medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2024, Number 12

<< Back Next >>

Ginecol Obstet Mex 2024; 92 (12)

Outcomes of the triconjugated antibiotics treatment in chorioamnionitis patients with intact membranes: A cases series

Vernaza LNJ, Guerrero MMA, Paredes MJR, Vélez GMA, Cubides MAM, Hernández-Carrillo M

Language: Spanish
References: 19
Page: 492-500
PDF size: 305.86 Kb.


ABSTRACT

Objective: To describe the clinical outcome of pregnant patients with suspected clinical or subclinical chorioamnionitis treated with ceftriaxone, clarithromycin, and metronidazole.
Materials and Methods: Observational, descriptive, case-series study conducted at the Farallones Clinic in Cali, Colombia, in patients with preterm pregnancy, between 24 and 34.6 weeks, with diagnostic suspicion of chorioamnionitis. After diagnostic suspicion, amniocentesis, cytochemical examination and culture of amniotic fluid were performed, and then a triconjugated antibiotic regimen was started, administered simultaneously for seven days.
Results: There were 12 patients with a mean age of 25.5 years and a mean gestational age of 30.8 weeks. Almost all were classified as having subclinical chorioamnionitis. After completion of 7 days of triconjugate treatment, the mean gestational week at the end of pregnancy was 34.6 in 5 patients who managed to reach 37 weeks, associated with a latency of 37 days (lower limit: 7-14 days n: 1; upper limit more than 75 days n: 2) from clinical suspicion to the end of pregnancy.
Conclusions: This case series demonstrates that patients with suspected subclinical chorioamnionitis, established by basic clinical and biochemical laboratory and microbiological variables, who receive treatment with a triconjugate antibiotic have a satisfactory pregnancy outcome, with an acceptable proportion of term births and minimal adverse maternal and perinatal outcomes.


REFERENCES

  1. Romero R, Sirtori M, Oyarzun E, Sabo V, et al. Prevalence,microbiology, and clinical significance of intraamnioticinfection in women with preterm labor and intact membranes.Am J Obstet Gynecol 1989; 161 (3): 817-24. https://doi.org/10.1016/0002-9378(89)90409-2

  2. Gomez-Lopez N, Romero R, Panaitescu B, Leng Y, et al.Inflammasome activation during spontaneous pretermlabor with intra-amniotic infection or sterile intra-amnioticinflammation. Am J Reprod Immunol 2018; 80 (5): e13049.https://doi.org/10.1111/aji.13049

  3. Yoon BH, Romero R, Park JS, Kim YA, et al. Microbial invasionof the amniotic cavity with Ureaplasma urealyticumis associated with a robust host response in fetal, amniotic,and maternal compartments. Am J Obstet Gynecol1998; 179 (5): 1254-60. https://doi.org/10.1016/s0002-9378(98)70142-5

  4. Yoon BH, Romero R, Moon JB, Kim M, et al. Clinicalsignificance of intra-amniotic inflammation in patientswith preterm labor and intact membranes. Am J ObstetGynecol 2001; 185 (5): 1130-6. https://doi.org/10.1067/mob.2001.117680

  5. Prelabor Rupture of Membranes: ACOG Practice Bulletin,Number 217. Obstet Gynecol. 2020; 135 (3): e80-e97.https://doi.org/10.1097/AOG.0000000000003700

  6. Chapman E, Reveiz L, Bonfill Cosp X, et al. Antibioticregimens for management of intra-amniotic infection.Cochrane Database Syst Rev 2014; 2014 (12): CD010976.https://doi.org/10.1002/14651858.CD010976.pub2

  7. Lyell DJ, Pullen K, Fuh K, Zamah AM, et al. Daily comparedwith 8-hour gentamicin for the treatment of intrapartumchorioamnionitis: a randomized controlled trial. Obstet Gynecol2010; 115 (2 Pt 1): 344-349. https://doi.org/10.1097/AOG.0b013e3181cb5c0e

  8. Martingano D, Renson A, Rogoff S, et al. Daily gentamicinusing ideal body weight demonstrates lower risk of postpartumendometritis and increased chance of successfuloutcome compared with traditional 8-hour dosing for thetreatment of intrapartum chorioamnionitis. J Matern FetalNeonatal Med 2019; 32 (19): 3204-3208. https://doi.org/10.1080/14767058.2018.1460348

  9. Lee J, Romero R, Kim SM, Chaemsaithong P, et al. A newanti-microbial combination prolongs the latency period,reduces acute histologic chorioamnionitis as well as funisitis,and improves neonatal outcomes in preterm PROM. JMatern Fetal Neonatal Med 2016; 29 (5): 707-20. https://doi.org/10.3109/14767058.2015.1020293

  10. Lee J, Romero R, Kim SM, Chaemsaithong P, et al. A newantibiotic regimen treats and prevents intra-amnioticinflammation/infection in patients with preterm PROM.J Matern Fetal Neonatal Med 2016; 29 (17): 2727-37.https://doi.org/10.3109/14767058.2015.1103729

  11. Yoon BH, Romero R, Park JY, et al. Antibiotic administrationcan eradicate intra-amniotic infection or intra-amnioticinflammation in a subset of patients with preterm laborand intact membranes. Am J Obstet Gynecol 2019;221 (2): 142.e1-142.e22. https://doi.org/10.1016/j.ajog.2019.03.018

  12. Higgins RD, Saade G, Polin RA, William GA, et al. evaluationand management of women and newborns witha maternal diagnosis of chorioamnionitis: summary of aWorkshop. Obstet Gynecol 2016; 127 (3): 426-436. https://doi.org/10.1097/AOG.0000000000001246

  13. Sarmiento LC, Gutiérrez LA, Sandoval DK. Parámetros dellíquido amniótico para diagnóstico de respuesta inflamatoriaen parto pretérmino. Rev Chil Obstet Ginecol 2022; 87(3). https://doi.org/10.24875/RECHOG.21000047

  14. Kachikis A, Eckert LO, Walker C, et al, Brighton CollaborationChorioamnionitis Working Group. Chorioamnionitis:Case definition & guidelines for data collection, analysis,and presentation of immunization safety data. Vaccine2019; 37 (52): 7610-7622. https://doi.org/10.1016/j.vaccine.2019.05.030.

  15. Carter SWD, Neubronner S, Su LL, Dashraath O, et al.Chorioamnionitis: An Update on Diagnostic Evaluation. Biomedicines2023; 11 (11): 2922. https://doi.org/10.3390/biomedicines11112922

  16. Pongchaikul P, Romero R, Mongkolsuk P, Vivithanporn P, et al.Genomic analysis of Enterococcus faecium strain RAOG174associated with acute chorioamnionitis carried antibioticresistance gene: is it time for precise microbiological identificationfor appropriate antibiotic use? BMC Genomics 2023;24 (1): 405. https://doi.org/10.1186/s12864-023-09511-1

  17. Goldstein JA, Gallagher K, Beck C, Kumar R, et al. Maternalfetalinflammation in the placenta and the developmentalorigins of health and disease. Front Immunol 2020; 11:531543. https://doi.org/3389/fimmu.2020.531543

  18. Berezowsky A, Romano A, Hochberg A, Krispin E, et al.The correlation between placental histology and microbiologicinfection in the diagnosis of chorioamnionitis inpreterm delivery. Placenta 2022; 128: 18-22. https://doi.org/10.1016/j.placenta.2022.08.005

  19. Oh KJ, Kim SM, Hong JS, Gomez-Lopez N, et al. Twenty-fourpercent of patients with clinical chorioamnionitis in pretermgestations have no evidence of either culture-provenintraamniotic infection or intraamniotic inflammation. AmJ Obstet Gynecol 2017; 216 (6): 604.e1-604.e11. https://doi.org/10.1016/j.ajog.2017.02.035




2020     |     www.medigraphic.com