阴道培养对预测早产胎膜早破新生儿早发性感染的作用。

Contribution of vaginal culture to predict early onset neonatal infection in preterm prelabor rupture of membranes.

机构信息

Assistance Publique-Hôpitaux de Paris Hôpital Louis Mourier Service de Gynécologie-Obstétrique, Colombes, France; Université de Paris, F-75006, Paris, France.

Université de Paris, F-75006, Paris, France; INSERM, IAME, F-75018, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, Service Microbiologie, Colombes, France.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2021 Jun;261:78-84. doi: 10.1016/j.ejogrb.2021.04.016. Epub 2021 Apr 16.

DOI:10.1016/j.ejogrb.2021.04.016

PMID:33901775

Abstract

BACKGROUND

Preterm prelabor rupture of membranes (PPROM) is a major cause of morbidity and mortality for both the mother and the newborn. The vaginal germ profile in PPROM is poorly known, particularly regarding the risk of early-onset neonatal infection (EONI).

OBJECTIVE

To determine microbiological risk factors for EONI in case of PPROM before 34 weeks of gestation (WG).

STUDY DESIGN

A retrospective single-center cohort of patients with PPROM before 34 W G from 2008 to 2016. Vaginal swabs were obtained at admission and at delivery as per usual care and were analyzed by Gram stain and culture for vaginal dysbiosisi.e lactobacilli depletion and/or presence of potential pathogens.

RESULTS

Among 268 cases of PPROM, 39 neonates had EONI 14.55 %; (95 %CI 0.11 - 0.19) Overall, vaginal samples culture was positive in 16.67 % (95 %CI 11.95 %-22.32 %) at the time of rupture and 24.76 % (95 %CI 19.02 %-31.23 %) at delivery, with no significant differences between EONI and no-EONI groups (p = 0.797 and 0.486, respectively), including for Group B Streptococci (GBS) and Escherichia coli. EONI was significantly associated with dysbiosis at the time of rupture (23.94 % versus 10.35 % in the absence of dysbiosis, p = 0.009) and at delivery (19.70 % versus 3.90 % if no dysbiosis, p < 0.001). Clinical intra-uterine infection was present in 78.5 % (n = 31) of the EONI group versus 37.2 % (n = 85) in the non-EONI group (p < 0.001) and chorioamnionitis and/or funisitis were found in 97.3 % and 91.9 %, respectively in the EONI group, versus 56.11 % and 53.96 %, respectively, in the non-EONI group (p < 0.001).

CONCLUSION

Dysbiosis following rupture and at delivery, but not the presence of pathogens in the VS culture, was associated with the risk of EONI in case of PPROM.

摘要

背景

早产胎膜早破（PPROM）是母亲和新生儿发病率和死亡率的主要原因。PPROM 患者的阴道菌群特征尚不清楚，尤其是与早发性新生儿感染（EONI）的风险相关的特征。

目的

确定 34 周前早产胎膜早破（PPROM）患者 EONI 的微生物学危险因素。

研究设计

回顾性分析了 2008 年至 2016 年期间在我院接受治疗的 34 周前早产胎膜早破患者的单中心队列。根据常规护理，在入院时和分娩时采集阴道拭子，通过革兰氏染色和培养分析阴道菌群失调，即乳杆菌减少和/或潜在病原体的存在。

结果

在 268 例 PPROM 患者中，39 例新生儿发生 EONI，发生率为 14.55%（95%CI 0.11-0.19）。总体而言，在胎膜破裂时，阴道样本培养阳性率为 16.67%（95%CI 11.95%-22.32%），在分娩时为 24.76%（95%CI 19.02%-31.23%），EONI 组和非 EONI 组之间无显著差异（p=0.797 和 0.486），包括 B 组链球菌（GBS）和大肠杆菌。EONI 与胎膜破裂时的菌群失调显著相关（无菌群失调时为 23.94%，有菌群失调时为 10.35%，p=0.009），与分娩时的菌群失调显著相关（无菌群失调时为 19.70%，有菌群失调时为 3.90%，p<0.001）。EONI 组中有 78.5%（n=31）的患者存在宫内临床感染，而非 EONI 组中有 37.2%（n=85）（p<0.001），EONI 组中有 97.3%和 91.9%的患者分别发生绒毛膜羊膜炎和/或脐带炎，而非 EONI 组中分别为 56.11%和 53.96%（p<0.001）。