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Published on: June 12, 2013
Pathogens in preterm prelabour rupture of membranes and erythromycin for antibiotic prophylaxis: a retrospective
1Department of Obstetrics and Gynaecology, United Christian Hospital, Kwun Tong, Hong Kong.
Insights
Erythromycin prophylaxis is often recommended for preterm prelabour rupture of membranes (PPROM), but this study found it insufficient in 67.7% of cases due to bacterial resistance. Alternative antibiotic strategies are needed for PPROM patients.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Diseases
Background:
- Preterm prelabour rupture of membranes (PPROM) is a significant obstetric complication.
- Erythromycin is a commonly recommended antibiotic prophylaxis for PPROM.
- The effectiveness of erythromycin in PPROM requires ongoing evaluation.
Purpose of the Study:
- To determine the spectrum of pathogens in PPROM.
- To assess the efficacy of erythromycin prophylaxis in PPROM.
- To identify bacterial resistance patterns to guide treatment.
Main Methods:
- Retrospective study of pregnant patients with PPROM (2013-2017).
- Analysis of pathogens from maternal, placental, and neonatal specimens.
- Evaluation of antibiotic sensitivity profiles and neonatal outcomes.
Main Results:
- Gram-positive bacteria (e.g., Group B Streptococcus) and Gram-negative bacteria (e.g., Escherichia coli) were identified in PPROM patients.
- Both bacterial types were significantly associated with early-onset neonatal sepsis.
- Erythromycin resistance was high in Gram-positive bacteria (e.g., 42.2% in GBS).
- Escherichia coli showed high resistance to ampicillin and gentamicin.
Conclusions:
- Erythromycin prophylaxis alone was insufficient in 67.7% of PPROM patients with positive cultures.
- Significant bacterial presence and resistance patterns challenge current prophylaxis guidelines.
- Further research into alternative or combination antibiotic therapies for PPROM is warranted.
Introduction:
Many authoritative guidelines recommend prescribing erythromycin as antibiotic prophylaxis in patients with preterm prelabour rupture of membranes (PPROM). This study evaluated the spectrum of pathogens in PPROM and assessed the effectiveness of erythromycin prophylaxis.
Methods:
This retrospective study enrolled pregnant patients who were diagnosed with PPROM and who delivered at ≥24 weeks of gestation in an obstetric unit from 2013 to 2017. Pathogens isolated from maternal, placental, and neonatal specimens were analysed; their sensitivity profiles to various antibiotics were recorded. Neonatal outcomes were also evaluated.
Results:
The overall incidence of PPROM was 2.63%. Gram-positive bacteria were cultured in 18.4% of PPROM patients (most frequent: Group B Streptococcus [GBS; 14.6%]); Gram-negative bacteria were cultured in 12.8% of PPROM patients (most frequent: Escherichia coli [8.0%]). Both Gram-positive and Gram-negative bacteria were significantly associated with early-onset neonatal sepsis (P=0.036 and P=0.001). In analyses stratified by bacterial species, E coli was significantly associated with early-onset neonatal sepsis (P=0.004), whereas GBS was not (P=0.39). Gram-positive bacteria had high rates of resistance to common antibiotics: 42.2% of GBS and 50.0% of Enterococcus and other Streptococcus bacteria were resistant to erythromycin. Escherichia coli had high rates of resistance to ampicillin (70.3%) and gentamicin (33.3%); rates of resistance to co-amoxiclav (3.6%) and intravenous cefuroxime (14.0%) were low.
Conclusion:
Gram-positive and Gram-negative bacteria were found in 29.1% of PPROM patients. Administration of erythromycin alone was insufficient to control these bacteria in 67.7% of patients with positive cultures.
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