title: Treatment of Preterm Premature Rupture of Membranes with Oligo-/Anhydramnion Colonized by Multiresistant Bacteria with Continuous Amnioinfusion and Antibiotic Administrations through a Subcutaneously Implanted Intrauterine Port System: A Case Report.
abstract: Bacterial infection is one of the main causes of preterm premature rupture of membranes (PPROM) leading to preterm delivery, pulmonary hypoplasia, sepsis and joint deformities. Expectant management, broad-spectrum antibiotics and antenatal corticosteroids are routinely used in this condition with very limited success to prevent bacteremia, chorioamnionitis, funisitis and intra-amniotic infection syndrome. Here, we report a case in which we attempted to treat PPROM at 26+3 weeks of gestation with anhydramnion colonized by multiresistant Klebsiella. A perinatal port system was implanted subcutaneously at 28+0 weeks of gestation, enabling long-term continuous lavage of the amniotic cavity with a hypotonic aqueous composition similar to human amniotic fluid combined with intra-amniotic antibiotic application. The patient gave birth to a preterm female infant at 31+1 weeks without any signs of infection. The girl was discharged with a weight of 2,730 g in very good condition. In the follow-up examinations at 5 months and 1 year of age, there was no apparent neurological disturbance, developmental delay or Klebsiella colonization.
authors.affiliation: Department of Obstetrics and Prenatal Medicine, Center of Fetal Surgery, University Hospital Halle (Saale), Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Tchirikov
authors.forename: Zhaxybay
authors.initials: Z
authors.lastname: Zhumadilov
authors.forename: Andreas Suhartoyo
authors.initials: AS
authors.lastname: Winarno
authors.forename: Roland
authors.initials: R
authors.lastname: Haase
authors.forename: Jörg
authors.initials: J
authors.lastname: Buchmann
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000382:microbiology*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000009:adverse effects; D001691:Biological Therapy / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D002821:Chorioamnionitis / Q000517:prevention & control; D003131:Combined Modality Therapy / Q000009:adverse effects; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D036502:Infusions, Intralesional; D007623:Kazakhstan; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000254:growth & development*; D050498:Live Birth; D016104:Oligohydramnios / Q000382:microbiology / Q000503:physiopathology / Q000628:therapy*; D011247:Pregnancy; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Amnioinfusion; Anhydramnion; Klebsiella; Port; Preterm premature rupture of membranes