Amnionitis with Ureaplasma urealyticum or other microbes leads to increased morbidity and prolonged hospitalization in very low birth weight infants
Amnionitis with Ureaplasma urealyticum or other microbes leads to increased morbidity and prolonged hospitalization in very low birth weight infants
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DOI：
10.1016/j.ejogrb.2006.09.013
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发表时间：
2007-09-01
影响因子：
2.6
通讯作者：
Zaknun, Daniela
中科院分区：
文献类型：
--
作者：
Kirchner, Lieselotte;Helmer, Hanns;Zaknun, Daniela
目的：探讨文化证实的宫内感染对早产发病率的影响，并测试抗菌治疗的效果。方法：回顾性队列研究进行了1997年10月至2001年2月之间的早产胎膜早破或早产的患者。采集阴道拭子样本并进行羊水穿刺术以进行羊水微生物培养。用交沙霉素治疗羊水中解脲脲原体的患者。婴儿产后根据出生体重，胎龄，APGAR评分和婴儿morbidity.Results：在49个合格的患者，40%的文化是阳性的，22%的解脲支原体，12%的其他细菌和6%的念珠菌。羊水培养阳性母亲的儿童胎龄显著较低（溶脲脲原体为26+4周[p = 0.04]，其他微生物为25+5周[p = 0.0017]，而羊水培养阴性母亲为28+6周），出生体重较低（975 g [n.s.]和828 g [p = 0.0072] vs. 1041 g），但适合其胎龄。33.3%和66.7% vs 24%的儿童接受了机械通气[n.s.]，机械通气持续时间分别为5.3天[p = 0.02]和10.1天[p = 0.04]与1.4天，慢性肺病患病率分别为38%和33%与11% [n.s.]。重度脑室内出血的患病率（12.5% [n.s.]和33% [p = 0.04]对比3.4%）和医院感染（两组阳性培养物均为50%，阴性培养物均为10.3%，p = 0.02和0.03，在这些患者中，平均住院时间（分别为121 [p = 0.02]和107天[p = 0.03] vs 60天）更长。母体阳性阴道拭子培养物与上述任何因素均无关。在没有大环内酯类药物治疗的患者证明解脲脲原体肺炎的微生物可以根除。结论：母亲阳性羊水培养已与较低的胎龄和出生体重较低。本组婴儿发病率较高，住院时间明显延长。阳性阴道拭子不能预测婴儿发病率。对羊水培养阳性的孕妇，用大睑球蚴治疗无效。(C)2006爱思唯尔爱尔兰有限公司保留所有权利。
Objective: To investigate the influence of culture proven intrauterine infection on preterm morbidity and to test the effect of antimicrobial treatment.Methods: Retrospective cohort study conducted between October 1997 and February 2001 in patients with preterm premature rupture of membranes or preterm labor. Vaginal swabs were sampled and amniocentesis for microbiologic culture of the amniotic fluid was per-formed. Patients with Ureaplasma urealyticum in the amniotic fluid were treated with josamycin. Infants were followed postpartum according to birth weight, gestational age, APGAR score and infant morbidity.Results: In 49 eligible patients, 40% of cultures were positive, 22% for Ureaplasma urealyticum, 12% for other bacteria and 6% for candida. Children of mothers with positive amniotic fluid cultures had significantly lower gestational ages (26+4 weeks for Ureaplasma urealyticum [p = 0.04] and 25+5 weeks for other microorganisms [p = 0.0017] versus 28+6 weeks for mothers with negative amniotic fluid cultures) and lower birth weights (975 g [n.s.] and 828 g [p = 0.0072] versus 1041 g) but were appropriate for their gestational ages. 33.3% and 66.7% versus 24% of the children were mechanically ventilated [n.s.], duration of mechanical ventilation was 5.3 [p = 0.02] and 10.1 days [p = 0.04] versus 1.4 days, and prevalence of chronic lung disease was 38% and 33% versus 11% [n.s.]. Prevalence of severe intraventricular hemorrhage (12.5% [n.s.] and 33% [p = 0.04] versus 3.4%) and nosocomial infections (50% for both groups of positive cultures versus 10.3% for negative cultures, p = 0.02 and 0.03, respectively) was higher and median length of stay was significantly longer (121 [p = 0.02] and 107 days [p = 0.03] versus 60 days) in these patients. Maternal positive vaginal swab cultures were not associated with any of the above-mentioned factors. In none of the patients treated with macrolids for proven Ureaplasma urealyticum amnionitis could the microbes be eradicated.Conclusion: Maternal positive amniotic fluid cultures have been associated with lower gestational age and lower birth weight. Rate of infant morbidity was higher and length of stay was significantly longer in this group. Positive vaginal swabs were not predictive for infant morbidity. Treatment of mothers showing positive amniotic fluid cultures with macrolids was not effective. (C) 2006 Elsevier Ireland Ltd. All rights reserved.