Re: GBS
From: R. Daniel Braun (rd.braun@gmail.com)
Wed Aug 17 11:52:40 2005
Just cause the guidelines say that doesn't make it so.
On 8/17/05, Seele, Mona <Mseele@tmh.tmc.edu> wrote:
>
> But the CDC literature from 2002 states that antibiotic use at delivery
> for
> GBS is not likely to be the cause of resistant microorganisms...they do
> question the use of antibiotics for PROM which is usually for a longer
> duration.
> -----Original Message-----
> From: ob-gyn-l@obgyn.net
> To: Multiple recipients of list OB-GYN-L
> Sent: 8/16/2005 8:23 PM
> Subject: Re: GBS
>
> In a message dated 8/16/05 7:44:19 PM, rd.braun@gmail.com writes:
>
> Not any more. Now it is E.coli resistant to ampicillin because of all
> the ampicillin we have been giving to treat GBBS.
>
> Uh, I agree with Dan, the Man. Like, uh, is this NEW? Or is it, like,
> over a decade old??? Like LAST MILLENIUM, even? Geeze!
>
> THE MAN
>
> Obstet Gynecol. 1993 Oct;82(4 Pt 1):487-9.
>
> Adverse perinatal outcome and resistant Enterobacteriaceae after
> antibiotic usage for premature rupture of the membranes and group B
> streptococcus carriage.
>
> McDuffie RS Jr, McGregor JA, Gibbs RS.
>
> Department of Obstetrics and Gynecology, Saint Joseph Hospital, Denver,
> Colorado.
>
> OBJECTIVE: To report a case series of adverse perinatal outcomes
> associated with resistant Enterobacteriaceae after antibiotic usage for
> premature rupture of the membranes (PROM) and group B streptococcus.
>
> METHODS: Maternal and neonatal records were reviewed of four cases in
> which adverse perinatal outcomes occurred from resistant
> Enterobacteriaceae after antibiotic usage for either PROM or positive
> group B streptococcal cultures. Information on clinical setting,
> antibiotic usage, maternal and neonatal complications, and maternal and
> neonatal cultures was noted.
>
> RESULTS: All four cases were complicated by PROM at 25-35 weeks'
> gestation. Ampicillin or amoxicillin was used in several clinical
> settings, including therapeutically for the presence of group B
> streptococcus, presumptively for PROM, and prophylactically pending the
> results of group B streptococcal cultures. Clinical chorioamnionitis
> subsequently developed in all four cases, and in two cases the maternal
> course was prolonged and complicated by persistent fever and the need
> for therapy for pelvic vein thrombophlebitis. Two neonates died from
> fulminant clinical sepsis. A third infant, one of a twin gestation, was
> stillborn, presumably because of sepsis. In three cases, neonatal and
> placental cultures revealed Escherichia coli resistant to ampicillin; in
> the fourth case, Klebsiella pneumoniae was identified, with only
> intermediate sensitivity to ampicillin.
>
> CONCLUSION: Resistant Enterobacteriaceae associated with adverse
> perinatal outcomes may result from the use of antibiotics, such as
> ampicillin or amoxicillin, after PROM. In deciding whether antibiotic
> therapy for PROM or group B streptococcal prophylaxis is appropriate,
> the value of purported benefits must be weighed against presumably
> infrequent but serious outcomes, including neonatal sepsis and death due
> to selection or overgrowth of resistant organisms.
>
> -----------------------------------------
> Methodist. Leading Medicine.
> -----------------------------------------
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--
R. Daniel Braun
Kinky for Governor
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