Vaginal Colonization and Aerobic Vaginitis  by Enterococcus spp. in Third-Trimester  Pregnant Women in Taiz, Yemen

Waheed A.M. Ali; Gamela H.S.S. Alrohaidy; Rawdah Aljady; Samera Alkhulaidi

Vaginal Colonization and Aerobic Vaginitis by Enterococcus spp. in Third-Trimester Pregnant Women in Taiz, Yemen

Authors

Waheed A.M. Ali MD (Medical Microbiology & Immunology), Associate Professor of Medical Microbiology & Immunology, Vice Dean, Faculty of Medicine and Health Sciences, Taiz University, and Dean, Faculty of Medical and Health Sciences, Al-Saeed University, Taiz, Yemen
Gamela H.S.S. Alrohaidy BSc (Medical Laboratory Sciences), Lecturer, Medical Laboratory Sciences Department, High Institute for Health Sciences Taiz Branch, Taiz, Yemen
Rawdah Aljady PhD (Microbiology), Assistant Professor and Head, Department of Microbiology, Faculty of Applied Sciences Taiz University, Taiz, Yemen
Samera Alkhulaidi MD (Gynecology & Obstetrics), Associate Professor, Department of Gynecology and Obstetrics, Faculty of Medicine and Health Sciences, Taiz University, Taiz, Yemen

Keywords:

Enterococcus spp, Vaginal colonization, Aerobic vaginitis, Pregnancy, Antimicrobial resistance

Abstract

Introduction: Enterococcus spp. are typically intestinal commensals that may colonize the vagina and are associated with obstetric complications such as preterm birth, low birth weight, and puerperal sepsis. Vancomycin-resistant Enterococci (VRE) have emerged as a global health concern. This study aimed to determine the prevalence of vaginal colonization and aerobic vaginitis (AV) caused by Enterococcus spp., in third-trimester pregnant women in Taiz city, Yemen, and assess the antimicrobial resistance pattern, including inducible clindamycin resistance.

Materials and Methods: This cross-sectional study involved 200 third-trimester pregnant women who attended one of three antenatal clinics in Taiz, Yemen, from April 2023 to June 2024. Vaginal swabs were inoculated on appropriate culture media for isolation. Antimicrobial susceptibility tests were performed by disk diffusion, and AV was diagnosed using Donder's criteria.

Results: Enterococcus species were isolated from 56 (28%) participants. Enterococcus faecium was identified in 30 isolates, and Enterococcus faecalis in 26 isolates. Among the 56 Enterococcus-colonized women, 33 (58.9%) fulfilled Donders’ criteria for AV. Mild AV (81.8%, 27/33) was predominantly associated with E. faecium, while moderate AV (18.2%, 6/33) involved both species equally. Antimicrobial resistance was highest for penicillin G (89.3%), erythromycin (87.5%), and vancomycin (58.9%). Amoxicillin-Clavulanate showed the highest sensitivity (91.1%).

Conclusion: The high burden of multidrug-resistant Enterococcus spp., including vancomycin-resistant strains, underscores the urgent need for antimicrobial stewardship and routine screening for aerobic vaginitis during prenatal care in low-resource settings.