title: Repeated maternal intramuscular or intraamniotic erythromycin incompletely resolves intrauterine Ureaplasma parvum infection in a sheep model of pregnancy.
abstract: OBJECTIVE
  Ureaplasma spp are the most commonly isolated microorganisms in association with preterm birth. Maternal erythromycin administration is a standard treatment for preterm prelabor rupture of membranes. There is little evidence of its effectiveness in eradicating Ureaplasma spp from the intrauterine cavity and fetus. We used a sheep model of intrauterine Ureaplasma spp infection to investigate the efficacy of repeated maternal intramuscular and intraamniotic erythromycin treatment to eradicate such an infection.
  
  
  METHODS
  Thirty ewes with singleton pregnancies received an intraamniotic injection of 10(7) color change units of erythromycin-sensitive Ureaplasma parvum serovar 3 at 55 days' gestation. At 116 days' gestation, 28 ewes with viable fetuses were randomized to receive (1) intraamniotic and maternal intramuscular saline solution treatment (n = 8), (2) single intraamniotic and repeated maternal intramuscular erythromycin treatment (n = 10), or (3) single maternal intramuscular and repeated intraamniotic erythromycin treatment (n = 10). Fetuses were surgically delivered at 125 days' gestation. Treatment efficacy was assessed by culture, quantitative polymerase chain reaction, and histopathologic evaluation.
  
  
  RESULTS
  Animals treated with intraamniotic erythromycin had significantly less viable U parvum serovar 3 in the amniotic fluid at delivery. However, neither combination of maternal intramuscular and intraamniotic erythromycin treatment successfully cleared U parvum serovar 3 from the amniotic fluid or fetal tissues. Three de novo erythromycin-resistant U parvum isolates were identified in erythromycin-treated animals.
  
  
  CONCLUSIONS
  Erythromycin treatment, given both to the ewe and into the amniotic cavity, fails to eradicate intrauterine and fetal U parvum serovar 3 infection and may lead to development of erythromycin resistant U parvum.
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Kemp
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Miura
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Payne
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Rory
authors.initials: R
authors.lastname: Watts
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Smruthi
authors.initials: S
authors.lastname: Megharaj
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia; Division of Pulmonary Biology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Alan H
authors.initials: AH
authors.lastname: Jobe
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia; Division of Pulmonary Biology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH.
authors.forename: Suhas G
authors.initials: SG
authors.lastname: Kallapur
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia; Division of Perinatal Medicine Centre for Perinatal and Neonatal Care, Tohoku University Hospital, Sendai, Miyagi Prefecture, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Saito
authors.affiliation: Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: O Brad
authors.initials: OB
authors.lastname: Spiller
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Keelan
authors.affiliation: School of Women's and Infants' Health, University of Western Australia, Perth, WA, Australia.
authors.forename: John P
authors.initials: JP
authors.lastname: Newnham
mesh_terms: D000650:Amnion; D000653:Amniotic Fluid / Q000382:microbiology; D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002823:Chorion / Q000378:metabolism / Q000382:microbiology / Q000473:pathology; D004269:DNA, Bacterial / Q000097:blood; D004334:Drug Administration Schedule; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D007267:Injections; D007273:Injections, Intramuscular; D007378:Interleukins / Q000378:metabolism; D008099:Liver / Q000378:metabolism; D008168:Lung / Q000378:metabolism; D023421:Models, Animal; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012329:RNA, Bacterial / Q000097:blood; D011897:Random Allocation; D000685:Serum Amyloid A Protein / Q000378:metabolism; D012756:Sheep; D012867:Skin / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014509:Ureaplasma / Q000235:genetics / Q000302:isolation & purification; D016869:Ureaplasma Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D007378:Interleukins; D012329:RNA, Bacterial; D000685:Serum Amyloid A Protein; D014409:Tumor Necrosis Factor-alpha; D004917:Erythromycin
keywords: Ureaplasma parvum; erythromycin; infection; preterm birth; sheep