Reconsidering the Current Preterm Premature Rupture of Membranes Antibiotic Prophylactic Protocol

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Infectious Diseases

Background:

• Preterm premature rupture of membranes (PPROM) necessitates antibiotic treatment to prevent maternal and neonatal infections.
• Chorioamnionitis and early-onset neonatal sepsis (EOS) are significant risks associated with PPROM.

Purpose of the Study:

• To evaluate the efficacy of current antibiotic regimens used for PPROM.
• To assess if existing treatments adequately cover prevalent causative agents of chorioamnionitis and EOS.
• To analyze antibiotic sensitivities of local pathogens.

Main Methods:

• A retrospective review of placental, amniotic membrane, and neonatal blood cultures over three years.
• Inclusion criteria: maternal fever, chorioamnionitis, PPROM, and neonatal EOS.
• Antimicrobial sensitivity testing using standard microbiology techniques.

Main Results:

• Over 1,133 positive cultures, 65.3% were gram-negative Enterobacteriaceae.
• In 27 neonates with EOS, 52% were caused by aerobic Enterobacteriaceae and 26% by group B Streptococcus.
• Only 38% of E. coli and Klebsiella species isolates were sensitive to ampicillin.

Conclusions:

• Local pathogen surveillance and antibiotic sensitivity profiling are crucial and should be updated periodically.
• Current antibiotic protocols for PPROM may require revision.
• Consideration should be given to replacing ampicillin with a regimen offering better coverage against gram-negative Enterobacteriaceae.