Expanded-spectrum antibiotics with preterm premature rupture of membranes

doi:10.1016/S0029-7844(00)00843-7

Obstetrics & Gynecology

Volume 96, Issue 1, July 2000, Pages 60-64

https://doi.org/10.1016/S0029-7844(00)00843-7 Get rights and content

Abstract

Objective: To compare maternal infection rates, neonatal sepsis rates, and bacterial resistance patterns in cases of neonatal sepsis for three antibiotic protocols for women with preterm premature rupture of membranes (PROM).

Methods: From January 1, 1988 to February 28, 1998, women with preterm PROM not requiring immediate delivery were treated according to one of three antibiotic protocols. During three distinct periods, patients received no antibiotics, intravenous ampicillin for 48 hours followed by oral amoxicillin, or intravenous ticarcillin-clavulanic acid for 48 hours followed by oral amoxicillin-clavulanic acid. Rates of chorioamnionitis, endometritis, and neonatal sepsis were compared, as were antimicrobial resistance patterns. Statistical analysis was done using χ² analysis, Fisher exact test, and the log-likelihood ratio test. The Bonferroni correction was used for multiple comparisons.

Results: During the three periods, preterm PROM was diagnosed in 1695 women. The incidence of endometritis was lower during the third (5.3%) compared with the first (15.1%, P < .001) and second (11.6%, P < .001) protocols. Chorioamnionitis rates were 13.6%, 12.7%, and 15.6% (P = .34) for the first, second, and third periods, respectively, and neonatal sepsis rates were 2.2%, 0.6%, and 1.1% (P = .08), respectively. Neonatal sepsis with gram-negative (P = .02) and ampicillin-resistant (P = .04) organisms was more likely when mothers received antepartum ampicillin or ticarcillin-clavulanic acid.

Conclusion: Antibiotic therapy for patients with preterm PROM was associated with a decrease in the rate of endometritis and a trend toward less neonatal sepsis but an increase in the proportion of gram-negative and ampicillin-resistant organisms causing neonatal sepsis.

Section snippets

Materials and methods

Infants at Shands Hospital at the University of Florida with positive blood cultures within the first 7 days of life from January 1, 1988 to February 28, 1998, were identified from the microbiology laboratory database. The medical records of these neonates were reviewed to identify those who had been born to mothers with preterm PROM who were treated expectantly. The charts of the mothers also were reviewed. In addition, our computerized obstetrics database was used to obtain demographic and

Results

During the study period, 1695 women with preterm PROM were treated at our institution. There were 465 cases during the first period, 510 received ampicillin during the second period, and 720 received ticarcillin-clavulanic acid during the third period. Demographic data are presented in Table 1. The gestational age given is the gestational age at delivery. The latency period, ie, the time from PROM to delivery, is not included in our database and is not available for this group of patients.

Discussion

The results of this study show a significantly lower rate of postpartum endometritis with antibiotic therapy for women with expectantly treated preterm PROM and a further reduction in this rate when a broader-spectrum agent was used. This result is not surprising given the polymicrobial nature of endometritis. What is surprising is that the rate of chorioamnionitis during the study period was decreased by antibiotic therapy only in the parous subgroup of patients, because both postpartum

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A case study regarding the use of antibiotic therapies for the treatment of preterm premature rupture of fetal membranes, and emergence of antibiotic resistant bacteria
2015, Journal de Gynecologie Obstetrique et Biologie de la Reproduction
Cette étude a comparé deux protocoles de prise en charge des ruptures prématurées des membranes (RPMAT) différant sur le type et la durée d’antibiothérapie.
L’antibiothérapie de la RPMAT à Fort-de-France (céphalosporine de 1^re génération pendant 7 jours) et à Pointe-à-Pitre (amoxicilline jusqu’à l’accouchement) a été comparée rétrospectivement pendant cinq ans. L’issue principale était l’apparition de bacilles Gram négatif (BGN) dans les prélèvements bactériologiques maternels ou néonataux chez les RPMAT ayant une latence ≥ quatre jours.
Nous avons comparé 38 cas de RPMAT en Martinique à 52 cas en Guadeloupe. Nous avons observé une sélection des BGN résistants au cours du suivi dans chaque centre. Elle est liée à la durée de latence dans les deux centres. L’apparition d’un BGN apparaît aussi liée à la durée d’antibiothérapie en cas de traitement long. Les durées de latences, les termes d’accouchement et la morbi-mortalité néonatale ou maternelle sont identiques.
Nous avons observé une apparition importante de BGN lors du traitement des RPMAT, d’autant plus que la latence rupture–accouchement et que le traitement sont longs.
The objective of this retrospective study is to compare two types of antimicrobial management used to treat premature rupture of membranes in pregnancy. This study evaluates both duration and the type of antibiotic therapy used for treatment.
The antimicrobials used to treat premature rupture of membranes include a first generation cephalosporin in one group and amoxicillin in the other group. Cephalosporin was used over a 7-day period to treat 38 cases, whereas amoxicillin was used through delivery in 52 cases. Emergence of multidrug-resistant Gram negative bacteria (GNB) on maternal of neonatal sampling was the primary outcome.
Emergence of antibiotic resistant GNB can be seen under both antibiotic regimens and appears to be linked to the duration of latency, and to duration of antibiotic treatment. Other outcomes (duration of latency period, gestational age at delivery, maternal and neonatal complications) were similar in both groups.
Antibiotic treatment in PPROM favors a selection of GNB. This emergence is positively linked with the duration of latency between rupture of membranes and delivery and with the length of antibiotic administration. The extension of antibiotherapy does not alter other maternal or neonatal parameters.
Microflora of the mother and her baby: Some perinatal aspects
2008, Journal de Pediatrie et de Puericulture
La flore vaginale durant la grossesse est un écosystème particulièrement vulnérable. Le maintien de son intégrité est cependant le meilleur moyen de diminuer les infections urogénitales chez la future mère. La vaginose bactérienne et l’infection urinaire constituent l’essentiel de ces problèmes infectieux. La première ne peut être dissociée de la seconde tant l’une peut souvent influencer le développement de l’autre. Ces infections urogénitales peuvent favoriser les chorioamnionites, avec ou sans rupture prématurée des membranes. Elles constituent donc un sérieux problème de santé publique par l’importance de la morbidité générée chez la mère, qui s’accompagne d’un risque augmenté d’accouchement prématuré. Si l’antibiothérapie, souvent administrée systématiquement dans ces situations cliniques, permet parfois d’enrayer le déclenchement prématuré du travail, elle favorise un déséquilibre de la flore maternelle avec, en conséquence, une perturbation de la flore colonisatrice du nouveau-né. Ce déséquilibre de la flore maternelle peut, en outre, être à l’origine d’une augmentation significative de la morbidité néonatale infectieuse chez les prématurés hospitalisés avec l’émergence de germes de plus en plus résistants. La modification de cette flore colonisatrice du nouveau-né, tant sur le plan quantitatif que qualitatif, pourrait être à l’origine d’une liaison suboptimale entre les entérocytes et les bactéries. Cette interface précoce entre l’hôte en bas âge et sa flore est pourtant un déterminant essentiel de l’induction immunitaire ultérieure et permet d’optimiser les mécanismes immunitaires complexes qui régissent l’acquisition de la tolérance à l’antigène alimentaire. Il convient donc d’avoir dès maintenant une réflexion globale importante sur l’optimisation de l’antibiothérapie durant cette période.
The vaginal bacterial ecosystem is at higher risk for disturbances during pregnancy. And yet, its maintenance at an adequate level is probably the best way to decrease the risk of getting urogenital infections in the mother. Bacterial vaginosis and urinary infections are the most common ones and cannot be dissociated from each other as pregnant women with vaginal bacteriosis are at increasing risk for urinary tract infections. These urogenital infections can favour chorioamnionitis with or without a rupture of membranes. The biochemical factors accompanying both infections are contributors of initiating the inflammatory cascade and by the end a preterm labour. Antibiotics can in part prevent or resolve these infections and are therefore very often used in clinical practice. However, these drugs will also further accentuate the vaginal dysbacteriosis favouring the colonisation of the vaginal tract of the mother and the intestine of the neonate with multiresistant microorganisms, realizing in such a way a real vicious circle. Birth is the only time in our life when the gastrointestinal tract, while sterile, is colonised by bacteria originating from the maternal flora as well as by that of the close direct birth environment. There is now evidence that the invasive microbial environment, first encountered during the birth process, is opportunistically used by the host to initiate its own defence mechanisms but also all immune mechanisms allowing oral tolerance to diet antigen. In fact, these mechanisms are still immature at that stage. Recent epidemiological data support the hypothesis that some increasing immune deviances observed in the last decades could have been originated from a modification of the bacterial environment in young populations. Our modern approach to perinatal care may, to some extent, have modified inadequately the overall quality of this bacterial–host interface. Keeping all above data in mind but without any denigration of each evidence-based data already got, which have been associated with an improvement of our perinatal care, it is nevertheless urgent to focus now on this maternal and neonatal bacterial environment at birth, which could have been secondarily modified. It is with the aim of finding the best way to ameliorate, in the future, the bacterial colonisation of the newborn. It is indeed of concern in terms of public health owing all these putative associated short and long terms morbidities in the mother and her baby related to the disturbances of the bacterial environment at birth.
Early bacterial colonisation of the intestine: why it matters?
2006, Archives de Pediatrie
La naissance est suivie de la mise en place progressive chez le nouveau-né d'une flore intestinale très riche, composée de nombreuses espèces différentes de bactéries. Cette colonisation crée une interface très particulière entre les bactéries et la cellule épithéliale de l'intestin qui débouche sur l'acceptation réciproque des 2 protagonistes. Cette relation particulière entre l'hôte et sa flore intestinale est à l'origine de l'induction immunitaire innée et adaptative. L'interface optimale entre ces dernières permet notamment l'acquisition de la tolérance à l'antigène alimentaire. Des études épidémiologiques récentes soulèvent l'hypothèse qu'une inadéquation de cette interface en bas âge puisse être à l'origine de désordres immunitaires ultérieurs. En outre, toutes les bactéries ne paraissent pas avoir la même importance dans l'initiation de ces mécanismes. Ainsi, la médecine périnatale moderne pourrait entraîner une modification précoce de l'interface hôte–bactéries. Une meilleure compréhension des mécanismes régissant l'induction immunitaire par cet envahissement bactérien dans le jeune âge, devrait permettre de mieux définir les moyens à mettre en place pour optimiser cette étape cruciale, sans renier les acquis positifs de la médecine périnatale de ces dernières années.
The birth process allows the progressive formation of complex intestinal microflora composed of myriad bacteria, leading to this recently identified host-bacterial mutualism in the human intestine. This kind of cross-talk originating from birth is opportunistically used by the young host to initiate its own immune system. Recent epidemiogical data support the hypothesis that some increasing immune deviances observed in the last 2 decades could have originated from a modification of the bacterial environment in young populations. Our modern approach to perinatal care may, to some extent, have modified inadequately the overall quality of this bacterial-host interface. The international medical community has to be made aware of the increasing importance that initial colonising intestinal microflora could have on the health and well-being of the host later in life. It is of great concern to decrease these possible negative influences and to discover in the near future the possible means of helping to manipulate positively the gut microbiotia of infants.
Complications of second and third trimester pregnancies
2003, Emergency Medicine Clinics of North America
Emergence of nosocomial Pseudomonas aeruginosa colonization/infection in pregnant women with preterm premature rupture of membranes and in their neonates
2003, Journal of Hospital Infection
Citation Excerpt :
To date, P. aeruginosa, naturally resistant to many β-lactam antibiotics, such as co-amoxiclav, is recognized as an infrequent cause of intrapartum or intrauterine infection.4,5 However, it seems that antibiotic prophylaxis in pPROM may select resistant bacteria and cause neonatal sepsis.2 Although the risk of nosocomial infection with resistant bacteria is recognized, no study until now has evaluated the level or precise nature of this risk.
The epidemiology, risk factors, maternal and neonatal outcomes of nosocomial Pseudomonas aeruginosa acquisition in preterm premature rupture of membranes were analysed. Of 63 women receiving antibiotic prophylaxis with co-amoxiclav, 11 acquired P. aeruginosa vaginal carriage with a median delay of 15 days (6–42) i.e. an incidence of 8.94 per 1000 days of expectant management. Five neonates born to 11 positive mothers were colonized or infected, three of whom died of fulminant sepsis. The duration of antibiotic treatment and multiple pregnancy were identified as independent risk factors. The epidemiological investigation revealed a vertical transmission between mothers and neonates, and suggested selective pressure of antibiotic treatment.
Antibiotics and the management of preterm premature rupture of the fetal membranes
2001, Clinics in Perinatology

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Expanded-spectrum antibiotics with preterm premature rupture of membranes

Abstract

Section snippets

Materials and methods

Results

Discussion

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