Kirchner Lieselotte, Helmer Hanns, Heinze Georg, Wald Martin, Brunbauer Mathias, Weninger Manfred, Zaknun Daniela
Department of Neonatology and Intensive Care, University Hospital of Pediatrics, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Eur J Obstet Gynecol Reprod Biol. 2007 Sep;134(1):44-50. doi: 10.1016/j.ejogrb.2006.09.013. Epub 2006 Nov 13.
To investigate the influence of culture proven intrauterine infection on preterm morbidity and to test the effect of antimicrobial treatment.
Retrospective cohort study conducted between October 1997 and February 2001 in patients with preterm premature rupture of membranes or preterm labor. Vaginal swabs were sampled and amniocentesis for microbiologic culture of the amniotic fluid was performed. Patients with Ureaplasma urealyticum in the amniotic fluid were treated with josamycin. Infants were followed post partum according to birth weight, gestational age, APGAR score and infant morbidity.
In 49 eligible patients, 40% of cultures were positive, 22% for Ureaplasma urealyticum, 12% for other bacteria and 6% for candida. Children of mothers with positive amniotic fluid cultures had significantly lower gestational ages (26+4 weeks for Ureaplasma urealyticum [p=0.04] and 25+5 weeks for other microorganisms [p=0.0017] versus 28+6 weeks for mothers with negative amniotic fluid cultures) and lower birth weights (975 g [n.s.] and 828 g [p=0.0072] versus 1,041 g) but were appropriate for their gestational ages. 33.3% and 66.7% versus 24% of the children were mechanically ventilated [n.s.], duration of mechanical ventilation was 5.3 [p=0.02] and 10.1 days [p=0.04] versus 1.4 days, and prevalence of chronic lung disease was 38% and 33% versus 11% [n.s.]. Prevalence of severe intraventricular hemorrhage (12.5% [n.s.] and 33% [p=0.04] versus 3.4%) and nosocomial infections (50% for both groups of positive cultures versus 10.3% for negative cultures, p=0.02 and 0.03, respectively) was higher and median length of stay was significantly longer (121 [p=0.02] and 107 days [p=0.03] versus 60 days) in these patients. Maternal positive vaginal swab cultures were not associated with any of the above-mentioned factors. In none of the patients treated with macrolids for proven Ureaplasma urealyticum amnionitis could the microbes be eradicated.
Maternal positive amniotic fluid cultures have been associated with lower gestational age and lower birth weight. Rate of infant morbidity was higher and length of stay was significantly longer in this group. Positive vaginal swabs were not predictive for infant morbidity. Treatment of mothers showing positive amniotic fluid cultures with macrolids was not effective.
探讨经培养证实的宫内感染对早产发病率的影响，并测试抗菌治疗的效果。
1997年10月至2001年2月对胎膜早破早产或早产患者进行回顾性队列研究。采集阴道拭子并进行羊水微生物培养的羊膜腔穿刺术。羊水解脲脲原体阳性的患者用交沙霉素治疗。根据出生体重、孕周、阿氏评分和婴儿发病率对婴儿进行产后随访。
在49例符合条件的患者中，40%的培养结果为阳性，解脲脲原体占22%，其他细菌占12%，念珠菌占6%。羊水培养阳性母亲的孩子孕周明显较低（解脲脲原体组为26 + 4周[p = 0.04]，其他微生物组为25 + 5周[p = 0.0017]，而羊水培养阴性母亲的孩子为28 + 6周），出生体重也较低（分别为975克[无统计学意义]和828克[p = 0.0072]，而后者为1041克），但与孕周相符。机械通气的儿童比例分别为33.3%和66.7%，而阴性组为24%[无统计学意义]，机械通气时间分别为5.3天[p = 0.02]和10.1天[p = 0.04]，而阴性组为1.4天，慢性肺病的患病率分别为38%和33%，而阴性组为11%[无统计学意义]。重度脑室内出血的患病率（分别为12.5%[无统计学意义]和33%[p = 0.04]，而阴性组为3.4%）和医院感染率（阳性培养组两组均为50%，阴性培养组为10.3%，p分别为0.02和0.03）较高，且这些患者的中位住院时间明显更长（分别为121天[p = 0.02]和107天[p = 0.03]，而阴性组为60天）。母亲阴道拭子培养阳性与上述任何因素均无关联。在确诊为解脲脲原体羊膜炎并用大环内酯类药物治疗的患者中，均未能根除微生物。
母亲羊水培养阳性与较低的孕周和较低的出生体重有关。该组婴儿发病率较高，住院时间明显更长。阴道拭子阳性不能预测婴儿发病率。用大环内酯类药物治疗羊水培养阳性的母亲无效。
