Antibiotic regimens for management of intra‐amniotic infection

摘要: Background Chorioamnionitis is a common infection that affects both mother and infant. Infant complications associated with chorioamnionitis include early neonatal sepsis, pneumonia, meningitis. Chorioamnionitis can also result in maternal morbidity such as pelvic septic shock. Clinical estimated to occur 1% 2% of term births 5% 10% preterm births; histologic found nearly 20% 50% births. Women have two three times higher risk for cesarean delivery four greater endomyometritis, wound infection, abscess, bacteremia, postpartum hemorrhage. Objectives To assess the effects administering antibiotic regimens intra-amniotic on perinatal mortality infection-related complications. Search methods We searched Cochrane Pregnancy Childbirth Group's Trials Register (1 October 2014), CENTRAL, MEDLINE, Embase, LILACS, WHO ICTRP (September 2014). We reference lists retrieved studies contacted experts field. Selection criteria Randomized controlled trials (RCTs) included women who experienced infection. were if they compared treatment placebo or no (if applicable), different regimens, timing therapy (intrapartum and/or postpartum). Therefore, this review assesses evaluating intrapartum antibiotics, antibiotics. Diagnosis was based standard criteria (clinical/test), limit placed gestational age. Data collection analysis Two authors independently assessed inclusion trial quality. Two extracted data checked them accuracy. quality evidence using Grades Recommendation, Assessment, Development Evaluation (GRADE) approach 'Summary findings' table. Main results Our prespecified primary outcomes mortality, severe duration hospital stay. We 11 (involving 1296 women) having low moderate bias - mainly because allocation concealment methods not adequately reported, most open, outcome reporting incomplete. The very outcomes, per GRADE approach. following antibiotics trials: ampicillin, ampicillin/sulbactam, gentamicin, clindamycin, cefotetan. During labor: meta-analysis clear differences rates sepsis (163 neonates; ratio (RR) 1.07, 95% confidence interval (CI) 0.40 2.86; I² = 9%; evidence), failure (endometritis) participants; RR 0.86, CI 0.27 2.70; 0%; hemorrhage (RR 1.39, 0.76 2.56; evidence) when dosages/regimens gentamicin assessed. No between groups any reported outcomes. did identify comparison versus treatment/placebo. Postpartum: evaluated use after vaginal showed significant endometritis. death endometritis treatment. Four assessing dual-agent triple-agent therapy, comparing outcomes; stay difference favor group received short-duration (one study, 292 women; mean (MD) -0.90 days, -1.64 -0.16; evidence). Intrapartum postpartum: one small study (45 ampicillin/gentamicin during immediate favoring number days trial, 45 MD -1.00 -1.94 0.06; -1.90 -3.91 -0.49; evidence). Although rate bacteremia pneumonia we observed 0.06, 0.00 0.95; evidence). Authors' conclusions This (having bias). Only (duration stay) considered provide (short duration) (long management Our main reasons downgrading limitations design execution (risk bias), imprecision, inconsistency results. Currently, limited available reveal appropriate antimicrobial regimen patients infection; whether should be continued period; which what used. Also, adverse intervention (not studies). One RCT period superior their reducing stay.