Kay Vanessa R, Liang Isabella, Twiss Jennifer, Morais Michelle
Department of Obstetrics and Gynecology, the Department of Family Medicine, and the Department of Neonatology, McMaster University, Hamilton, Ontario, Canada.
O G Open. 2025 Aug 7;2(4):e104. doi: 10.1097/og9.0000000000000104. eCollection 2025 Aug.
To evaluate antibiotic regimens for the optimization of maternal and neonatal outcomes in pregnancies affected by chorioamnionitis.
A change in the standard antibiotic regimen for chorioamnionitis from ceftriaxone-metronidazole to ampicillin-tobramycin with the addition of metronidazole provided an opportunity to compare the outcomes of these antibiotic regimens in a real-world setting. This single-center retrospective cohort study included individuals with singleton gestations with a diagnosis of clinical chorioamnionitis who were treated with one of the two antibiotic regimens and who delivered after 24 0/7 weeks of gestation between January 1, 2019, and December 21, 2022, along with their neonates. Individuals with multiple gestations and terminations were excluded. Information about maternal and neonatal characteristics, labor and delivery, and chorioamnionitis diagnosis, as well as neonatal and maternal outcomes, was obtained through chart review. Logistic regression was done to calculate propensity scores for the antibiotic regimen, and the overlap weights method was used to balance the groups. Baseline characteristics included in the propensity score were compared using the standardized mean difference, with a value of at least 0.1 considered significant. Weighted risk differences were used to compare outcomes, with <.05 considered significant.
Overall, 459 maternal-neonatal dyads were identified and included in the analysis, with 276 receiving ceftriaxone-metronidazole and 183 receiving ampicillin-tobramycin. Although the groups initially differed on several characteristics, they were balanced after propensity score weighting. There was no difference in infectious maternal morbidity, postpartum hemorrhage, blood transfusion, admission to a monitored setting, or hysterectomy when ampicillin-tobramycin was compared with ceftriaxone-metronidazole. However, when neonatal outcomes were compared, a lower rate of early-onset neonatal sepsis was present in the group that received ampicillin-tobramycin (3.3% vs 11.1%; weighted risk difference -6.9%, 95% CI, -11.8 to -0.7, <.01). Other secondary neonatal outcomes were not different.
We conclude that ampicillin-tobramycin, with the addition of metronidazole for cesarean delivery, is a more appropriate empiric antibiotic choice to treat clinical chorioamnionitis due to reduced rates of early-onset neonatal sepsis when compared with ceftriaxone-metronidazole.
评估抗生素治疗方案，以优化绒毛膜羊膜炎孕妇的母婴结局。
绒毛膜羊膜炎的标准抗生素治疗方案从头孢曲松 - 甲硝唑改为氨苄西林 - 妥布霉素并加用甲硝唑，这为在实际临床环境中比较这些抗生素治疗方案的结局提供了机会。这项单中心回顾性队列研究纳入了单胎妊娠且诊断为临床绒毛膜羊膜炎的患者，这些患者在2019年1月1日至2022年12月21日期间接受了两种抗生素治疗方案之一的治疗，并在妊娠24 0/7周后分娩，同时纳入了他们的新生儿。多胎妊娠和终止妊娠的患者被排除。通过病历审查获取有关母婴特征、分娩过程以及绒毛膜羊膜炎诊断以及新生儿和母亲结局的信息。进行逻辑回归以计算抗生素治疗方案的倾向得分，并使用重叠权重法平衡各组。使用标准化均值差比较倾向得分中包含的基线特征，值至少为0.1被认为具有统计学意义。加权风险差异用于比较结局，<0.05被认为具有统计学意义。
总体而言，共识别出459对母婴二元组并纳入分析，其中276例接受头孢曲松 - 甲硝唑治疗，183例接受氨苄西林 - 妥布霉素治疗。尽管两组最初在几个特征上存在差异，但在倾向得分加权后达到了平衡。将氨苄西林 - 妥布霉素与头孢曲松 - 甲硝唑进行比较时，产妇感染性发病率、产后出血、输血、入住监测病房或子宫切除术方面没有差异。然而，在比较新生儿结局时，接受氨苄西林 - 妥布霉素治疗的组中早发型新生儿败血症的发生率较低（3.3% 对11.1%；加权风险差异 -6.9%，95% CI，-11.8至 -0.7，<0.01）。其他次要新生儿结局没有差异。
我们得出结论，与头孢曲松 - 甲硝唑相比，氨苄西林 - 妥布霉素加用甲硝唑用于剖宫产，是治疗临床绒毛膜羊膜炎更合适的经验性抗生素选择，因为早发型新生儿败血症的发生率较低。
