Intrapartum Antibiotic Prophylaxis Increases theIncidence of Gram-Negative Neonatal Sepsis

[摘要] Objective:To investigate the influence of the increased use of intrapartum chemoprophylaxis on theincidence of vertically transmitted neonatal sepsis.Methods:Multiple institutional databases were queried for the number of cases in which intrapartumantibiotics were used, the obstetric risk factors that were present, and the number ofresultant cases of neonatal sepsis that occurred for deliveries from 1992 through 1997. Intrapartumantibiotic use was compared between the first and fourth quarter of 1997. Comparisons were madebetween the years 1992–1996 and 1997 for the incidence of the various pathogens causing neonatalsepsis; group B streptococcus (GBS), gram-negative sepsis, and others.Results:We found a significant increase in intrapartum chemoprophylaxis between the first andfourth quarters of 1997 corresponding to the increased physician awareness of published guidelines.As expected, the incidence of neonatal GBS sepsis was drastically reduced (from 1.7/1000 livebirths to 0 in 3730 births,P= 0.02). Unfortunately, there was a concomitant increase in theincidence of gram-negative sepsis (0.29/1000 vs. 1.3/1000,P= .02). The overall incidence of neonatalsepsis remained unchanged (2.7/1000 vs. 2.1/1000,P= .69).Conclusions:Published guidelines have encouraged physicians to increase the use of intrapartumchemoprophylaxis to reduce vertical transmission of GBS. This study confirms the efficacy of thisapproach. Unfortunately, this reduction comes at the cost of increasing the incidence of ampicillinresistantgram-negative neonatal sepsis with a resultant increased mortality. These data providecompelling evidence that the policy of providing ampicillin chemoprophylaxis in selected patientsneeds to be reconsidered. Infect. Dis. Obstet. Gynecol. 7:210–213, 1999.

[学科分类] 妇产科学