Use Of Intrapartum Antibiotics Research Articles

Study of clinical spectrum and risk factors of neonatal candidemia.

Candida colonization in neonates results in significant morbidity and mortality. The prevalence and clinical significance of neonatal candidemia are poorly understood. This study aimed to study clinical spectrum and risk factors of neonatal candidemia. 108 cases of septicemia were studied. Blood samples were collected into Glucose broth and Bile broth, which are inoculated on Blood agar and MacConkey's agar and incubated at 37° C for 7 days. Candida species were isolated were confirmed by standard techniques. The data was collected and analyzed using by using SPSS IBM Company, Chicago, Version 16.0. 62 newborn patients who had a positive Candida blood culture. 47 (79.03%) were low birth weight and 37 (59.67%) were male. 19 (30.65%) were died. Candida species was a contributory factor to mortality in 14 (73.68%) patients. Among Candida isolates, Candida albicans was the commonest (65%) followed by Candida parapsilosis (15%) and Candida glabrata (10%). The risk factors like intrapartum use of antibiotics, vaginal delivery, low birth weight are identified in culture positive neonates. Candida species are assuming an increasing role in nosocomial infections in neonates and is associated with an increased risk of mortality.

Direct identification of Streptococcus agalactiae and capsular type by real-time PCR in vaginal swabs from pregnant women.

Most group B streptococcus (GBS) infections in newborns are with capsular type Ia, Ib, or III. To prevent these infections more effectively, we developed a real-time PCR method to simultaneously detect GBS species and identify these 3 capsular types in vaginal swab samples from women at 36-39 weeks of gestation. DNA to be detected included those of the dltS gene (encoding a histidine kinase specific to GBS) and cps genes encoding capsular types. PCR sensitivity was 10 CFU/well for a 33-35 threshold cycle. Results were obtained within 2 h. Direct PCR results were compared with results obtained from cultures. Samples numbering 1226 underwent PCR between September 2008 and August 2012. GBS positivity rates by direct PCR and after routine culture were 15.7% (n = 192) and 12.6% (n = 154), respectively. Sensitivity and specificity of direct PCR relative to culture were 96.1% and 95.9%. Of GBS positive samples identified by PCR, capsular types determined directly by real-time PCR were Ia (n = 24), Ib (n = 32), and III (n = 26). Real-time PCR using our designed cycling probe is a practical, highly sensitive method for identification of GBS in pregnant carriers, allowing use of prophylactic intrapartum antibiotics in time to cover the possibility of unexpected premature birth.

G206(P) Group B Streptococcus: Intrapartum antibiotic management and neonatal outcome

ObjectiveWe audited the use of intrapartum intravenous antibiotics in mothers who were Group B Streptococcus (GBS) positive in their current pregnancy, and compared the neonatal management and outcomes in those...

G90 Ranitidine Treatment in Preterm Infants and The Prevalence of Atopy at Two Years of Age

BackgroundAcid suppression treatment has been linked to an increased incidence of allergy in adults. We evaluate how ranitidine, widely used off-label to treat gastro-esophageal reflux symptoms in neonates, may impair...

Allergic diseases of the skin and drug allergies – 2016. Ranitidine treatment in preterm infants and the prevalence of atopy at two years of age

Methods We carried out a retrospective review of preterm infants of between 26 and 37 weeks gestation admitted over a two-year period between April 2008 and March 2010. Those preterm infants treated with the H2-receptor antagonist ranitidine for more than seven days were identified. A control group of preterm infants who did not receive treatment was selected by matching gestation, birth weight and disease severity using a validated scoring method. We analysed both maternal data (mode of delivery, use of intrapartum antibiotics, prolonged rupture of the membranes, sepsis) and neonatal data (birth weight, gestation, interventions, sepsis, type of feeding and neonatal complications). Information concerning the development of atopy in children in both groups, as well as any family history of atopy, was obtained through a simple questionnaire.

The Association of Intrapartum Antibiotic Exposure With the Incidence and Antibiotic Resistance of Infantile Late-Onset Serious Bacterial Infections

The widespread use of intrapartum antibiotics (IPA) has raised concerns regarding the adverse effects on the newborn. To determine if IPA is associated with infantile late-onset serious bacterial infections (SBIs) and with antibiotic resistance. From 2005 to 2009, data were prospectively collected for all infants born at our center, aged 7 to 90 days, who were hospitalized for fever. Cases included infants with culture-proven SBIs, and controls included infants without SBIs. Results. A total of 71 cases and 124 controls were included. IPA was documented in 11.3% of cases and in 7.3% of controls (P = .34). Among cases, ampicillin resistance was documented in 85% of antibiotic-exposed infants and in 63% of nonexposed infants (P = .19). Corresponding rates for first-generation cephalosporin resistance in urinary tract infection were 75% and 23.5% (P = .04). IPA is associated with a trend toward increased antibiotic resistance in late-onset SBIs. This should be taken into consideration in the selection of empirical therapy for febrile infants.

Streptococcus agalactiae increase in resistance to erythromycin and clindamycin in vaginal-anal colonization in third quarter of pregnancy in one decade of universal screening

Streptococcus agalactiae (GBS) is the main causative agent of early perinatal sepsis. The acquisition of prevention policies has led to frequent use of intrapartum antibiotics. Surveillance of antimicrobial resistance is indispensable for defining drugs of choice and alternatives for such prophylaxis. To determine the evolution of antimicrobial resistance of GBS from maternal colonization to drugs used in the prevention of neonatal sepsis, between 2002 and 2008. We studied 100 GBS positive vaginal and anal samples from pregnant women. Disc diffussion susceptibility method was performed for penicillin, ampicillin, cefazolin, erythromycin and clindamycin according to the Clinical and Laboratory Standards Institute (CLSI). We analyzed the susceptibility of 99 strains. Seventeen were resistant to erythromycin (17.1%) and 13 were resistant to clindamycin (13.1%). Thirteen of the 17 strains resistant to erythromycin had the MLS phenotype (resistance to erythromycin and clindamycin) and 4 had the M phenotype (resistance to erythromycin only). Within the MLS phenotype, resistance was constitutive in 9 strains, and induced in 4 strains (positive D test). Compared with 2002 there was a significant increase in resistance to clindamycin (from 3.27% to 13.1% p < 0.002) and erythromycin (1.09% to 17% p < 0.001). 100% GSB remained sensitive to penicillin and ampicillin. GBS remains highly susceptible to drugs of choice for prevention of perinatal sepsis. There is a significant increase in antimicrobial resistance to clindamycin and erythromycin. Therefore, it is necessary to request susceptibility testing in GBS from third trimester of pregnancy screening in patients allergic to penicillin.

Aumento de resistencia de Streptococcus agalactiae vaginal-anal en el tercer trimestre de gestación a eritromicina y clindamicina al cabo de una década de tamizaje universal

Streptococcus agalactiae (GBS) is the main causative agent of early perinatal sepsis. The acquisition of prevention policies has led to frequent use of intrapartum antibiotics. Surveillance of antimicrobial resistance is indispensable for defining drugs of choice and alternatives for such prophylaxis.To determine the evolution of antimicrobial resistance of GBS from maternal colonization to drugs used in the prevention of neonatal sepsis, between 2002 and 2008.We studied 100 GBS positive vaginal and anal samples from pregnant women. Disc diffussion susceptibility method was performed for penicillin, ampicillin, cefazolin, erythromycin and clindamycin according to the Clinical and Laboratory Standards Institute (CLSI).We analyzed the susceptibility of 99 strains. Seventeen were resistant to erythromycin (17.1%) and 13 were resistant to clindamycin (13.1%). Thirteen of the 17 strains resistant to erythromycin had the MLS phenotype (resistance to erythromycin and clindamycin) and 4 had the M phenotype (resistance to erythromycin only). Within the MLS phenotype, resistance was constitutive in 9 strains, and induced in 4 strains (positive D test). Compared with 2002 there was a significant increase in resistance to clindamycin (from 3.27% to 13.1% p < 0.002) and erythromycin (1.09% to 17% p < 0.001). 100% GSB remained sensitive to penicillin and ampicillin.GBS remains highly susceptible to drugs of choice for prevention of perinatal sepsis. There is a significant increase in antimicrobial resistance to clindamycin and erythromycin. Therefore, it is necessary to request susceptibility testing in GBS from third trimester of pregnancy screening in patients allergic to penicillin.

A randomised trial of home energy efficiency improvement in the homes of elderly COPD patients

A randomised trial of 178 patients in Aberdeen, UK with a previous hospital admission for chronic obstructive pulmonary disease (COPD) was carried out in order to determine whether improving home energy efficiency improves health-related quality of life in COPD patients. 118 patients were randomised and 60 agreed to monitoring only. Energy efficiency upgrading was carried out in 42% of homes randomised to intervention. Independent energy efficiency action was taken by 15% of control participants and 18% in the monitoring group. The main outcome measures were respiratory and general health status, home energy efficiency and hospital admissions. Intention-to-treat analysis found no difference in outcomes between the two groups. In 45 patients, who had energy efficiency action independent of original randomisation, there were significant improvements in respiratory symptom scores (adjusted mean 9.0, 95% CI 2.5-15.5), decreases in estimated annual fuel costs (- pound65.3, 95% CI - pound31.9- - pound98.7) and improved home energy efficiency rating (1.1, 95% CI 0-1.4). COPD patients are unlikely to take up home energy efficiency upgrading, if offered. Secondary "pragmatic" analysis suggests that those who do take action may achieve clinically significant improvement in respiratory health, which is not associated with an increase in indoor warmth.

Missed opportunities for preventing group B streptococcus infection

Background:Group B streptococcus (GBS) is the most common cause of early onset (EO) neonatal infection in the UK. National guidelines for its prevention were introduced in 2003. We assessed the...

In vitro activity of an aqueous allicin extract and a novel allicin topical gel formulation against Lancefield group B streptococci

Studies have shown the efficacy of intra-partum antibiotics in preventing early-onset group B streptococcal sepsis. This approach results in a high intra-partum antibiotic use. Worryingly, the same antibiotics used in prophylaxis are also first-line treatment for neonatal sepsis, and antibiotic exposure in the peri-natal period has been shown to be a risk factor for late-onset serious bacterial infections and allergic disease. Antibiotic exposure in the peri-natal period is becoming a major public health issue; alternative strategies are needed. Garlic has been traditionally used to treat vaginal infections. Allicin is the main antibacterial agent isolated from garlic. The aim of the study was to investigate the in vitro activity of a novel allicin extract in aqueous and gel formulation against 76 clinical isolates of Lancefield group B streptococci (GBS). MICs and MBCs of allicin were determined for 76 GBS isolates by agar dilution and microtitre plate methods. Killing kinetics were determined for a selected 16 of the 76 strains. Agar diffusion tests were compared for allicin liquid and gel (500 mg/L). MICs and MBCs of allicin liquid were 35 to 95 mg/L and 75 to 315 mg/L, respectively. Time/dose kill curves produced a 2-3 log reduction in cfu/mL within 3 h and no detectable growth at 8 and 24 h. A novel 500 mg/L allicin gel produced an average zone size of 23+/-6 mm compared with 21+/-6 mm for allicin in water. Aqueous allicin is bactericidal against GBS isolates and maintains activity in a novel gel formulation.

Genotypic Diversity and Serotype Distribution of Group BStreptococcusIsolated from Women Before and After Delivery

Most studies of the dynamics of maternal group B Streptococcus (GBS) colonization have relied on capsular serotyping to define GBS acquisition or loss. Newer molecular methods that distinguish GBS clones may expand our knowledge and influence vaccination strategies. We used multilocus sequence typing (MLST) and GBS capsular gene cluster (cps) genotyping to investigate the dynamics of perinatal GBS colonization. A total of 338 GBS isolates obtained from 212 colonized women who were enrolled in a prior prospective cohort study were serotyped and genotyped by MLST and cps typing before (visit 1) and 6 weeks after (visit 2) delivery. Of the 212 women, 126 were colonized at both visits, whereas 66 lost and 20 acquired GBS by visit 2. MLST of the 338 strains identified 29 sequence types marking distinct bacterial clones. A change in sequence type or cps and serotype occurred in 23 (18.3%) of the 126 women who were colonized at both visits. Specific sequence types were associated with GBS loss and persistence. Older maternal age and exclusive intrapartum antibiotic use were associated with persistent colonization. Although most GBS-positive pregnant women were stably colonized during the peripartum period, we detected changes in capsule expression and recolonization with antigenically distinct GBS clones over time by applying MLST. Combining the epidemiologic and molecular typing data revealed host factors and clones associated with persistent colonization, as well as a clone that was more readily lost. This knowledge is useful for the development of prevention and intervention strategies to reduce the likelihood of maternal GBS colonization.

Maternal Intrapartum Antibiotic Use and Severity of Neonatal Infection in Qatar: A hospital-based cohort study

To study the effect of intrapartum antibiotics on neonatal mortality and morbidity for infants with cultureproven neonatal sepsis the records were reviewed of all live born infants with culture positive neonatal septicemia admitted to the Neonatal Intensive Care Unit (NICU), Women's Hospital, Qatar between January 1st 2004 and April 30th 2005. Of 113 infants with culture-proven septicemia, 59 had received intrapartum antibiotics. Using univariate analysis, infants whose mothers had received intrapartum antibiotics were less likely to survive the septic episode (OR 0.09,95% CL 0.11-0.75, p = 0.009) and more likely to have severe septicemia (OR 4.38, 95% CI 1.74-11.02, p = 0.01) but gestational age adjusted estimates of survival and severe sepsis showed no difference between study and comparison groups. Being retrospective the study had certain limitations in variables but there is no clear evidence that intrapartum use of antibiotics plays a direct role in increasing mortality in septicemic infants.

Group B streptococcal carriage in Sweden: a national study on risk factors for mother and infant colonisation

To study group B streptococcus (GBS) colonisation in parturients and infants in relation to obstetric outcome and to define serotypes and antibiotic resistance in GBS isolates acquired. A population-based, national cohort of parturients and their infants was investigated. During 1 calendar week in 2005 all women giving birth (n=1,754) were requested to participate in the study. A total of 1,569 mother/infant pairs with obstetric and bacteriological data were obtained. Maternal carriage rate was 25.4% (95% confidence interval (CI): 23.3-27.6). In GBS-positive mothers with vaginal delivery and no intrapartum antibiotics, the infant colonisation rate was 68%. Some 30% of infants were colonised after acute caesarean section, and 0% were colonised after an elective procedure. Duration of transport of maternal recto/vaginal swabs of more than 1 day impeded culture sensitivity. Infant mMales were more frequently colonised than females (76.9 versus 59.8%, odds ratio (OR): 2.16; 95% CI: 1.27-3.70), as were infants born after rupture of membranes > or =24 h (p =0.039). Gestational age, birth weight and duration of labor did not significantly influence infant colonisation. Some 30% of parturients with at least one risk factor for neonatal disease received intrapartum antibiotics. The most common GBS serotypes were type III and V. Some 5% of the isolates were resistant to clindamycin and erythromycin, respectively. Maternal GBS prevalence and infant transfer rate were high in Sweden. Males were more frequently colonised than females. The sensitivity of maternal cultures decreased with the duration of sample transport. Clindamycin resistance was scarce. The use of intrapartum antibiotics was limited in parturients with obstetric risk factors for early onset group B streptococcal disease.

Prenatal antibiotic treatment does not decrease group B streptococcus colonization at delivery

Objective: To evaluate whether an outpatient antibiotic regimen decreased group B streptococcal (GBS) colonization to preclude the use of intrapartum antibiotics. Methods: A double-blind randomized controlled trial evaluating prenatal oral amoxicillin versus placebo with the primary outcome of GBS colonization at the time of labor. Results: Of those patients receiving both amoxicillin and a repeat culture at the time of labor, 6 of the 14 (43%) tested positive for GBS colonization. Given persistent GBS colonization of 67% (10/15) in the placebo group, treatment with amoxicillin did not significantly impact colonization at the time of delivery ( P = 0.20). Conclusion: A regimen of outpatient amoxicillin was associated with persistent GBS colonization in 43% of women at the time of labor. Oral prenatal antibiotic prophylaxis against GBS does not sufficiently reduce colonization to preclude intrapartum intravenous antibiotics.

Clinical and economic outcomes for term infants associated with increasing administration of antibiotics to their mothers

Implementation of national guidelines for the prevention of group B streptococcal (GBS) infections has led to an increase in intrapartum antibiotic use and reduction in early-onset GBS infections in newborns. Other outcomes, including the clinical diagnosis of sepsis in term infants, treatment with antibiotics, length of stay, and cost have not been described. To examine these outcomes, we performed an analysis of maternal and newborn data collected between 1998 and 2002 of 130 447 in-hospital births of newborns >or=37 weeks gestation and their mothers from a large vertically integrated healthcare organisation in Utah. The main outcome measures included: (i) the number of women delivering at term who received intravenous antibiotics; (ii) the number of newborns treated for 'clinical sepsis', which was defined as receiving antibiotics for >72 h and the number of newborns who received antibiotics for <or=48 h, i.e. a 'rule-out-sepsis' course. We also compared the lengths of stay and variable costs of infants whose mothers received antibiotics with those whose mothers did not. We found that the proportion of mothers who received intravenous antibiotics rose from 26.8% in 1998 to 40.6% in 2002 (P < 0.0001). The proportion of newborns treated for clinical sepsis ranged from 1.2% to 1.4% over the 5-year period. (P for trend = 0.04). After controlling for maternal chorioamnionitis, delivery by caesarean section and maternal GBS status, newborns of mothers who received antibiotics were significantly more likely to be treated for clinical sepsis than were newborns of mothers who had not received them [adjusted OR = 3.3; 95% CI 2.9, 3.8]. The average length of stay for newborns whose mothers were treated with antibiotics was 55.8 h compared with 41.6 h for those not treated (P < 0.0001). The cost of caring for newborns whose mothers received antibiotics was $740 compared with $638 for those whose mothers had not received them (P < 0.001).

Risk Factors for Invasive, Early-Onset Escherichia coli in the Era of Widespread Intrapartum Antibiotic Use

Risk Factors for Invasive, Early-Onset Escherichia coli in the Era of Widespread Intrapartum Antibiotic Use

Impact of clinical and histologic correlates of maternal and fetal inflammatory response on gestational age in preterm births

Objective. To evaluate the impact of clinical and histopathologic correlates related to maternal and fetal inflammatory responses (MIR and FIR) on degree of preterm birth.Methods. Pathology reports and clinical data from 577 singleton preterm births (<37 weeks of gestation) that took place between 1998 and 2004 were analyzed according to decreasing gestational age (≥33 weeks, 29–32 weeks, and <29 weeks). MIR was defined by presence of subchorionitis, chorioamnionitis, deciduitis, or free membranitis; FIR was defined by presence of funisitis or chorionic plate vasculitis. The associations between MIR alone and MIR with FIR and gestational age subgroups were assessed using logistic regression.Results. The presence of FIR in addition to MIR was more strongly associated with degree of prematurity than the presence of MIR alone, especially for those born at <29 weeks (OR = 10.1 (95% CI 4.3–23.7) and OR = 5.3 (95% CI 2.3–12.5), respectively). These associations remained significant after adjusting for maternal race, clinical signs of chorioamnionitis, medically indicated birth, and intrapartum corticosteroid, tocolysis and antibiotic use, and after stratification by clinical signs of chorioamnionitis and medically indicated birth.Conclusions. The combined presence of MIR and FIR is associated with a higher risk of extreme preterm birth (<29 weeks) than MIR alone, suggesting a contributory role of FIR in the pathophysiology of preterm birth.

Risk Factors for Invasive, Early-Onset Escherichia coli Infections in the Era of Widespread Intrapartum Antibiotic Use

The goal was to evaluate risk factors for invasive Escherichia coli infections in the first week of life (early onset), focusing on the role of intrapartum antibiotic use. We conducted a retrospective case-control study. Between 1997 and 2001, case infants, defined as infants < 7 days of age with E coli isolated from blood or cerebrospinal fluid, were identified in selected counties of California, Georgia, and Connecticut by the Active Bacterial Core Surveillance/Emerging Infections Program Network. Control infants (N = 1212) were identified from a labor and delivery record review of a stratified random sample of live births at the same hospitals in 1998 and 1999. Surveillance identified 132 E coli cases, including 68 ampicillin-resistant cases. The case fatality rate was 16% (21 of 132 cases). Two thirds of case infants were preterm, and 49% (64 of 132 infants) were born at < or = 33 weeks of gestation. Fifty-three percent of case mothers (70 of 132 mothers) received intrapartum antibiotic therapy; 70% of those received ampicillin or penicillin. Low gestational age (< or = 33 weeks), intrapartum fever, and membrane rupture of > or = 18 hours were associated with increased odds of early-onset E coli infection. Results were similar when case subjects were limited to those infected with ampicillin-resistant strains. Exposure to any intrapartum antibiotic treatment, beta-lactam antibiotic treatment, or > or = 4 hours of intrapartum antibiotic therapy was associated with increased odds of E coli infection and ampicillin-resistant infection in univariate analyses. Among preterm infants, intrapartum antibiotic exposure did not remain associated with either outcome in multivariable models. Among term infants, exposure to > or = 4 hours of intrapartum antibiotic therapy was associated with decreased odds of early-onset E coli infection. Exposure to intrapartum antibiotic therapy did not increase the odds of invasive, early-onset E coli infection. Intrapartum antibiotic therapy was effective in preventing E coli infection only among term infants.

198 Placental Cultures in the Era of Peripartum Antibiotic Use.

Top of pageAbstract Background: Examination of the placenta can yield valuable information that may be clinically significant for both mother and baby. In-utero infection may have serious long-term sequelae in the neonate. With the advent of intrapartum antibiotic prophylaxis for at risk pregnancies, the number of positive placental cultures may be decreased and significant infections may not be identified Aim: To determine whether placental culture rates are affected by antibiotic administration in the intrapartum period. Methods: A review of all placentas submitted for histopathology in 2003 was performed. The clinical records were reviewed for: gestation at delivery, duration of rupture of membranes prior to delivery, intrapartum antibiotic use, placental culture result and histological findings. Results: 425 cases were identified. Of these 282 (66%) were cultured and 12 (4.3%) had positive culture results. Five (41.7%) of the women with positive placental cultures had received intrapartum antibiotics. All of these placentas had histopathological evidence of in-utero inflammation with chorioamnionitis and funisitis. Three of these cases were preterm deliveries (gestation < 37 weeks). Of the seven positive culture results without intrapartum antibiotics, 4 had evidence of in-utero inflammation on histological evaluation. 104/425 (24%) had histopathological evidence of in-utero inflammation, 51 (49%) had received intrapartum antibiotics. Bacteria cultured included Group B streptococcus, Bacteroides, Enterobacter cloacae, E. coli, Klebsiella, Morganella morganii and a coliform. Conclusion: Despite a significant proportion of placentas noted to have evidence of in-utero inflammation, only a small proportion had positive placental cultures. The presence or absence of intrapartum antibiotics did not appear to significantly affect the number of positive culture results. Other possible reasons include a non microbiological cause of the inflammation or culturing techniques that cannot detect all possible causative organisms. A review of culture techniques is required to determine whether alternative methods may improve culture growth.