Amniotic cavity cultures, blood cultures, and surface swabs in preterm infants--useful tools for the management of early-onset sepsis?
OBJECTIVE
To evaluate the potential benefit of amniotic fluid and amniotic/placental membrane cultures for the management of early-onset sepsis in preterm infants.


METHODS
The results of amniotic cavity cultures obtained during cesarean section and of peripheral blood cultures and surface swabs obtained from the preterm infant at the time of admission were analyzed with respect to the diagnosis of clinical sepsis in 221 preterm infants <34 weeks of gestation.


RESULTS
136 (61.5%) patients had negative amniotic cavity culture results or growth of contaminants, 56 (25.3%) had growth of Ureaplasma urealyticum, and 29 (13.1%) of other pathogens. The corresponding numbers for surface swabs were 82.8%, 11.6%, and 5.6%. A positive blood culture was found in only two neonates. Fifty-four patients (24.4%) had clinical early-onset sepsis. Patients with amniotic cavity culture results that were positive for other pathogens were significantly more likely to experience clinical sepsis than patients with negative culture results (51.7% vs 15.1%, OR 6.1, p<0.0001). Regarding surface swabs, this correlation did not reach statistical significance.


CONCLUSIONS
The strong association between positive amniotic cavity culture results and clinical early-onset sepsis supports the existence of a causal relation and provides evidence for the potential value of amniotic and/or placental membrane sampling in the management of early-onset sepsis in preterm infants. Surface swabs add no additional information and hence should not be performed routinely.
Berger
Angelika
A
Department of Pediatrics, Division of Neonatology and Intensive Care, University Hospital Vienna, Austria. angelika.berger@akh-wien.ac.at
Witt
Armin
A
Haiden
Nadja
N
Kretzer
Veronika
V
Heinze
Georg
G
Pollak
Arnold
A
D000650:Amnion / Q000382:microbiology*; D001317:Austria / Q000453:epidemiology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D015169:Colony Count, Microbial / Q000295:instrumentation / Q000379:methods*; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D008297:Male; D010920:Placenta / Q000382:microbiology*; D011237:Predictive Value of Tests; D016990:Ureaplasma urealyticum / Q000302:isolation & purification