Authors (including presenting author) :
Lee SR (1) Shu W (2) Chan D (2)
Affiliation :
1. Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital 2. Department of Obstetrics and Gynaecology, Pamela Youde Nethersole Eastern Hospital
Introduction :
Intra-amniotic infection could cause significant morbidity and mortality to pregnant mothers and their neonates. The American College of Obstetrics and Gynecology (ACOG) recommended the use of ampicillin and gentamycin for intra-amniotic infection to cover the common pathogens of pregnant mothers in their urinary and genital tracts namely Group B streptococcus, Escherichia Coli, and other gram negative bacilli.1 The ACOG remarked that the choice of antibiotics should be adapted in each community based on local data on antibiogram.
Objectives :
To obtain the antibiogram of organisms cultured from urinary and genital tracts of pregnant women in our obstetric unit and thereby come up with a recommendation of empirical antibiotics for intra-amniotic infection.
Methodology :
We used CDARS (a search engine in the CMS of the Hospital Authority) to obtain culture and sensitivity results of specimens from urinary and genital tracts of women in our obstetric unit in the period from 2017to 2019.
Result & Outcome :
There were 729 specimen showing positive growths. 82 positive growths were from specimens of low vaginal plus rectal swab obtained for screening for Group B Streptococcus carrier. The rest of the specimens were performed for clinical indications: suspected urinary tract infection, maternal fever, prolonged premature rupture of membrane, premature birth etc. The organisms recovered included: Group B Streptococcus infection (373), Escherichia Coli (93), Enteroocccus (56), Staphylococcus aureus (40), other Streptococcus, Klebsiella (14), Proteus (13), Pseudomonas (2), Citrobacter Koseri (2), Enterobacter sp (1). All Group B Streptococcus are sensitive to penicillin and all Enterococcus are sensitive to ampicillin. Half of the Escherichia Coli were resistant to ampicillin. Sensitivity of the gram negative organisms to gentamycin were: Escherichia Coli (87.1%), Klebsiella (85.7%), Proteus (100%). The sensitivity of the gram negative organisms to intravenous cefuroxime were: Escherichia Coli (83.9%), Klebsiella (71.4%), Proteus (84.6%). From the result of the antibiogram, we could adopt the recommendation of ACOG using ampicillin and gentamycin for intra-amniotic infection with ampicillin covering possible Group B Streptococcus infection and gentamycin covering infection due to gram negative organisms. An alternative antibiotic of choice for coverage of gram negative organism is intravenous cefuroxime.
