BJOG. 2021 Dec 26; doi: 10.1111/1471-0528.17081. Epub 2021 Dec 26.
Antibiotic prophylaxis in preterm premature rupture of membranes at 24-31 weeks' gestation: Perinatal and 2-year outcomes in the EPIPAGE-2 cohort.
BJOG : an international journal of obstetrics and gynaecology
Elsa Lorthe, Mathilde Letouzey, Héloïse Torchin, Laurence Foix L'Helias, Christèle Gras-Le Guen, Valérie Benhammou, Pascal Boileau, Caroline Charlier, Gilles Kayem,
Affiliations
Affiliations
- Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, Paris, France.
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Department of Neonatal Paediatrics, Poissy Saint Germain Hospital, Versailles Saint Quentin en Yvelines University, Poissy, France.
- Department of Neonatal Paediatrics, Cochin Port Royal Hospital, APHP, Paris, France.
- Department of Neonatal Paediatrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France.
- Department of Paediatrics, Paediatrics Emergency Unit and General Paediatrics, Nantes University Hospital, Hôpital Mère-Enfant, CHU de Nantes, Nantes, France.
- UFR des Sciences de la Santé Simone Veil, Versailles St Quentin en Yvelines University, Montigny le Bretonneux, France.
- Université de Paris, Hôpital Universitaire Necker-Enfants Malades, Biology of Infection Unit, Division of Infectious Diseases and Tropical Medicine, Assistance Publique-Hôpitaux de Paris, Institut Pasteur, French National Reference Centre and WHO Collaborating Centre for Listeria U1117, Inserm U1117, Paris, France.
- Department of Gynaecology and Obstetrics, Trousseau Hospital, APHP, Sorbonne University, Paris, France.
PMID: 34954867
DOI: 10.1111/1471-0528.17081
Abstract
OBJECTIVE: To compare different antibiotic prophylaxis administered after preterm premature rupture of membranes to determine whether any were associated with differences in obstetric and/or neonatal outcomes and/or neurodevelopmental outcomes at 2 years of corrected age.
DESIGN: Prospective, nationwide, population-based EPIPAGE-2 cohort study of preterm infants.
SETTING: France, 2011.
SAMPLE: We included 492 women with a singleton pregnancy and a diagnosis of preterm premature rupture of membranes at 24-31 weeks. Exclusion criteria were contraindication to expectant management or indication for antibiotic therapy other than preterm premature rupture of membranes. Antibiotic prophylaxis was categorised as amoxicillin (n = 345), macrolide (n = 30), third-generation cephalosporin (n = 45) or any combinations covering Streptococcus agalactiae and >90% of Escherichia coli (n = 72), initiated within 24 hours after preterm premature rupture of membranes.
METHODS: Population-averaged robust Poisson models.
MAIN OUTCOME MEASURES: Survival at discharge without severe neonatal morbidity, 2-year neurodevelopment.
RESULTS: With amoxicillin, macrolide, third-generation cephalosporin and combinations, 78.5%, 83.9%, 93.6% and 86.0% of neonates were discharged alive without severe morbidity. The administration of third-generation cephalosporin or any E. coli-targeting combinations was associated with improved survival without severe morbidity (adjusted risk ratio 1.25 [95% confidence interval 1.08-1.45] and 1.10 [95 % confidence interval 1.01-1.20], respectively) compared with amoxicillin. We evidenced no increase in neonatal sepsis related to third-generation cephalosporin-resistant pathogen.
CONCLUSION: In preterm premature rupture of membranes at 24-31 weeks, antibiotic prophylaxis based on third-generation cephalosporin may be associated with improved survival without severe neonatal morbidity when compared with amoxicillin, with no evidence of increase in neonatal sepsis related to third-generation cephalosporin-resistant pathogen.
© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
Keywords: amoxicillin; antenatal management; cephalosporins; latency; macrolides; neurodevelopment; obstetric intervention; perinatal outcome; prematurity; prophylactic antibiotics
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