Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra-amniotic infection
Antibiotic administration to patients with preterm premature rupture of membranes does not eradicate intra-amniotic infection
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DOI：
10.1080/14767050601135485
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发表时间：
2007-02-01
影响因子：
1.8
通讯作者：
Rojas, Ivan
中科院分区：
文献类型：
--
作者：
Gomez, Ricardo;Romero, Roberto;Rojas, Ivan
Objective.抗生素给药已成为早产胎膜早破（PROM）患者的标准治疗的一部分。然而，抗生素治疗期间宫内感染/炎症的自然史在很大程度上仍然未知。本研究旨在确定母亲使用抗生素是否能根除羊膜内感染和/或降低羊膜内炎症的发生率，羊膜内炎症是即将发生早产/分娩和不良新生儿结局的危险因素。一部分早产胎膜早破患者在抗生素治疗前后接受了羊膜腔穿刺术，以指导临床治疗。羊水分析包括革兰氏染色、需氧菌和厌氧菌以及生殖器支原体培养和羊水白色血细胞（WBC）计数。羊水培养阳性者定义为羊膜腔微生物侵入。羊水内炎症定义为羊水WBC计数≥ 100/mm（3）。患者在妊娠第24周后给予抗生素和类固醇。无羊膜腔炎症或MIAC的患者抗生素治疗包括氨苄青霉素和红霉素7天，有羊膜腔炎症或MIAC的患者抗生素治疗包括头孢曲松、克林霉素和红霉素10-14天。46例首次胎膜早破穿刺术在18 ~ 32周（中位27.4周）之间进行的早产胎膜早破患者被纳入本研究。第一次羊膜腔穿刺术中羊膜内炎症的总患病率为39%（18/46）。7例羊水微生物培养阳性。在第二次羊水穿刺时，羊水培养阳性的7名患者中有6名有微生物。在18名入院时有羊膜内炎症的患者中，只有3名在抗生素治疗后没有炎症的迹象。在入院时无羊膜内炎症证据的患者中，32%（9/28）尽管接受了治疗仍发生炎症。5例羊水培养阳性。(1)抗生素给药（头孢曲松、克林霉素和红霉素）很少能根除早产胎膜早破患者的羊膜内感染;（2）三分之一入院时无炎症的患者，尽管使用了抗生素，仍发生了羊膜内炎症;（3）一个子--一组有羊膜腔炎症记录的患者在抗生素治疗后，局
Objective. Antibiotic administration has become part of the standard of care for patients with preterm premature rupture of membranes (PROM). Yet, the natural history of intrauterine infection/inflammation during antibiotic therapy remains largely unknown. This study was conducted to determine if antibiotic administration to the mother eradicates intra-amniotic infection and/or reduces the frequency of intra-amniotic inflammation, a risk factor for impending preterm labor/delivery and adverse neonatal outcome.Methods. A subset of patients with preterm PROM admitted to our institution underwent amniocenteses before and after antibiotic administration in order to guide clinical management. Amniotic fluid analysis consisted of a Gram stain, culture for aerobic and anaerobic bacteria as well as genital mycoplasmas, and amniotic fluid white blood cell (WBC) count. Microbial invasion of the amniotic cavity (MIAC) was defined as a positive amniotic fluid culture. Intra-amniotic inflammation was defined as an amniotic fluid WBC count >= 100/mm(3). Patients were given antibiotics and steroids after the 24th week of gestation. Antibiotic treatment consisted of ampicillin and erythromycin for 7 days for patients without evidence of intra-amniotic inflammation or MIAC, and ceftriaxone, clindamycin and erythromycin for 10-14 days for those with intra-amniotic inflammation or MIAC.Results. Forty-six patients with preterm PROM whose first amniocentesis was performed between 18 and 32 weeks (median 27.4 weeks) were included in the study. The overall prevalence of intra-amniotic inflammation in the first amniocentesis was 39% (18/46). Seven had a positive amniotic fluid culture for microorganisms. At the time of the second amniocentesis, six of the seven patients with a positive amniotic fluid culture had microorganisms. Of 18 patients with intra-amniotic inflammation at admission, only three showed no evidence of inflammation after antibiotic treatment. Among patients with no evidence of intra-amniotic inflammation at admission, 32% (9/28) developed inflammation despite therapy. Five of these nine patients had positive amniotic fluid cultures.Conclusions. (1) Antibiotic administration (ceftriaxone, clindamycin, and erythromycin) rarely eradicates intra-amniotic infection in patients with preterm PROM; (2) intra-amniotic inflammation developed in one-third of patients who did not have inflammation at admission, despite antibiotic administration; (3) a sub-group of patients with documented inflammation of the amniotic cavity demonstrated a decrease in the intensity of the inflammatory process after antibiotic administration.