Erenberg Miriam, Yagel Yael, Press Fernanda, Weintraub Adi Y
Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Department of Infectious Diseases, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Eur J Obstet Gynecol Reprod Biol. 2017 Apr;211:227-230. doi: 10.1016/j.ejogrb.2017.02.024. Epub 2017 Feb 28.
The incidence of chorioamnionitis varies widely. The highest incidence is reported in preterm deliveries. Among preterm deliveries, chorioamnionitis usually occurs after preterm premature rupture of membranes (PPROM). To date, only five cases of chorioamnionitis due to Serratia marcescens were reported. Here we present a case of a pregnant woman with chorioamnionitis due to Serratia marcescens who delivered a premature neonate at 28 weeks and four days of gestation. We also conducted a review of the literature in order to identify and characterize the clinical presentation and outcomes of this rare infection. A 36 year old female (gravida 9, para 6) was admitted with cervical effacement of 16mm and intact membranes at gestational age of 25 weeks and five days. One week following her admission PPROM was noticed. Treatment with the standard antibiotic regimen for PPROM was initiated. Thirteen days after the diagnosis of PPROM (28 weeks and four days) she developed chills, abdominal pain, sub febrile fever, tachycardia, leukocytosis and fetal tachycardia, and a clinical diagnosis of chorioamnionitis was made. An urgent CS was performed. In the first post-operative day the patient developed surgical sight infection. Cultures obtained from the purulent discharge of the wound, as well as cultures from the placenta and uterine cavity that were obtained during surgery grew Serratia marcescens. The patient was treated with Meropenem for six days, with a good clinical response. We present a rare case of nosocomialy acquired Serratia marcescens chorioamnionitis in a patient with PPROM. This case emphasizes the need for good infection control measures. Our favorable outcome together with the scares reports in the literature, add insight into this type of rare infection.
绒毛膜羊膜炎的发病率差异很大。据报道，发病率最高的是早产。在早产中，绒毛膜羊膜炎通常发生在胎膜早破（PPROM）之后。迄今为止，仅报告了5例由粘质沙雷氏菌引起的绒毛膜羊膜炎。在此，我们报告一例因粘质沙雷氏菌引起绒毛膜羊膜炎的孕妇，该孕妇在妊娠28周零4天时分娩了一名早产新生儿。我们还对文献进行了综述，以确定和描述这种罕见感染的临床表现及结局。一名36岁女性（孕9产6）在妊娠25周零5天时因宫颈管消退16mm且胎膜完整入院。入院一周后发现胎膜早破。开始采用治疗胎膜早破的标准抗生素方案进行治疗。胎膜早破诊断13天后（28周零4天），她出现寒战、腹痛、低热、心动过速、白细胞增多和胎儿心动过速，临床诊断为绒毛膜羊膜炎。紧急进行了剖宫产。术后第一天患者发生手术切口感染。从伤口脓性分泌物中获取的培养物，以及手术期间从胎盘和子宫腔获取的培养物均培养出粘质沙雷氏菌。患者接受美罗培南治疗6天，临床反应良好。我们报告了一例在胎膜早破患者中院内获得性粘质沙雷氏菌绒毛膜羊膜炎的罕见病例。该病例强调了良好感染控制措施的必要性。我们的良好结局以及文献中的罕见报道，为这类罕见感染提供了见解。
