Wolf Maya Frank, Miron Dan, Peleg David, Rechnitzer Hagai, Portnov Igor, Salim Raed, Keness Yoram, Reich Dan, Ami Moshe Ben, Peretz Avi, Koshnir Amir, Shachar Inbar Ben
Department of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
Department of Infectious Disease Consultation Service, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
Am J Perinatol. 2015 Nov;32(13):1247-50. doi: 10.1055/s-0035-1552935. Epub 2015 May 29.
The purpose of our study was to determine whether the current antibiotic regimen for preterm premature rupture of membranes (PPROM) is adequate for covering the current causative agents and sensitivities of chorioamnionitis and early-onset neonatal sepsis.
During a 3-year period, we retrieved the results from placental and amniotic membrane cultures obtained at delivery in cases of maternal fever, chorioamnionitis, and PPROM, and from blood cultures obtained from neonates with early-onset sepsis (EOS) in three participating hospitals. Sensitivity of pathogens to antimicrobial agents was performed using routine microbiologic techniques.
There were 1,133 positive placental or amniotic cultures, 740 (65.3%) were from gram-negative Enterobacteriaceae. There were 27 neonates diagnosed with EOS with positive blood cultures. Aerobic Enterobacteriaceae accounted for 14 cases (52%) and group B streptococcus for 7 cases (26%). Of the Escherichia coli and Klebsiella sp., only 38% were sensitive to ampicillin.
Local pathogens and their antibiotic sensitivity profiles should be explored every few years and an effective antibiotic protocol chosen to cover the main pathogens causing chorioamnionitis and EOS. Consideration should be made for changing ampicillin in women with PPROM to a regimen with better coverage of gram-negative Enterobacteriaceae.
我们研究的目的是确定目前用于胎膜早破（PPROM）的抗生素方案是否足以覆盖当前绒毛膜羊膜炎和早发性新生儿败血症的病原体及敏感性。
在3年期间，我们收集了三家参与研究医院中，产妇发热、绒毛膜羊膜炎和PPROM病例分娩时胎盘和羊膜培养结果，以及早发性败血症（EOS）新生儿血培养结果。采用常规微生物学技术检测病原体对抗菌药物的敏感性。
胎盘或羊膜培养阳性1133例，其中740例（65.3%）为革兰氏阴性肠杆菌科细菌。27例新生儿血培养阳性诊断为EOS。需氧肠杆菌科细菌占14例（52%），B族链球菌占7例（26%）。大肠杆菌和克雷伯菌属中，仅38%对氨苄西林敏感。
应每隔几年探索当地病原体及其抗生素敏感性概况，并选择有效的抗生素方案以覆盖引起绒毛膜羊膜炎和EOS的主要病原体。对于PPROM女性，应考虑将氨苄西林换成能更好覆盖革兰氏阴性肠杆菌科细菌的方案。
