Abstract:
Preterm prelabour rupture of membranes (PPROM) is a common obstetric condition occurring in 3%-4.5% of pregnancies. The significance of PPROM is that it is the leading cause of preterm birth which is a major risk factor for neonatal mortality and morbidity. amniotic fluid infections caused by ascending microbes from the genital tract play a major role in leading to PPROM. these ascending infections are treated by antibiotics which also reduce the inflammatory process elicited by them. Antibiotics have shown to prolong pregnancy and reduce neonatal morbidity. The drug of choice in PPROM is erythromycin however other drugs including ampicillin, cotrimoxazole and co-amoxiclav are used. The rise of antibiotic resistance and adverse effects associated with antibiotics used in PPROM, has led to the need for new antimicrobial agents such as Malaysian propolis. In this study, we assessed the susceptibility of 42 clinical isolates from PPROM patients to Malaysian propolis including isolates that possessed antibiotic resistant plasmids. Propolis susceptibility was investigated at 100 μg/mL, 500 μg/mL,1000 μg/mL using agar dilution method. Bacteriostatic/Bactericidal effect was investigated in broth. Antibiotic susceptibility of antibiotics to PPROM isolates was assessed using gentamicin 10ug (CN), chloramphenicol 30ug (C), cotrimoxazole 25ug (SXT), ceftriaxone 30ug (CRO), ampicillin 10ug (AMP), erythromycin 15ug(E) and co-amoxiclav 30ug (AMC). Plasmid curing agents Ethidium bromide, Acridine orange and Sodium dodecyl sulfate at a concentration of 200 μg/mL, were used to identify presence of antibiotic resistant plasmids in the clinical isolates.
Results from the study showed Malaysian propolis was effective for 62% of the isolates while 38% were resistant. Propolis was effective against Gram-positive isolates namely, Staphylococcus aureus, Enterococcus faecalis, Group B streptococcus, Clostridium spp, Corynebacterium spp, Bacillus spp, however, Gram-negative isolates, Escherichia coli and Klebsiella pneumoniae were resistant. Legionella pneumophila was the only Gramnegative isolate susceptible to propolis. Candida albicans isolates were susceptible to propolis. Overall propolis had a bacteriostatic effect on most susceptible clinical isolates. Compared to the antibiotics used in the study, propolis was more effective than erythromycin, ampicillin, cotrimoxazole and ceftriaxone which encountered high resistance against clinical isolates. Chloramphenicol and co-amoxiclav were more effective than propolis. Plasmids were present in all clinical isolates including those susceptible to propolis. Ethidium bromide was most effective at curing plasmids compared to acridine orange and sodium dodecyl sulfate.
In closing, propolis was effective in majority of clinical isolates of PPROM, it was a more effective treatment than erythromycin, ampicillin and cotrimoxazole which are first line antibiotics used in PPROM. Furthermore, plasmids were present in the clinical isolates successfully treated with propolis.
