Among Women with prolonged rupture of membranes and fever which is better- dual antibiotic regimen or ampicillin alone?

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

There has been an increase in the impact of E. coli in causing peripartum infections due to rising ampicillin resistance. Raneen Abu Shqara, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel, and colleagues compared neonatal and maternal outcomes of women with prolonged ROM and intrapartum fever according to two antibiotics regimens they were administered with. They also described the bacterial distribution focusing on risk factors for Enterobacteriaceae-related infectious morbidity.

For this purpose, the researchers performed a 10-year retrospective study of women with ROM >18h and intrapartum fever comprising 62 women who were treated with ampicillin and gentamicin for suspected intraamniotic infection and 79 in which these signs were absent, who were treated with ampicillin alone. The study's primary outcomes were neonatal early-onset sepsis (EOS) and endometritis rates. A comparison was drawn between the outcomes using multivariate and univariate analyses.

The authors reported the following findings:

• Among women who received ampicillin alone compared with dual therapy, rates were higher of endometritis (16.5% versus 3.2%), neonatal early onset sepsis (7.5% versus 0%), Enterobacteriaceae positive placental swab culture (67.9% versus 15.7%), and histopathological subchorionitis (25.3% versus 8.0%).
• 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.

"We found that rates of neonatal EOS and postpartum endometritis were significantly higher among women with term prolonged ROM (>18h), who developed intrapartum fever (>38°) versus those with suspected IAI," the researchers wrote. They noted that the former group were treated alone with ampicillin, while the latter received dual therapy of gentamicin and ampicillin.

Reference:

Abu Shqara, R., Bang, S., Glikman, D., Lowenstein, L., & Frank Wolf, M. (2023). Single versus dual antibiotic regimen in women with term prolonged rupture of membranes and intrapartum fever: A retrospective study. Journal of Gynecology Obstetrics and Human Reproduction, 52(6), 102599. https://doi.org/10.1016/j.jogoh.2023.102599