title: Is Ureaplasma spp. the leading causative agent of acute chorioamnionitis in women with preterm birth?
abstract: OBJECTIVE
  Aim of this study was to detect microorganisms in fetal membranes and placental tissue in preterm chorioamnionitis by combining fluorescence in situ hybridization (FISH) with broad range PCR. The combination of the two molecular techniques enables identification and localization of the microorganisms within the tissue, confirming their clinical relevance.
  
  
  METHODS
  In a prospective cohort study, we compared 31 women with preterm premature rupture of membranes or preterm labour and preterm delivery by caesarean section with a control group of 26 women undergoing elective caesarean section at term. Fetal membranes and placental tissue were analysed by FISH and broad range 16S rRNA-gene PCR and sequencing.
  
  
  RESULTS
  For 20 women in the preterm group, caesarean section was performed because of a clinical diagnosis of chorioamnionitis. Microorganisms were detected in the tissues by both molecular techniques in 11 out of 20 women. Among those, Ureaplasma spp. was most abundant, with five cases that remained culture-negative and would have been missed by routine diagnostic procedures. Other infections were caused by Staphylococcus aureus, Streptococcus mitis or Escherichia coli. FISH and PCR were negative for all women without suspected chorioamnionitis and for the control group.
  
  
  CONCLUSIONS
  Combination of FISH with broad-range PCR and sequencing permitted unambiguous identification of the causative microorganisms in chorioamnionitis. The high prevalence of Ureaplasma spp. should lead to a re-evaluation of its clinical significance and possible therapeutic consequences.
authors.affiliation: Biofilmzentrum, German Heart Institute Berlin, Berlin, Germany; Institut für Mikrobiologie und Hygiene, Charité - Universitätsmedizin Berlin, Campus Charité Benjamin Franklin, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Kikhney
authors.affiliation: Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: von Schöning
authors.affiliation: Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Steding
authors.affiliation: Biofilmzentrum, German Heart Institute Berlin, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Schulze
authors.affiliation: Institut für Mikrobiologie und Hygiene, Charité - Universitätsmedizin Berlin, Campus Charité Benjamin Franklin, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Petrich
authors.affiliation: Institute of Clinical Microbiology and Hygiene - University Hospital Regensburg, Regensburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Hiergeist
authors.affiliation: Institute of Clinical Microbiology and Hygiene - University Hospital Regensburg, Regensburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Reischl
authors.affiliation: Biofilmzentrum, German Heart Institute Berlin, Berlin, Germany. Electronic address: moter@dhzb.de.
authors.forename: A
authors.initials: A
authors.lastname: Moter
authors.affiliation: Klinik für Geburtsmedizin, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D002821:Chorioamnionitis / Q000175:diagnosis* / Q000382:microbiology*; D005260:Female; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008875:Middle Aged; D010920:Placenta / Q000382:microbiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D047928:Premature Birth; D011446:Prospective Studies; D012336:RNA, Ribosomal, 16S; D012307:Risk Factors; D014509:Ureaplasma / Q000145:classification / Q000235:genetics; D016869:Ureaplasma Infections / Q000175:diagnosis* / Q000382:microbiology*; D055815:Young Adult
chemical_list: D012336:RNA, Ribosomal, 16S
keywords: 16S rRNA; Chorioamnionitis; Fluorescence in situ hybridization; Neonatal mortality; Preterm birth; Ureaplasma