Intra-amniotic infection (IAI) is a major cause of preterm birth with a poor perinatal prognosis. We aimed to determine whether analyzing vaginal microbiota can evaluate the risk of chorioamnionitis (CAM) in preterm labor cases. Vaginal discharge samples were collected from 83 pregnant women admitted for preterm labor. Based on Blanc’s classification, the participants were divided into CAM (stage ≥ II; n = 46) and non-CAM (stage ≤ I; n = 37) groups. The 16S rDNA amplicons (V1–V2) from vaginal samples were sequenced and analyzed. Using a random forest algorithm, the bacterial species associated with CAM were identified, and a predictive CAM (PCAM) scoring method was developed. The α diversity was significantly higher in the CAM than in the non-CAM group (P < 0.001). The area under the curve was 0.849 (95% confidence interval 0.765–0.934) using the PCAM score. Among patients at < 35 weeks of gestation, the PCAM group (n = 22) had a significantly shorter extended gestational period than the non-PCAM group (n = 25; P = 0.022). Multivariate analysis revealed a significant difference in the frequency of developmental disorders in 3-year-old infants (PCAM, 28%, non-PCAM, 4%; P = 0.022). Analyzing vaginal microbiota can evaluate the risk of IAI. Future studies should establish appropriate interventions for IAI high-risk patients to improve perinatal prognosis.

Background Invasive candidiasis (IC) is a leading cause of morbidity and mortality in preterm infants. The objective of this study was to determine the prevalence of IC infection in newborns in the neonatal intensive care unit (NICU) of a tertiary hospital in Japan, and to identify specific predisposing factors for IC. Methods We retrospectively collected data on demographics, clinical characteristics, and outcomes of infants with IC, who were discharged from a tertiary NICU in Japan between January 2009 and December 2020. We compared predisposing factors associated with the occurrence of early‐onset IC (EOIC < 72 h) and late‐onset IC (LOIC ≥ 72 h) with those of early‐onset and late‐onset bacterial sepsis. Results Between January 2009 and December 2020, 3,549 infants were admitted to the NICU, including 344 extremely‐low birthweight (ELBW) infants. Eleven infants (including nine ELBW infants) had IC (incidence 0.31%), and the mortality rate of IC was 0%. Four (36%) infants had EOIC and seven (64%) had LOIC. All those with EOIC presented with skin lesions and 86% with LOIC had thrombocytopenia. Maternal vaginal Candida colonization was a more specific predisposing factor for EOIC, while gestational age <26 weeks, broad‐spectrum antibiotic use, prior bacterial infection, prior gastrointestinal (GI) surgery, and GI diseases were more specific predisposing factors for LOIC. Conclusions The findings suggest that maternal vaginal Candida colonization and skin lesions in ELBW infants may contribute to early recognition of EOIC. LOIC should be suspected if ELBW infants with several predisposing factors of LOIC have thrombocytopenia.

Background We investigated the pathogenic, clinical, and laboratory characteristics of children diagnosed with septic arthritis (SA) during the past 24 years and identified the risk factors for SA‐related sequelae. Methods We retrospectively reviewed the records of patients admitted to Fukuoka University Hospital from 1997 to 2020. Causative pathogens were compared between the first (1997–2008) and second (2009–2020) periods. We also compared the clinical and laboratory characteristics in patients with known or unknown pathogens, and in patients with or without sequelae. Results A total of 37 patients with SA were identified, including 28 patients (76%) in the first period and nine patients (24%) in the second period. Sixteen of 37 patients (43%) were younger than 2 years, including two neonates. Pathogens were identified in 25 (68%) of 37 patients. Patients with known pathogens had a significantly higher C‐reactive protein level on admission than those with unknown pathogens (P < 0.05). The predominant pathogen was Staphylococcus aureus (38%, 14/37). Although S. aureus and Hemophilus influenzae type b (Hib) were predominant pathogens in the first period, Hib was not found in the second period. Six (16%) of 37 patients with SA experienced sequelae. Moreover, the risk factors for the development of sequelae were significantly associated with infection at age <1 month and delayed surgical treatment (>4 days). Conclusions The incidence of SA had decreased dramatically in the second period, and Hib was no longer the predominant pathogen. Earlier surgical drainage should be performed in neonates with SA.

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