Group B Streptococcus and preterm premature rupture of membranes: A randomized, double-blind clinical trial of antepartum ampicillin

Grable, Ian; Garcia, Patricia; Perry, David S.; Socol, Michael L.

doi:10.1016/s0002-9378(96)80049-4

Cited by 37 publications

(37 citation statements)

References 13 publications

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“…For group B Streptococcus prophylaxis, it has therefore been advocated to use penicillin G (as recommended in the consensus guidelines) preferentially to amoxicillin (used in most centers, including ours) [15,17,18], even if its theoretical benefit remains to be clearly established in clinical studies [15,20]. Amoxicillin has been used in most clinical trials on antenatal antibiotic treatment in PPROM and has been shown to prolong pregnancy and to reduce neonatal morbidity [5][6][7][8]. A recent multicenter trial [9] indicated that antenatal administration of erythromycin in PPROM led to an improvement in neonatal outcome, whereas co-amoxiclav (amoxicillin/clavulanic acid) was associated with a significant increase in the occurrence of neonatal necrotizing enterocolitis, possibly by selecting drug-resistant bacterial strains (amoxicillin alone was not tested in this study).…”

Section: Discussionmentioning

confidence: 99%

“…According to the consensus guidelines published in 1996 to prevent early-onset neonatal group B streptococcal disease [1][2][3], the existence of an obstetric risk factor for neonatal sepsis (premature delivery, prolonged rupture of the membranes, intrapartum fever) or the identification of a group B Streptococcus from a vaginal swab necessitates intrapartum antibiotic prophylaxis. Other studies [4][5][6][7][8][9] advocated the use of antepartum antibiotics in the case of preterm premature rupture of the membranes (PPROM) to prolong pregnancy and reduce infant morbidity. For this purpose, maternal antibiotics are commonly applied for 5-10 days, sometimes until delivery.…”

Section: Introductionmentioning

confidence: 99%

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Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Laugel¹,

Kuhn²,

Beladdale³

et al. 2003

Neonatology

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Background: Recommendations for the use of antenatal antibiotics have been widely implemented in the past few years, notably to prevent group B streptococcal disease or to prolong pregnancy in the case of preterm premature rupture of the membranes. Objectives: We designed a retrospective study to assess the potential effects of this increasing use of antibiotics on the incidence and bacteriological profile of early-onset neonatal sepsis (EONS). Methods: All neonates referred to our department for suspected EONS from January 1 1995 through December 31 1999 were included. Antenatal antibiotic exposure together with clinical and microbiological data from the neonatal period were gathered and analyzed on a yearly basis. Results: Of the 485 newborns who met the inclusion criteria, there were 101 cases of culture-confirmed sepsis; 339 cases of suspected sepsis and 69 cases of confirmed sepsis involved children born in the hospital, among a total of 16,627 live births registered in our center over the study period. The overall incidence of EONS dropped from 6.8 to 0.6/1,000 births between 1995 and 1999 (p < 0.001), but the rate of group B streptococcal infection decreased much more rapidly than that of non-group B streptococcal infection. We observed a trend towards the emergence of ampicillin-resistant Escherichia coli strains, which were isolated in seven cases. Among E. coli infections, ampicillin resistance was statistically linked with antenatal antibiotic use (p = 0.025). We also delineated several risk factors associated with these infections. Conclusion: In our center, antenatal antibiotic treatment was effective in reducing the incidence of EONS, but this benefit may come at the cost of favoring the emergence of ampicillin-resistant organisms causing severe neonatal infections. Antenatal and postnatal antibiotic treatment strategies should take this adverse effect into account.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Laugel¹,

Kuhn²,

Beladdale³

et al. 2003

Neonatology

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“…Secondly, if the link between extending pregnancy with PROM and infant CP were confirmed, the benefit of extending pregnancy with PROM would probably have to be reconsidered for 28-32 week pregnancies in this era of maternal corticoids and surfactant use. Recent randomized trials on the management of PROM [27,28] used the prolongation of pregnancy as a primary outcome.…”

Section: Discussionmentioning

confidence: 99%

Some Risk Factors for Cerebral Palsy in Very Premature Infants: Importance of Premature Rupture of Membranes and Monochorionic Twin Placentation

Burguet

Monnet²,

Pauchard³

et al. 1999

Neonatology

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Objective: To delineate the perinatal risk factors of neurodevelopmental disabilities in very preterm birth applying logistic regression analysis. Design: This prospective, geographically defined collaborative study was carried out in the Franche-Comté region of France. Subjects: From October 1, 1990 to September 30, 1992, perinatal and follow-up data were collected on 203 consecutive live-born singleton or twin non-malformed infants with strictly ascertained gestational ages of less than 33 weeks. Main Outcome Measure: The rate of cerebral palsy and/or severe mental retardation as diagnosed by a family physician or pediatrician with a screening-skill test performed at 2 years of age. Results: 167/171 (98%) survivors were evaluated. Twenty-two of the 167 examined infants (13%) showed signs of cerebral palsy, and 10 of these had severe cerebral palsy or mental retardation. Risk factors for disabilities were selected by a multivariate approach: premature rupture of membranes ≥48 h (OR 4.3, 95% CI 1.6–11.8); monochorionic twin placentation (OR 6.0, 95% CI 1.7–21.3), and respiratory distress syndrome (OR 2.8, 95% CI 1.1–7.1). Conclusion: This geographically defined prospective study gives epidemiological data and highly suggests that there is a link between prenatal events (premature rupture of membranes, monochorionic twin placentation), postnatal events (respiratory distress syndrome), and neurological disabilities in former preterm infants.

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“…In several of these studies, GBS-colonized women were excluded 48,51,52 or were given intrapartum prophylaxis. 53,55 In three trials in which intervention was not contingent on GBS colonization status, 46,50,54 there were no cases of early-onset GBS infection in 104 infants whose mothers received intrapartum antibiotics and 7 cases in 152 infants born to women who were not given antibiotics (P Ͼ .05). When combined with a recent study from which GBS-colonized women were excluded, 55 these studies imply that administration of antibiotics to women with preterm premature rupture of membranes reduces the risk of early-onset sepsis by 56% and reduces the risk of GBS sepsis by 36% (Table 1).…”

Section: Intrapartum Treatment For Preterm Premature Rupture Of Membrmentioning

confidence: 99%

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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ABSTRACT. Objective. To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.Study Design. Literature review and reanalysis of published data.Results. The rate of early-onset GBS sepsis in highrisk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.Conclusions. Women with chorioamnionitis or preterm premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. Pediatrics 1999;103(6). URL: http://www.pediatrics.org/cgi/content/full/103/6/e78; group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.ABBREVIATIONS. EOGBS, early-onset neonatal group B streptococcus infection; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; GBS, group B streptococcus. P revention of early-onset neonatal group B streptococcal (EOGBS) sepsis requires the identification of infants who are at high risk and the use of effective preventive intervention. The American Academy of Pediatrics (AAP), 1,2 American College of Obstetricians and Gynecologists (ACOG), 3,4 and Centers for Disease Control and Prevention (CDC) 5 agree that this intervention should be intrapartum antibiotic treatment. The commentaries that accompany those recommendations and several recent cost-benefit or efficacy analyses implicitly 1-7 or explicitly 8 -11 assume that intrapartum antimicrobial prophylaxis is 100% effective, but reports of at least 50 cases of EOGBS disease in infants whose mothers received intrapartum prophylaxis [12][13][14][15] demonstrate that this cannot be correct. The decision analysis cited by the CDC recommendations 1...

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Group B Streptococcus and preterm premature rupture of membranes: A randomized, double-blind clinical trial of antepartum ampicillin

Cited by 37 publications

References 13 publications

Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Effects of Antenatal Antibiotics on the Incidence and Bacteriological Profile of Early-Onset Neonatal Sepsis

Some Risk Factors for Cerebral Palsy in Very Premature Infants: Importance of Premature Rupture of Membranes and Monochorionic Twin Placentation

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

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