Hopkins L, Smaill F
Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Room 2N29, 1200 Main Street West, Hamilton, Ontario, Canada, L8N 3Z5.
Cochrane Database Syst Rev. 2002;2002(3):CD003254. doi: 10.1002/14651858.CD003254.
Intraamniotic infection is associated with maternal morbidity and neonatal sepsis, pneumonia and death. Although antibiotic treatment is accepted as the standard of care, few studies have been conducted to examine the effectiveness of different antibiotic regimens for this infection and whether to administer antibiotics intrapartum or postpartum.
To study the effects of different maternal antibiotic regimens for intraamniotic infection on maternal and perinatal morbidity and mortality.
We searched the Cochrane Pregnancy and Childbirth Group trials register (May 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, Issue 2, 2002).
Trials where there was a randomized comparison of different antibiotic regimens to treat women with a diagnosis of intraamniotic infection were included. The primary outcome was perinatal morbidity.
Data were extracted from each publication independently by the authors.
Two eligible trials (181 women) were included in this review. No trials were identified that compared antibiotic treatment with no treatment. Intrapartum treatment with antibiotics for intraamniotic infection was associated with a reduction in neonatal sepsis (relative risk (RR) 0.08; 95% confidence interval (CI) 0.00, 1.44) and pneumonia (RR 0.15; CI 0.01, 2.92) compared with treatment given immediately postpartum, but these results did not reach statistical significance (number of women studied = 45). There was no difference in the incidence of maternal bacteremia (RR 2.19; CI 0.25, 19.48). There was no difference in the outcomes of neonatal sepsis (RR 2.16; CI 0.20, 23.21) or neonatal death (RR 0.72; CI 0.12, 4.16) between a regimen with and without anaerobic activity (number of women studied = 133). There was a trend towards a decrease in the incidence of post-partum endometritis in women who received treatment with ampicillin, gentamicin and clindamycin compared with ampicillin and gentamicin alone, but this did not reach statistical significance (RR 0.54; CI 0.19, 1.49).
REVIEWER'S CONCLUSIONS: The conclusions that can be drawn from this meta-analysis are limited due to the small number of studies. For none of the outcomes was a statistically significant difference seen between the different interventions. Current consensus is for the intrapartum administration of antibiotics when the diagnosis of intraamniotic infection is made; however, the results of this review neither support nor refute this although there was a trend towards improved neonatal outcomes when antibiotics were administered intrapartum. No recommendations can be made on the most appropriate antimicrobial regimen to choose to treat intraamniotic infection.
羊膜腔内感染与孕产妇发病以及新生儿败血症、肺炎和死亡相关。尽管抗生素治疗被视为标准治疗方法，但很少有研究探讨不同抗生素治疗方案对这种感染的有效性，以及抗生素应在产时还是产后使用。
研究不同的孕产妇抗生素治疗方案对羊膜腔内感染的孕产妇及围产期发病率和死亡率的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2002年5月）以及Cochrane对照试验注册库（《Cochrane图书馆》，2002年第2期）。
纳入对诊断为羊膜腔内感染的女性进行不同抗生素治疗方案随机对照的试验。主要结局是围产期发病率。
作者独立从每篇出版物中提取数据。
本综述纳入了两项符合条件的试验（181名女性）。未发现将抗生素治疗与不治疗进行比较的试验。与产后立即治疗相比，产时使用抗生素治疗羊膜腔内感染与新生儿败血症（相对危险度（RR）0.08；95%置信区间（CI）0.00，1.44）和肺炎（RR 0.15；CI 0.01，2.92）的发生率降低相关，但这些结果未达到统计学显著性（研究的女性人数 = 45）。孕产妇菌血症的发生率没有差异（RR 2.19；CI 0.25，19.48）。有无厌氧活性的治疗方案在新生儿败血症（RR 2.16；CI 0.20，23.21）或新生儿死亡（RR 0.72；CI 0.12，4.16）的结局方面没有差异（研究的女性人数 = 133）。与单独使用氨苄西林和庆大霉素相比，接受氨苄西林、庆大霉素和克林霉素治疗的女性产后子宫内膜炎的发生率有下降趋势，但未达到统计学显著性（RR 0.54；CI 0.19，1.49）。
由于研究数量较少，本荟萃分析得出的结论有限。在不同干预措施之间，没有任何结局显示出统计学上的显著差异。目前的共识是在诊断为羊膜腔内感染时在产时使用抗生素；然而，本综述的结果既不支持也不反驳这一点，尽管产时使用抗生素时有新生儿结局改善的趋势。对于选择治疗羊膜腔内感染的最合适抗菌方案无法提出建议。
