Infection-mediated preterm birth: Bacterial origins and avenues for intervention

Area of Science:

• Obstetrics and Gynecology
• Neonatal Medicine
• Infectious Diseases

Background:

• Preterm birth (PTB) is a leading cause of neonatal death and disability.
• Intra-amniotic infection is a primary driver of PTB, particularly extreme PTB (<28 weeks gestation).
• Neonatal morbidities are frequently linked to infection-mediated extreme PTB.

Purpose of the Study:

• To review current understanding of intra-amniotic infection pathways.
• To evaluate the efficacy and limitations of antibiotic therapy for intra-amniotic infection.
• To propose novel therapeutic strategies for infection-mediated PTB.

Main Methods:

• Synthesis of evidence from animal models and human studies.
• Analysis of culture-based microbiological data and next-generation sequencing findings.
• Review of existing literature on intra-amniotic infection pathogenesis and treatment.

Main Results:

• Next-generation sequencing and microbiological data reveal diverse routes of intra-amniotic infection beyond ascending vaginal pathways.
• Current antibiotic treatments for intra-amniotic infection show mixed success due to issues like drug resistance and poor placental transfer.
• Understanding infection pathways is crucial for developing targeted therapies.

Conclusions:

• Further research into the pathogenesis of intra-amniotic infection is needed.
• Optimizing antibiotic selection and delivery is critical for managing infection-mediated PTB.
• Development of innovative treatments is essential to improve outcomes for extreme preterm infants.