Ranu S S, Valencia G B, Piecuch S
Department of Pediatrics, State University of New York, Health Science Center at Brooklyn, USA.
J Perinatol. 1999 Oct-Nov;19(7):533-5. doi: 10.1038/sj.jp.7200230.
This paper reports a case of chorioamnionitis due to Morganella morganii in a mother who presented with ruptured membranes at 24 weeks' gestation and was treated with dexamethasone and prophylactic ampicillin. Her premature infant developed severe early onset infection due to the same organism and expired.
A clinical case report of M. morganii infection complicating preterm rupture of membranes is presented. Possible risk factors for maternal and neonatal infection with this organism as well as the therapy of neonatal M. morganii infection are discussed.
Risk factors in the mother included having a cervical cerclage in place and treatment with dexamethasone and prophylactic ampicillin. The major risk factors in the infant were maternal chorioamnionitis and extreme prematurity. The mother responded to treatment with ampicillin, metronidazole, and gentamicin following delivery and had an uncomplicated recovery. Her infant developed severe early onset M. morganii infection complicated by neutropenia, thrombocytopenia, and severe acidosis and expired. Postmortem cultures of pleural fluid, peritoneal fluid, and blood were positive despite treatment with gentamicin, an antibiotic to which the organism was sensitive.
M. morganii may cause serious infection in pregnancy and in the neonatal period. The use of dexamethasone and prophylactic ampicillin may have increased the risk of infection with this ampicillin-resistant organism. The failure of gentamicin to sterilize the infant's blood and body fluids emphasizes the necessity of treating such infections with a combination of an aminoglycoside and a third-generation cephalosporin, such as cefotaxime.
本文报告一例因摩根摩根菌引起的绒毛膜羊膜炎病例，该孕妇在妊娠24周时胎膜破裂，接受了地塞米松和预防性氨苄西林治疗。她的早产儿因同一病原体发生严重的早发型感染并死亡。
本文介绍了一例摩根摩根菌感染并发胎膜早破的临床病例报告。讨论了该病原体导致母婴感染的可能危险因素以及新生儿摩根摩根菌感染的治疗方法。
母亲的危险因素包括宫颈环扎术、地塞米松和预防性氨苄西林治疗。婴儿的主要危险因素是母亲绒毛膜羊膜炎和极度早产。母亲在分娩后接受氨苄西林、甲硝唑和庆大霉素治疗后病情好转，恢复过程顺利。她的婴儿发生了严重的早发型摩根摩根菌感染，并发中性粒细胞减少、血小板减少和严重酸中毒，最终死亡。尽管使用了对该病原体敏感的抗生素庆大霉素进行治疗，但胸水、腹水和血液的尸检培养结果仍为阳性。
摩根摩根菌可能在妊娠期和新生儿期引起严重感染。地塞米松和预防性氨苄西林的使用可能增加了感染这种耐氨苄西林病原体的风险。庆大霉素未能清除婴儿血液和体液中的病原体，这强调了使用氨基糖苷类药物和第三代头孢菌素（如头孢噻肟）联合治疗此类感染的必要性。
