Ganatra HA, Stoll BJ, Zaidi AK. International perspective on early-onset neonatal sepsis. Clin Perinatol. 2010; 37(2):501-23.
4. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014; 27(1):21-47.
 5. Schuchat A, Zywicki SS, Dinsmoor MJ, Mercer B, Romaguera J, O'sullivan MJ, et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics. 2000; 105(1):21-6.
 6. Mosayebi Z, Movahedian AH, Soori T. Clinical and bacteriological characteristics of neonatal sepsis in an inten-sive care unit in Kashan, Iran: a 2 year descriptive study. Arch Pediatr. 2013; 1(2):62.
 7. Baltimore RS. Neonatal sepsis: epidemiology and management. Pediatr Drugs. 2003; 5(11):723-40.
 8. Torkaman M, Afsharpaiman S, Hoseini M, Moradi M, Mazraati A, Amirsalari S, et al. Platelet count and neonatal sepsis: a high prevalence of Enterobacter spp. Singapore Med J. 2009; 50(5):482-5.
9. Bhat R, Lewis LE, Vandana K. Bacterial isolates of early-onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: an audit from a center in India. Ital J Pediatr. 2011; 37(1):32.
 10. Afsharpaiman S, Torkaman M, Saburi A, Farzaampur A, Amirsalari S, Kavehmanesh Z. Trends in incidence of neonatal sepsis and antibiotic susceptibility of causative agents in two neonatal intensive care units in Tehran, IR Iran. J Clin Neonatol. 2012; 1(3):124-30.
11. Hamedi A, Akhlaghi F, Seyedi SJ, Kharazmi A. Evaluation of group B Streptococci colonization rate in pregnant women and their newborn. Acta Med Iran. 2012; 50(12):805-8.
12. Aftab R, Iqbal I. Bacteriological agents of neonatal sepsis in NICU at Nishtar Hospital Multan. J Coll Physicians Surg Pak. 2006; 16(3):216-9.
13. Kerur BM, Vishnu Bhat B, Harish B, Habeebullah S, Uday Kumar C. Maternal genital bacteria and surface colonization in early neonatal sepsis. Indian J Pediatr. 2006; 73(1):29-32.
14. Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics. 2011; 127(5):817-26.
 15. Top KA, Buet A, Whittier S, Ratner AJ, Saiman L. Predictors of staphylococcus aureus rectovaginal colonization in pregnant women and risk for maternal and neonatal infections. J Pediatr Infect Dis Soc. 2012; 1(1):7-15.
 16. Karambin M, Zarkesh M. Entrobacter, the most common pathogen of neonatal septicemia in Rasht, Iran. Iran J Pediatr. 2011; 21(1):83-7.
17. Parm Ü, Metsvaht T, Sepp E, Ilmoja ML, Pisarev H, Pauskar M, et al. Risk factors associated with gut and nasopharyngeal colonization by common Gramnegative species and yeasts in neonatal intensive care units patients. Early Huma Dev. 2011; 87(6):391-9.
18. Akhlaghi F, Hamedi A, Mahbobeh NN. Comparison of group B streptococcal colonization in the pregnant diabetic and non-diabetic women. Acta Med Iran. 2009; 47(2):103-8.
 19. Hadavand S, Ghafoorimehr F, Rajabi L, Davati A, Zafarghandi N. Frequency of Group B Streptococcal colonization in pregnant women aged 35-37 weeks in clinical centers of Shahed University, Tehran, Iran. Iran J Pathol. 2015; 10(2):120-6.
 20. Raimer K, O'sullivan MJ. Influence of diabetes on group B Streptococcus colonization in the pregnant patient. J Matern Fetal Medicin. 1997; 6(2):120-3.
21. Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev. 2014; 35(10):417-28.
22. Alam MM, Saleem AF, Shaikh AS, Munir O, Qadir M. Neonatal sepsis following prolonged rupture of membranes in a tertiary care hospital in Karachi, Pakistan. J Infect Dev Ctries. 2014; 8(1):67-73.
 23. Mulla ZD, Carrillo T, Kalamegham R, Hernandez LL, Portugal E, Nuwayhid BS. Is maternal colonization with group B streptococci a risk factor for preeclampsia? J Reprod Med. 2015; 60(3-4):117-26.
24. Mulla Z, Annavajjhala V, Gonzalez-Sanchez J, Simon M, Nuwayhid B. Group B streptococcal colonization and the risk of pre-eclampsia. Epidemiol Infect. 2013; 141(5):1089-98.
25. Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Neonatal Med. 2009; 22(2):124-8.
26. Lawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC Pregnancy Childbirth. 2010; 10(1):S1.
 27. Stoll BJ, Hansen NI, Higgins RD, Fanaroff AA, Duara S, Goldberg R, et al. Very low birth weight preterm infants with early onset neonatal sepsis: the predominance of gram-negative infections continues in the National Institute of Child Health and Human Development Neonatal Research Network, 2002-2003. Pediatr Infect Dis J. 2005; 24(7):635-9.
 28. Verma P, Berwal PK, Nagaraj N, Swami S, Jivaji P, Narayan S. Neonatal sepsis: epidemiology, clinical spectrum, recent antimicrobial agents and their antibiotic susceptibility pattern. Int J Contemporary Pediatr. 2017; 2(3):176-80.
29. Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. Obstet Gynecol Sur. 2003; 58(1):17-8.