ADVERSE PERINATAL OUTCOME AND RESISTANT ENTEROBACTERIACEAE AFTER ANTIBIOTIC USAGE FOR PREMATURE RUPTURE OF THE MEMBRANES AND GROUP-B STREPTOCOCCUS CARRIAGE

Objective: To report a case series of adverse perinatal outcomes assoc iated with resistant Enterobacteriaceae after antibiotic usage for pre mature rupture of the membranes (PROM) and group B streptococcus. Meth ods: Maternal and neonatal records were reviewed of four cases in whic h adverse perinatal outcomes occurred from resistant Enterobacteriacea e after antibiotic usage for either PROM or positive group B streptoco ccal cultures. Information on clinical setting, antibiotic usage, mate rnal and neonatal complications, and maternal and neonatal cultures wa s noted. Results: All four cases were complicated by PROM at 25-35 wee ks' gestation. Ampicillin or amoxicillin was used in several clinical settings, including therapeutically for the presence of group B strept ococcus, presumptively for PROM, and prophylactically pending the resu lts of group B streptococcal cultures. Clinical chorioamnionitis subse quently developed in all four cases, and in two cases the maternal cou rse was prolonged and complicated by persistent fever and the need for therapy for pelvic vein thrombophlebitis. Two neonates died from fulm inant clinical sepsis. A third infant, one of a twin gestation, was st illborn, presumably because of sepsis. In three cases, neonatal and pl acental cultures revealed Escherichia coli resistant to ampicillin; in the fourth case, Klebsiella pneumoniae was identified, with only inte rmediate sensitivity to ampicillin. Conclusion: Resistant Enterobacter iaceae 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 we ighed against presumably infrequent but serious outcomes, including ne onatal sepsis and death due to selection or overgrowth of resistant or ganisms.