Rodney K Edwards1, Penny Clark, Christopher L Sistrom, Patrick Duff. 1. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Florida College of Medicine, Gainesville 32610-0294, USA. edwardsr@obgyn.ufl.edu
Abstract
OBJECTIVE: To assess whether the antibiotic chosen for intrapartum antibiotic prophylaxis affects the subsequent exposure of the neonate to ampicillin-resistant gram-negative bacteria. METHODS: We performed a randomized clinical trial of ampicillin versus penicillin for intrapartum antibiotic prophylaxis. Genital tract cultures for Enterobacteriaceae were obtained at study entry and 8-36 hours postpartum. Organisms were isolated, identified, and tested for ampicillin susceptibility. RESULTS: The ampicillin (n = 175) and penicillin (n = 177) groups, respectively, did not differ in rates of ampicillin-resistant Escherichia coli at entry (25% versus 22%, P =.57) or postpartum (36% versus 38%, P =.64). Similarly, groups did not differ in rates of ampicillin-resistant Enterobacteriaceae at entry (38% versus 32%, P =.23) or postpartum (51% versus 55%, P =.46). However, postpartum culture rates of resistant Escherichia coli were higher than entry culture rates for both the ampicillin (36% versus 25%, P =.026) and penicillin (38% versus 22%, P <.001) groups. Postpartum culture rates of resistant Enterobacteriaceae were also higher than entry culture rates for both the ampicillin (51% versus 38%, P <.001) and penicillin (55% versus 32%, P <.001) groups. Results were similar when considering only women who received two or more doses and no additional antibiotics. CONCLUSION: Intrapartum antibiotic prophylaxis with either ampicillin or penicillin increases exposure of neonates to ampicillin-resistant Enterobacteriaceae.
RCT Entities:
OBJECTIVE: To assess whether the antibiotic chosen for intrapartum antibiotic prophylaxis affects the subsequent exposure of the neonate to ampicillin-resistant gram-negative bacteria. METHODS: We performed a randomized clinical trial of ampicillin versus penicillin for intrapartum antibiotic prophylaxis. Genital tract cultures for Enterobacteriaceae were obtained at study entry and 8-36 hours postpartum. Organisms were isolated, identified, and tested for ampicillin susceptibility. RESULTS: The ampicillin (n = 175) and penicillin (n = 177) groups, respectively, did not differ in rates of ampicillin-resistant Escherichia coli at entry (25% versus 22%, P =.57) or postpartum (36% versus 38%, P =.64). Similarly, groups did not differ in rates of ampicillin-resistant Enterobacteriaceae at entry (38% versus 32%, P =.23) or postpartum (51% versus 55%, P =.46). However, postpartum culture rates of resistant Escherichia coli were higher than entry culture rates for both the ampicillin (36% versus 25%, P =.026) and penicillin (38% versus 22%, P <.001) groups. Postpartum culture rates of resistant Enterobacteriaceae were also higher than entry culture rates for both the ampicillin (51% versus 38%, P <.001) and penicillin (55% versus 32%, P <.001) groups. Results were similar when considering only women who received two or more doses and no additional antibiotics. CONCLUSION: Intrapartum antibiotic prophylaxis with either ampicillin or penicillin increases exposure of neonates to ampicillin-resistant Enterobacteriaceae.
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