McDuffie R S, McGregor J A, Gibbs R S
Department of Obstetrics and Gynecology, Saint Joseph Hospital, Denver, Colorado.
Obstet Gynecol. 1993 Oct;82(4 Pt 1):487-9.
To report a case series of adverse perinatal outcomes associated with resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes (PROM) and group B streptococcus.
Maternal and neonatal records were reviewed of four cases in which adverse perinatal outcomes occurred from resistant Enterobacteriaceae after antibiotic usage for either PROM or positive group B streptococcal cultures. Information on clinical setting, antibiotic usage, maternal and neonatal complications, and maternal and neonatal cultures was noted.
All four cases were complicated by PROM at 25-35 weeks' gestation. Ampicillin or amoxicillin was used in several clinical settings, including therapeutically for the presence of group B streptococcus, presumptively for PROM, and prophylactically pending the results of group B streptococcal cultures. Clinical chorioamnionitis subsequently developed in all four cases, and in two cases the maternal course was prolonged and complicated by persistent fever and the need for therapy for pelvic vein thrombophlebitis. Two neonates died from fulminant clinical sepsis. A third infant, one of a twin gestation, was stillborn, presumably because of sepsis. In three cases, neonatal and placental cultures revealed Escherichia coli resistant to ampicillin; in the fourth case, Klebsiella pneumoniae was identified, with only intermediate sensitivity to ampicillin.
Resistant Enterobacteriaceae associated with adverse perinatal outcomes may result from the use of antibiotics, such as ampicillin or amoxicillin, after PROM. In deciding whether antibiotic therapy for PROM or group B streptococcal prophylaxis is appropriate, the value of purported benefits must be weighed against presumably infrequent but serious outcomes, including neonatal sepsis and death due to selection or overgrowth of resistant organisms.
报告一系列围产期不良结局病例，这些结局与胎膜早破（PROM）及B族链球菌感染后使用抗生素导致的产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）感染有关。
回顾了4例产妇及新生儿的病历，这些病例均在PROM或B族链球菌培养阳性后使用抗生素治疗，随后发生了ESBL-E感染并导致围产期不良结局。记录了临床情况、抗生素使用情况、母婴并发症以及母婴培养结果等信息。
所有4例均为妊娠25-35周的PROM患者。在多种临床情况下使用了氨苄西林或阿莫西林，包括治疗性使用以应对B族链球菌感染、推测性使用以应对PROM以及预防性使用直至B族链球菌培养结果出来。随后所有4例均发生了临床绒毛膜羊膜炎，2例产妇病程延长，出现持续发热并需要治疗盆腔静脉血栓性静脉炎。2例新生儿死于暴发性临床败血症。第3例婴儿为双胎妊娠之一，死产，推测原因是败血症。3例中，新生儿及胎盘培养显示大肠埃希菌对氨苄西林耐药；第4例中，鉴定出肺炎克雷伯菌，对氨苄西林仅中度敏感。
PROM后使用氨苄西林或阿莫西林等抗生素可能导致产ESBL-E感染并引起围产期不良结局。在决定PROM的抗生素治疗或B族链球菌预防是否适当时，必须权衡预期益处与可能罕见但严重的后果，包括因耐药菌的选择或过度生长导致的新生儿败血症和死亡。
