title: Reconsidering the Current Preterm Premature Rupture of Membranes Antibiotic Prophylactic Protocol.
abstract: OBJECTIVE
  The purpose of our study was to determine whether the current antibiotic regimen for preterm premature rupture of membranes (PPROM) is adequate for covering the current causative agents and sensitivities of chorioamnionitis and early-onset neonatal sepsis.
  
  
  METHODS
  During a 3-year period, we retrieved the results from placental and amniotic membrane cultures obtained at delivery in cases of maternal fever, chorioamnionitis, and PPROM, and from blood cultures obtained from neonates with early-onset sepsis (EOS) in three participating hospitals. Sensitivity of pathogens to antimicrobial agents was performed using routine microbiologic techniques.
  
  
  RESULTS
  There were 1,133 positive placental or amniotic cultures, 740 (65.3%) were from gram-negative Enterobacteriaceae. There were 27 neonates diagnosed with EOS with positive blood cultures. Aerobic Enterobacteriaceae accounted for 14 cases (52%) and group B streptococcus for 7 cases (26%). Of the Escherichia coli and Klebsiella sp., only 38% were sensitive to ampicillin.
  
  
  CONCLUSIONS
  Local pathogens and their antibiotic sensitivity profiles should be explored every few years and an effective antibiotic protocol chosen to cover the main pathogens causing chorioamnionitis and EOS. Consideration should be made for changing ampicillin in women with PPROM to a regimen with better coverage of gram-negative Enterobacteriaceae.
authors.affiliation: Department of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
authors.forename: Maya Frank
authors.initials: MF
authors.lastname: Wolf
authors.affiliation: Department of Infectious Disease Consultation Service, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Miron
authors.affiliation: Department of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Peleg
authors.affiliation: Microbiology Laboratory, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
authors.forename: Hagai
authors.initials: H
authors.lastname: Rechnitzer
authors.affiliation: Department of Neonatology, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
authors.forename: Igor
authors.initials: I
authors.lastname: Portnov
authors.affiliation: Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Ruth and Bruce School of Medicine, Technion, Haifa, Israel.
authors.forename: Raed
authors.initials: R
authors.lastname: Salim
authors.affiliation: Microbiology Laboratory, Emek Medical Center, Afula, Ruth and Bruce School of Medicine, Technion, Haifa, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Keness
authors.affiliation: Department of Neonatology, Emek Medical Center, Afula, Ruth and Bruce School of Medicine, Technion, Haifa, Israel.
authors.forename: Dan
authors.initials: D
authors.lastname: Reich
authors.affiliation: Department of Obstetrics and Gynecology, The Baruch Padeh Medical Center, Poriya, Israel.
authors.forename: Moshe Ben
authors.initials: MB
authors.lastname: Ami
authors.affiliation: Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Peretz
authors.affiliation: Department of Neonatology, The Baruch Padeh Medical Center, Poriya, Israel.
authors.forename: Amir
authors.initials: A
authors.lastname: Koshnir
authors.affiliation: Department of Obstetrics and Gynecology, Ziv Medical Center, Bar-Ilan University, Zefat, Israel.
authors.forename: Inbar Ben
authors.initials: IB
authors.lastname: Shachar
mesh_terms: D000650:Amnion / Q000382:microbiology; D000658:Amoxicillin / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002821:Chorioamnionitis / Q000382:microbiology / Q000517:prevention & control*; D002981:Clindamycin / Q000627:therapeutic use; D002985:Clinical Protocols; D024881:Drug Resistance, Bacterial; D004756:Enterobacteriaceae Infections / Q000382:microbiology / Q000517:prevention & control; D004927:Escherichia coli Infections / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000382:microbiology / Q000517:prevention & control*; D007710:Klebsiella Infections / Q000382:microbiology / Q000517:prevention & control; D008826:Microbial Sensitivity Tests; D010920:Placenta / Q000382:microbiology; D011247:Pregnancy; D012189:Retrospective Studies; D015575:Roxithromycin / Q000627:therapeutic use; D018805:Sepsis / Q000382:microbiology / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000382:microbiology / Q000517:prevention & control; D013292:Streptococcus agalactiae
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D015575:Roxithromycin; D002981:Clindamycin; D000667:Ampicillin; D000658:Amoxicillin