Antibiotic administration reduces the rate of intraamniotic inflammation in preterm prelabor rupture of the membranes.

Adult Amniotic Fluid / chemistry Anti-Bacterial Agents / therapeutic use Bacterial Infections / etiology Chorioamnionitis / etiology Clarithromycin / therapeutic use Clindamycin / therapeutic use Cohort Studies DNA, Bacterial / analysis Female Fetal Membranes, Premature Rupture Humans Interleukin-6 / analysis Penicillin G / therapeutic use Pregnancy Retrospective Studies Ureaplasma / genetics
16S ribosomal RNA Ureaplasma amniocentesis amniotic fluid bacteria benzylpenicillin biomarker chorioamnionitis clarithromycin funisitis genital mycoplasmas great obstetrical syndromes inflammation interleukin-6 intraamniotic infection microbial invasion of the amniotic cavity neonatal outcome neonatal sepsis nucleic acid polymerase chain reaction pregnancy prematurity preterm birth rapid point of care test sterile intraamniotic inflammation

Journal

American journal of obstetrics and gynecology
ISSN: 1097-6868
Titre abrégé: Am J Obstet Gynecol
Pays: United States
ID NLM: 0370476

Informations de publication

Date de publication:
07 2020
Historique:
received: 10 10 2019
revised: 22 01 2020
accepted: 24 01 2020
entrez: 28 6 2020
pubmed: 28 6 2020
medline: 21 8 2020
Statut: ppublish

Résumé

Preterm prelabor rupture of the membranes (PPROM) is frequently complicated by intraamniotic inflammatory processes such as intraamniotic infection and sterile intraamniotic inflammation. Antibiotic therapy is recommended to patients with PPROM to prolong the interval between this complication and delivery (latency period), reduce the risk of clinical chorioamnionitis, and improve neonatal outcome. However, there is a lack of information regarding whether the administration of antibiotics can reduce the intensity of the intraamniotic inflammatory response or eradicate microorganisms in patients with PPROM. The first aim of the study was to determine whether antimicrobial agents can reduce the magnitude of the intraamniotic inflammatory response in patients with PPROM by assessing the concentrations of interleukin-6 in amniotic fluid before and after antibiotic treatment. The second aim was to determine whether treatment with intravenous clarithromycin changes the microbial load of Ureaplasma spp DNA in amniotic fluid. A retrospective cohort study included patients who had (1) a singleton gestation, (2) PPROM between 24+0 and 33+6 weeks, (3) a transabdominal amniocentesis at the time of admission, and (4) intravenous antibiotic treatment (clarithromycin for patients with intraamniotic inflammation and benzylpenicillin/clindamycin in the cases of allergy in patients without intraamniotic inflammation) for 7 days. Follow-up amniocenteses (7 A total of 270 patients with PPROM were included in this study: 207 patients delivered within 7 days and 63 patients delivered after 7 days of admission. Of the 63 patients who delivered after 7 days following the initial amniocentesis, 40 underwent a follow-up amniocentesis. Patients with intraamniotic infection (n = 7) and sterile intraamniotic inflammation (n = 7) were treated with intravenous clarithromycin. Patients without either microbial invasion of the amniotic cavity or intraamniotic inflammation (n = 26) were treated with benzylpenicillin or clindamycin. Treatment with clarithromycin decreased the interleukin-6 concentration in amniotic fluid at the follow-up amniocentesis compared to the initial amniocentesis in patients with intraamniotic infection (follow-up: median, 295 pg/mL, interquartile range [IQR], 72-673 vs initial: median, 2973 pg/mL, IQR, 1750-6296; P = .02) and in those with sterile intraamniotic inflammation (follow-up: median, 221 pg/mL, IQR 118-366 pg/mL vs initial: median, 1446 pg/mL, IQR, 1300-2941; P = .02). Samples of amniotic fluid with Ureaplasma spp DNA had a lower microbial load at the time of follow-up amniocentesis compared to the initial amniocentesis (follow-up: median, 1.8 × 10 Intravenous therapy with clarithromycin was associated with a reduction in the intensity of the intraamniotic inflammatory response in patients with PPROM with either intraamniotic infection or sterile intraamniotic inflammation. Moreover, treatment with clarithromycin was related to a reduction in the load of Ureaplasma spp DNA in the amniotic fluid of patients with PPROM <34 weeks of gestation.

Sections du résumé

BACKGROUND
Preterm prelabor rupture of the membranes (PPROM) is frequently complicated by intraamniotic inflammatory processes such as intraamniotic infection and sterile intraamniotic inflammation. Antibiotic therapy is recommended to patients with PPROM to prolong the interval between this complication and delivery (latency period), reduce the risk of clinical chorioamnionitis, and improve neonatal outcome. However, there is a lack of information regarding whether the administration of antibiotics can reduce the intensity of the intraamniotic inflammatory response or eradicate microorganisms in patients with PPROM.
OBJECTIVE
The first aim of the study was to determine whether antimicrobial agents can reduce the magnitude of the intraamniotic inflammatory response in patients with PPROM by assessing the concentrations of interleukin-6 in amniotic fluid before and after antibiotic treatment. The second aim was to determine whether treatment with intravenous clarithromycin changes the microbial load of Ureaplasma spp DNA in amniotic fluid.
STUDY DESIGN
A retrospective cohort study included patients who had (1) a singleton gestation, (2) PPROM between 24+0 and 33+6 weeks, (3) a transabdominal amniocentesis at the time of admission, and (4) intravenous antibiotic treatment (clarithromycin for patients with intraamniotic inflammation and benzylpenicillin/clindamycin in the cases of allergy in patients without intraamniotic inflammation) for 7 days. Follow-up amniocenteses (7
RESULTS
A total of 270 patients with PPROM were included in this study: 207 patients delivered within 7 days and 63 patients delivered after 7 days of admission. Of the 63 patients who delivered after 7 days following the initial amniocentesis, 40 underwent a follow-up amniocentesis. Patients with intraamniotic infection (n = 7) and sterile intraamniotic inflammation (n = 7) were treated with intravenous clarithromycin. Patients without either microbial invasion of the amniotic cavity or intraamniotic inflammation (n = 26) were treated with benzylpenicillin or clindamycin. Treatment with clarithromycin decreased the interleukin-6 concentration in amniotic fluid at the follow-up amniocentesis compared to the initial amniocentesis in patients with intraamniotic infection (follow-up: median, 295 pg/mL, interquartile range [IQR], 72-673 vs initial: median, 2973 pg/mL, IQR, 1750-6296; P = .02) and in those with sterile intraamniotic inflammation (follow-up: median, 221 pg/mL, IQR 118-366 pg/mL vs initial: median, 1446 pg/mL, IQR, 1300-2941; P = .02). Samples of amniotic fluid with Ureaplasma spp DNA had a lower microbial load at the time of follow-up amniocentesis compared to the initial amniocentesis (follow-up: median, 1.8 × 10
CONCLUSION
Intravenous therapy with clarithromycin was associated with a reduction in the intensity of the intraamniotic inflammatory response in patients with PPROM with either intraamniotic infection or sterile intraamniotic inflammation. Moreover, treatment with clarithromycin was related to a reduction in the load of Ureaplasma spp DNA in the amniotic fluid of patients with PPROM <34 weeks of gestation.

Identifiants

DOI: 10.1016/j.ajog.2020.01.043 PMID: 32591087 PMC: PMC9125527
pubmed: 32591087
pii: S0002-9378(20)30065-X
doi: 10.1016/j.ajog.2020.01.043
pmc: PMC9125527
mid: NIHMS1800220
pii:
doi:

Substances chimiques

Anti-Bacterial Agents 0
DNA, Bacterial 0
IL6 protein, human 0
Interleukin-6 0
Clindamycin 3U02EL437C
Clarithromycin H1250JIK0A
Penicillin G Q42T66VG0C

Types de publication

Journal Article Research Support, N.I.H., Extramural

Langues

eng

Sous-ensembles de citation

IM

Pagination

114.e1-114.e20

Subventions

Organisme : NICHD NIH HHS
ID : HHSN275201300006C
Pays : United States
Organisme : Intramural NIH HHS
ID : Z01 HD002400
Pays : United States

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

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Auteurs

Marian Kacerovsky (M)

Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic; Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic. Electronic address: mkacerovsky@med.wayne.edu.

Roberto Romero (R)

Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI; Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan; Detroit Medical Center, Detroit, MI; Department of Obstetrics and Gynecology, Florida International University, Miami, FL.

Martin Stepan (M)

Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic.

Jaroslav Stranik (J)

Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic.

Jan Maly (J)

Department of Pediatrics, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.

Lenka Pliskova (L)

Institute of Clinical Biochemistry and Diagnosis, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.

Radka Bolehovska (R)

Institute of Clinical Biochemistry and Diagnosis, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.

Vladimir Palicka (V)

Institute of Clinical Biochemistry and Diagnosis, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.

Helena Zemlickova (H)

Institute of Clinical Microbiology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.

Helena Hornychova (H)

Fingerland's Department of Pathology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic.

Jiri Spacek (J)

Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic.

Bo Jacobsson (B)

Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg Sweden; Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway.

Percy Pacora (P)

Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI.

Ivana Musilova (I)

Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, and Detroit, MI; Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI; Department of Obstetrics and Gynecology, University Hospital Hradec Kralove, Charles University, Faculty of Medicine, Hradec Kralove, Czech Republic.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Structures de l'embryon › Foetus › Liquide amniotique › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Actions chimiques et utilisations › Actions pharmacologiques › Utilisations thérapeutiques › Anti-infectieux › Antibactériens › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Infection › Infections bactériennes et mycoses › Infections bactériennes › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Malformations et maladies congénitales, héréditaires et néonatales › Maladies foetales › Chorioamnionite › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Composés chimiques organiques › Lactones › Érythromycine › Clarithromycine › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Glucides › Hétérosides › Lincosamides › Lincomycine › Clindamycine › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Acides nucléiques, nucléotides et nucléosides › Acides nucléiques › ADN › ADN bactérien › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Rupture prématurée des membranes foetales › Antibiotic administration reduces the rate of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Antibiotic administration reduces the rate of...
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