0 477

Cited 115 times in

Antibiotic administration can eradicate intra-amniotic infection or intra-amniotic inflammation in a subset of patients with preterm labor and intact membranes

DC Field Value Language
dc.contributor.author이준호-
dc.date.accessioned2020-11-24T05:31:30Z-
dc.date.available2020-11-24T05:31:30Z-
dc.date.issued2019-08-
dc.identifier.issn0002-9378-
dc.identifier.urihttps://ir.ymlib.yonsei.ac.kr/handle/22282913/179884-
dc.description.abstractBackground: Intra-amniotic infection is present in 10% of patients with an episode of preterm labor, and is a risk factor for impending preterm delivery and neonatal morbidity/mortality. Intra-amniotic inflammation is often associated with intra-amniotic infection, but is sometimes present in the absence of detectable microorganisms. Antibiotic treatment of intra-amniotic infection has traditionally been considered to be ineffective. Intra-amniotic inflammation without microorganisms has a prognosis similar to that of intra-amniotic infection. Objective: To determine whether antibiotics can eradicate intra-amniotic infection or intra-amniotic inflammation in a subset of patients with preterm labor and intact membranes. Materials and methods: The study population consisted of women who met the following criteria: 1) singleton gestation between 20 and 34 weeks; 2) preterm labor and intact membranes; 3) transabdominal amniocentesis performed for the evaluation of the microbiologic/inflammatory status of the amniotic cavity; 4) intra-amniotic infection and/or intra-amniotic inflammation; and 5) received antibiotic treatment that consisted of ceftriaxone, clarithromycin, and metronidazole. Follow-up amniocentesis was performed in a subset of patients. Amniotic fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas, and polymerase chain reaction was performed for Ureaplasma spp. Intra-amniotic infection was defined as a positive amniotic fluid culture or positive polymerase chain reaction, and intra-amniotic inflammation was suspected when there was an elevated amniotic fluid white blood cell count or a positive result of a rapid test for matrix metalloproteinase-8. For this study, the final diagnosis of intra-amniotic inflammation was made by measuring the interleukin-6 concentration in stored amniotic fluid (>2.6 ng/mL). These results were not available to managing clinicians. Treatment success was defined as eradication of intra-amniotic infection and/or intra-amniotic inflammation or delivery ≥37 weeks. Results: Of 62 patients with intra-amniotic infection and/or intra-amniotic inflammation, 50 received the antibiotic regimen. Of those patients, 29 were undelivered for ≥7 days and 19 underwent a follow-up amniocentesis. Microorganisms were identified by culture or polymerase chain reaction of amniotic fluid obtained at admission in 21% of patients (4/19) who had a follow-up amniocentesis, and were eradicated in 3 of the 4 patients. Resolution of intra-amniotic infection/inflammation was confirmed in 79% of patients (15/19), and 1 other patient delivered at term, although resolution of intra-amniotic inflammation could not be confirmed after a follow-up amniocentesis. Thus, resolution of intra-amniotic inflammation/infection or term delivery (treatment success) occurred in 84% of patients (16/19) who had a follow-up amniocentesis. Treatment success occurred in 32% of patients (16/50) with intra-amniotic infection/inflammation who received antibiotics. The median amniocentesis-to-delivery interval was significantly longer among women who received the combination of antibiotics than among those who did not (11.4 days vs 3.1 days: P = .04). Conclusion: Eradication of intra-amniotic infection/inflammation after treatment with antibiotics was confirmed in 79% of patients with preterm labor, intact membranes, and intra-amniotic infection/inflammation who had a follow-up amniocentesis. Treatment success occurred in 84% of patients who underwent a follow-up amniocentesis and in 32% of women who received the antibiotic regimen.-
dc.description.statementOfResponsibilityrestriction-
dc.languageEnglish-
dc.publisherElsevier-
dc.relation.isPartOfAMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.subject.MESHAdult-
dc.subject.MESHAmniocentesis-
dc.subject.MESHAmniotic Fluid / metabolism-
dc.subject.MESHAmniotic Fluid / microbiology-
dc.subject.MESHAnti-Bacterial Agents / therapeutic use*-
dc.subject.MESHBiomarkers / metabolism-
dc.subject.MESHCeftriaxone / therapeutic use-
dc.subject.MESHChorioamnionitis / drug therapy*-
dc.subject.MESHChorioamnionitis / microbiology-
dc.subject.MESHClarithromycin / therapeutic use-
dc.subject.MESHDelivery, Obstetric-
dc.subject.MESHFemale-
dc.subject.MESHHumans-
dc.subject.MESHInterleukin-6 / metabolism-
dc.subject.MESHLeukocyte Count-
dc.subject.MESHMatrix Metalloproteinase 8 / metabolism-
dc.subject.MESHMetronidazole / therapeutic use-
dc.subject.MESHObstetric Labor, Premature*-
dc.subject.MESHPregnancy-
dc.subject.MESHPregnancy Complications, Infectious / drug therapy*-
dc.subject.MESHPregnancy Complications, Infectious / microbiology-
dc.subject.MESHRetrospective Studies-
dc.titleAntibiotic administration can eradicate intra-amniotic infection or intra-amniotic inflammation in a subset of patients with preterm labor and intact membranes-
dc.typeArticle-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Obstetrics and Gynecology (산부인과학교실)-
dc.contributor.googleauthorBo Hyun Yoon-
dc.contributor.googleauthorRoberto Romero-
dc.contributor.googleauthorJee Yoon Park-
dc.contributor.googleauthorKyung Joon Oh-
dc.contributor.googleauthorJoonHo Lee-
dc.contributor.googleauthorAgustin Conde-Agudelo-
dc.contributor.googleauthorJoon-Seok Hong-
dc.identifier.doi10.1016/j.ajog.2019.03.018-
dc.contributor.localIdA04846-
dc.contributor.localIdA00088-
dc.contributor.localIdA05465-
dc.contributor.localIdA02993-
dc.contributor.localIdA04497-
dc.relation.journalcodeJ00096-
dc.identifier.eissn1097-6868-
dc.identifier.pmid30928566-
dc.identifier.urlhttps://www.sciencedirect.com/science/article/pii/S000293781930496X-
dc.subject.keywordMMP-8-
dc.subject.keywordamniotic fluid-
dc.subject.keywordceftriaxone-
dc.subject.keywordchorioamnionitis-
dc.subject.keywordclarithromycin-
dc.subject.keywordinterleukin-6-
dc.subject.keywordintra-amniotic inflammation-
dc.subject.keywordmetronidazole-
dc.subject.keywordpregnancy-
dc.subject.keywordprematurity-
dc.subject.keywordwhite blood cell-
dc.contributor.alternativeNameLee, Joon Ho-
dc.contributor.affiliatedAuthor이준호-
dc.citation.volume221-
dc.citation.number2-
dc.citation.startPage142.e1-
dc.citation.endPage142.e22-
dc.identifier.bibliographicCitationAMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY, Vol.221(2) : 142.e1-142.e22, 2019-08-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.