Tantengco Ourlad Alzeus G, Yanagihara Itaru
Department of Developmental Medicine, Research Institute, Osaka Women's and Children's Hospital, Izumi, Japan.
College of Medicine, University of the Philippines Manila, Manila, Philippines.
J Obstet Gynaecol Res. 2019 Sep;45(9):1796-1808. doi: 10.1111/jog.14052. Epub 2019 Jul 16.
Considerable evidence has shown that intra-amniotic infection with Ureaplasma spp. increases the risk of chorioamnionitis and preterm labor. Ureaplasma spp. are among the smallest organisms, and their isolation is uncommon in routine clinical practice because of their size and high auxotrophy. Although Ureaplasma spp. have been reported as causative agents of preterm birth, they also have a high incidence in vaginal swabs collected from healthy reproductive-age women; this has led to questions on the virulence of Ureaplasma spp. and to them being considered as harmless commensal bacteria. Therefore, many efforts have been made to clarify the pathogenicity of Ureaplasma spp. at the molecular level. Ureaplasma spp. are surrounded by lipoproteins, including multiple-banded antigen. Both multiple-banded antigen and its derivative, that is, the synthetic lipopeptide, UPM-1, induce an inflammatory response in a preterm mice model, which was adequate to cause preterm birth or stillbirth. In this review, we present an overview of the virulence mechanisms of Ureaplasma spp. and treatment of ureaplasma infection during pregnancy to prevent possible serious sequelae in infants. In addition, relevant mechanisms underlying antibiotic resistance in Ureaplasma spp. are discussed. Ureaplasma spp. are naturally resistant against β-lactam antibiotics because of the lack of a cell wall. Azithromycin is one of the effective agents that can control intrauterine ureaplasma infection. In fact, macrolide- and fluoroquinolone-resistant isolates of Ureaplasma spp. have already been observed in perinatal practice in Japan.
大量证据表明，解脲脲原体的羊膜腔内感染会增加绒毛膜羊膜炎和早产的风险。解脲脲原体是最小的微生物之一，由于其体积小和营养缺陷型高，在常规临床实践中其分离并不常见。尽管解脲脲原体已被报道为早产的病原体，但在从健康育龄妇女收集的阴道拭子中其发生率也很高；这引发了关于解脲脲原体毒力的问题，并导致它们被视为无害的共生细菌。因此，人们已经做出了许多努力来在分子水平上阐明解脲脲原体的致病性。解脲脲原体被脂蛋白包围，包括多条带抗原。多条带抗原及其衍生物，即合成脂肽UPM-1，在早产小鼠模型中诱导炎症反应，足以导致早产或死产。在这篇综述中，我们概述了解脲脲原体的毒力机制以及孕期解脲脲原体感染的治疗，以预防婴儿可能出现的严重后遗症。此外，还讨论了解脲脲原体抗生素耐药性的相关机制。由于缺乏细胞壁，解脲脲原体对β-内酰胺类抗生素天然耐药。阿奇霉素是能够控制子宫内解脲脲原体感染的有效药物之一。事实上，在日本的围产期实践中已经观察到解脲脲原体的大环内酯类和氟喹诺酮类耐药菌株。
