Vaginal culture examinations
Since 2010, our institution has introduced a practice protocol in which upper vaginal culture is routinely performed for high-risk patients diagnosed with pPROM, PTL, IIOC, and short CL. Vaginal culture samples were collected under sterile technique using a sterile swab and a sterile non-lubricated speculum and transported to the laboratory for analysis using a suitable transportation medium. The samples were Gram-stained and cultured according to the standard laboratory procedures of our institution. They were directly inoculated on a blood agar plate, MacConkey agar plate, and Thayer–Martin agar plate and incubated at 35°C for up to 72 h in a 5% CO2 incubator. Antimicrobial susceptibility testing, including that for ESBL-E activity, was performed using the VITEK 2 system (bioMérieux, Hazelwood, MO). Cefepime, cefotaxime, ceftazidime, cefepime/clavulanic acid, cefotaxime/clavulanic acid, and ceftazidime/clavulanic acid were included in the ESBL-E testing using the VITEK 2 system. There was no significant change in the diagnostic method for ESBL-E during the study period.