Microbiological findings in pregnant women with premature rupture of the membranes

Evaldson, George R.; Carlström, Gun; Lagrelius, A.; Malmborg, Anna‐Stina; Nord, Carl‐Erik

doi:10.1007/bf02121812

Cited by 38 publications

(17 citation statements)

References 23 publications

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“…More rarely, D. pneumosintes has been isolated from bite wound infections, during respiratory tract and head and neck infections (7,9), from amniotic fluid and placenta samples (6), in human brain abscesses (18), and during bacteremia (12,18). D. invisus has also been identified in urinary tract specimens from renal transplant recipients (4).…”

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Antimicrobial Susceptibilities and Clinical Sources ofDialisterSpecies

Morio

Jean-Pierre

Dubreuil

et al. 2007

Antimicrob Agents Chemother

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Seventy-four strains representing the four species of the genus Dialister were isolated from various clinical samples. Dialister pneumosintes and Dialister micraerophilus were the two mainly encountered species. Fifty-five isolates were tested against 14 antimicrobial agents. Decreased susceptibilities to piperacillin, metronidazole, macrolides, fluoroquinolones, and rifampin were demonstrated. The clinical impact of these decreased susceptibilities remains to be investigated but should prompt microbiologists to perform antimicrobial susceptibility testing for clinically important Dialister spp.Four species are currently described in the genus Dialister: Dialister pneumosintes, Dialister invisus, Dialister micraerophilus, and Dialister propionicifaciens, the last three being described since 2003 (5, 11). They are small, anaerobic or microaerophilic gram-negative coccobacilli that grow as small, circular, tiny, and transparent colonies on Columbia blood agar, making their recovery in mixed anaerobic cultures relatively difficult. Besides, strains may be difficult to distinguish from tiny, gram-negative anaerobic cocci. Usually, Dialister spp. could be distinguished from members of the genus Veillonella by both the absence of nitrate reduction and the pattern of susceptibility to special-potency disks. Indeed, they display susceptibility to kanamycin (500 g), bile (1 mg), and metronidazole (50 g) and resistance to vancomycin (5 g) and colistin (10 g) disks, whereas Veillonella species are susceptible to the colistin disk, except for Veillonella montpellierensis and Veillonella ratti (10, 11). However, due to their biochemical characteristics (i.e., asaccharolytic and nonreactive in conventional biochemical tests), identification of members of the genus Dialister often requires molecular methods such as 16S rRNA gene sequencing (11). The involvement of Dialister spp. in human infections is now clearly established. D. pneu-

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confidence: 99%

Antimicrobial Susceptibilities and Clinical Sources ofDialisterSpecies

Morio

Jean-Pierre

Dubreuil

et al. 2007

Antimicrob Agents Chemother

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“…Leptotrichia buccalis, a part of oral flora, has been implicated in periodontal disease (8,17) but rarely causes serious systemic infections (7,14,21,22). Leptotrichia is known to be part of the periurethral flora of healthy girls (3) and has been isolated from the cervix of a patient with a premature rupture of the membranes (9). A Leptotrichia sp.…”

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Leptotrichia amnionii, an Emerging Pathogen of the Female Urogenital Tract

et al. 2007

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Leptotrichia amnionii, a recently described, very fastidious, gram-negative anaerobic bacterium, is an opportunistic pathogen of the female urogenital tract. We report a case of second-trimester abortion in a patient with chorioamnionitis and L. amnionii bacteremia and a case of renal abscess in a female 5 weeks postpartum. CASE REPORTS Case 1.A 33-year-old, previously healthy female presented in the second trimester of pregnancy with a 2-to 3-day history of vaginal bleeding, lower back pain, fatigue, and fever. On admission, her blood pressure was 95/50, her pulse was 80/min, and her temperature was 39.6°C. Abdominal examination revealed tenderness in the lower right and left quadrants on palpation. There was no guarding or rebound tenderness. There was no vaginal discharge. Ultrasound examination showed a viable normal fetus of approximately 13 weeks gestation. Initial laboratory values showed a normal white blood cell count and differential, a hemoglobin level of 11.1 g/dl, and a C-reactive protein level (CRP) of 88 mg/liter. Urinalysis results were positive for nitrites, ketones, leukocytes, and blood. Urosepsis was suspected. Three sets of blood cultures from peripheral veins (BACTEC Plus aerobic/F and anaerobic/F culture vials) and a urine sample for culture were obtained prior to initiating treatment with intravenous mecillinam (an amidinopenicillin). On the second day of admission, an ultrasound of the urinary tract was reported as normal, urine culture yielded no significant bacterial growth, and the CRP peaked at 178 mg/liter. Gram-negative bacteria were detected in the blood cultures. Chorioamnionitis was suspected. The antibiotic regimen was changed to cefotaxime and metronidazole, after which the patient became afebrile and the CRP fell to 42 mg/liter. The episodes of vaginal bleeding continued, however, and a spontaneous abortion occurred on day 9. Curettage was performed. None of the products were sent for culture, but chorioamnionitis was diagnosed on the basis of the histopathology of the placenta. The patient was discharged from the hospital 2 days later on amoxicillin therapy and made a full recovery. She delivered a healthy baby 1 year later after an uncomplicated pregnancy.Microbiological findings. Two anaerobic and two aerobic BACTEC Plus blood culture vials were flagged as positive after 2 and 3 days, respectively, of incubation. Gram staining showed gram-negative/gram-variable pleomorphic rods and coccobacilli. After 48 to 72 h of incubation of the chocolate agar plates under anaerobic conditions, gray convex colonies of less than 1 mm in size were seen. In comparison, there was less growth on the anaerobic blood agar plates. Under aerobic conditions (37°C, 5% CO 2 ), growth was detected on chocolate agar plates only after 48 to 72 h of incubation. Catalase and indole spot tests were negative. The isolate was sensitive to kanamycin, brilliant green, and oxgall (Diatabs; Rosco). Antimicrobial susceptibility was determined by Etest (AB Biodisk, Solna, Sweden) on Isosensitest chocolate agar ...

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“…are not often isolated from this flora. Anaerobes are also usually present in the cervical flora of pregnant women, but it is interesting that, in a study of risk factors of PROM, a Leptotrichia species had been isolated only once from cervical flora of a pregnant woman with PROM but never in the control group of healthy pregnant women (5).…”

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Peripartum Bacteremias Due to Leptotrichia amnionii and Sneathia sanguinegens , Rare Causes of Fever during and after Delivery

Martino¹,

Mahoudeau²,

Brettes

et al. 2004

J Clin Microbiol

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We report three cases of delivery and postpartum bacteremia due to unusual anaerobic bacteria in healthy young women. Leptotrichia amnionii bacteremia occurred during delivery in two mothers and was associated with fetal distress during labor. Conversely, Sneathia sanguinegens bacteremia occurred postpartum, 2 days after delivery, without consequence for the neonate. CASE REPORTS Case 1.A 36-year-old woman from North Africa who was living in France had a pregnancy without complications. Vaginal delivery was associated with fetal distress during labor (acidosis, abnormal cardiac rhythm, and colored amniotic liquid), and a maternal postpartum fever up to 39°C occurred rapidly 1 h after delivery. Three blood cultures from peripheral veins were obtained after delivery but before any antibiotic administration. Each blood culture consisted of a pair of BACTEC PLUS Aerobic/F and Anaerobic/F culture vials (BD, Meylan, France). After blood cultures were obtained, the patient was treated with intravenous antibiotic therapy. One gram of intravenous amoxicillin was administered three times per day. Within 10 days of antibiotic therapy, the patient had recovered completely. The newborn did not develop postnatal clinical or laboratory evidence of infection despite initial fetal distress during labor.Case 2. A 32-year-old woman from Turkey who was living in France had a pregnancy without complications. Vaginal delivery was as described above for case 1, and a maternal postpartum fever up to 39°C occurred rapidly 1 h after delivery. Three blood cultures from peripheral veins were obtained after delivery but before any antibiotic administration. Each blood culture consisted of a pair of BACTEC PLUS Aerobic/F and Anaerobic/F culture vials. After blood cultures were obtained, the patient was treated with intravenous antibiotic therapy. One gram of intravenous amoxicillin was administered three times per day. However, because of fever relapse, clavulanic acid was added on the third day. On day 6, this patient developed another febrile episode, while her white blood cell count and C-reactive protein levels were normal and additional blood cultures remained negative. Within 10 days of antibiotic therapy, the patient had recovered completely. The newborn did not develop postnatal clinical or laboratory evidence of infection despite initial fetal distress during labor.Case 3. A 21-year-old woman from Turkey who was living in France had a pregnancy without complications. Vaginal delivery was without fetal distress, but the patient presented with fever up to 39°C 2 days after delivery. Three blood cultures from peripheral veins were obtained after delivery but before any antibiotic administration. Each blood culture consisted of a pair of BACTEC PLUS Aerobic/F and Anaerobic/F culture vials. After blood cultures were obtained, the patient was treated intravenously with 1 g of amoxicillin-clavulanic acid three times per day, 500 mg of metronidazole two times per day, and 100 mg of netilmicin two times per day for 4 days, which was then sw...

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Microbiological findings in pregnant women with premature rupture of the membranes

Cited by 38 publications

References 23 publications

Antimicrobial Susceptibilities and Clinical Sources ofDialisterSpecies

Antimicrobial Susceptibilities and Clinical Sources ofDialisterSpecies

Leptotrichia amnionii, an Emerging Pathogen of the Female Urogenital Tract

Peripartum Bacteremias Due to Leptotrichia amnionii and Sneathia sanguinegens , Rare Causes of Fever during and after Delivery

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