Asindi Asindi A, Archibong Eric I, Mannan Nivedita B
Department of Pediatrics, Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia.
Saudi Med J. 2002 Oct;23(10):1270-4.
This study aims to determine the incidence of prelabor rupture of membranes (PROM) in a tertiary care institution, the bacterial pathogens involved in maternal and neonatal colonization, and the major bacterial pathogens of neonatal sepsis in PROM.
This prospective study was conducted over 2 years from March 1999 to February 2001 in Abha Maternity Hospital, Abha, Kingdom of Saudi Arabia. Consecutive admissions of infant-and-mother pairs with PROM constitute the subjects of this survey. Every mother had endocervical swab taken before delivery, and their infants had surface swabs and sepsis screening before starting antibiotic therapy.
The incidence of PROM was 12.6 per 1000 live births. Premature delivery rate was 54.6% while, the overall prematurity rate was 7.2%. The major microorganisms involved in genital colonization of the mothers were coagulase negative Staphylococcus (CONS) (24%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (11.3%) and Enterococcus species (11.3%). The infants were colonized largely with CONS (31%), Klebsiella pneumoniae (18%) and Escherichia coli (E.coli) (17%). Fourteen percent of the infants were infected but in only 6% was septicemia documented (Staphylococcus aureus, 3 cases and 1 case each with CONS, group B Streptococci (GBS) and E.coli). In contrast to Western experience, the incidence of GBS was uncommon in both mothers and infants. The bacterial pattern suggests vancomycin and cefotaxime or aminoglycoside combination as empirical antibiotic therapy for both infected infants and selected contaminated mothers with PROM.
Generally, it appears wasteful to routinely admit, screen and empirically treat all infants born after PROM; only ill infants, febrile mothers, or either, with associated chorioamnionitis deserve antibiotic treatment.
本研究旨在确定一家三级医疗机构中胎膜早破（PROM）的发生率、母婴定植所涉及的细菌病原体以及胎膜早破新生儿败血症的主要细菌病原体。
这项前瞻性研究于1999年3月至2001年2月在沙特阿拉伯王国阿卜哈市的阿卜哈妇产医院进行了2年。连续收治的胎膜早破母婴对构成了本调查的对象。每位母亲在分娩前进行宫颈拭子采样，其婴儿在开始抗生素治疗前进行体表拭子采样和败血症筛查。
胎膜早破的发生率为每1000例活产12.6例。早产率为54.6%，而总体早产率为7.2%。母亲生殖道定植所涉及的主要微生物为凝固酶阴性葡萄球菌（CONS）（24%）、肺炎克雷伯菌（13%）、铜绿假单胞菌（11.3%）和肠球菌属（11.3%）。婴儿主要定植有CONS（31%）、肺炎克雷伯菌（18%）和大肠杆菌（E.coli）（17%）。14%的婴儿受到感染，但仅有6%被记录为败血症（金黄色葡萄球菌3例，CONS、B组链球菌（GBS）和大肠杆菌各1例）。与西方的经验不同，GBS在母亲和婴儿中的发生率都不常见。细菌模式表明，对于受感染的婴儿和选定的胎膜早破污染母亲，万古霉素与头孢噻肟或氨基糖苷类联合作为经验性抗生素治疗。
一般来说，对所有胎膜早破后出生的婴儿进行常规收治、筛查和经验性治疗似乎是浪费的；只有患病婴儿、发热母亲或伴有绒毛膜羊膜炎的两者才值得进行抗生素治疗。
