Available online 20 April 2023, 102599

Author links open overlay panel, , , , ABSTRACTObjectives

The impact of E. coli in causing peripartum infections has been increasing due to rising ampicillin resistance. In this study, we compared maternal and neonatal outcomes of women with prolonged rupture of membranes (ROM >18h) and intrapartum fever, according to two antibiotic regimens they received, and describe the bacterial distribution focusing on risk factors for Enterobacteriaceae-related infectious morbidity.

Study Design

This 10-year retrospective study of women with ROM >18h and intrapartum fever included 62 women who were treated with ampicillin and gentamicin due to suspected intraamniotic infection and 79 without these signs who were treated with ampicillin alone. The primary outcomes were endometritis and neonatal early-onset sepsis (EOS) rates. Outcomes were compared using univariate and multivariate analyses.

Results

Among women who received ampicillin alone compared with dual therapy, rates were higher of endometritis (17% vs. 3%, p<0.001), neonatal early onset sepsis (7.5% vs. 0%, p=0.03), Enterobacteriaceae positive placental swab culture (67.9% vs. 15.7%, p<0.001), and histopathological subchorionitis (25.3% vs. 8.0%, p=0.008). Over 83% of Enterobacteriaceae isolates were ampicillin-resistant. Gestational age at delivery >41 weeks, meconium at delivery, ROM >24h and treatment with a single antibiotic agent were associated with the presence of a positive Enterobacteriaceae placental swab culture.

Conclusion

Ampicillin compared to dual treatment in women with prolonged ROM and fever might promote the growth of ampicillin-resistant Enterobacteriaceae (including E.coli) and increase risks of maternal and neonatal infectious morbidity.

Section snippetsINTRODUCTION

Intraamniotic infection (IAI) is an acute inflammation of the membranes and chorion of the placenta, typically due to ascending polymicrobial bacterial infection in the setting of membrane rupture [1]. The risk factors of IAI include prolonged active labor >12h, group B streptococci (GBS) colonization, meconium-stained amniotic fluid and prolonged rupture of membranes (ROM) >18h (1); the latter was shown to increase the risk of IAI by 6.9 times [2].

The antibiotics protocol recommended by the

Study description

This retrospective study was conducted in a single tertiary university-affiliated hospital from 2011-2020. The hospital's Institutional Review Board approved the study.

All laboring women with ROM >18h received ampicillin 2g q.i.d for the prevention of GBS-related neonatal EOS. Women with ROM >18h who developed intrapartum fever were stratified to two groups according to antibiotic treatment administered during labor. We compared obstetrical outcomes between women who received intravenous

RESULTS

Of 46,868 deliveries at our institution during the study period, 944 (2.0%) were complicated by intrapartum fever >38°C, of which 181 (19.2%) were accompanied by prolonged ROM. Excluded were: 20 (11.0%) deliveries due to preterm birth, 7 (3.9%) due to twin pregnancy, 5 (2.8%) due to diagnosis of either urinary tract infection or pneumonia, 5 (2.8%) due to incomplete data (of whom 3 had missing placental cultures) and 3 (1.7%) due to penicillin allergy. Notably, during the study period, 737

Main findings

We found that among women with term prolonged ROM (>18h), who developed intrapartum fever (>38°), rates of postpartum endometritis and neonatal EOS were significantly higher among those with isolated intrapartum fever vs. those with suspected IAI. Notably, the former group were treated with ampicillin alone, while the latter received dual therapy of ampicillin and gentamicin. Among women with isolated intrapartum fever, treated with ampicillin alone, placental histopathological examination

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