{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T11:20:21Z","timestamp":1792149621803,"version":"4.4.0"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,10,24]],"date-time":"2019-10-24T00:00:00Z","timestamp":1571875200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>While many guidelines recommend a 10\u2010day course of oral erythromycin following preterm prelabour rupture of membranes (PPROM) as derived from the ORACLE I trial, evidence is emerging that this may encourage a state of antenatal genital tract dysbiosis. In addition, erythromycin\u2019s lack of efficacy toward Gram\u2010negative microorganisms may promote colonisation and infection, conveying more significant unrecognised risk for very and extremely preterm newborns.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To define patterns of placental infection or colonisation in newborns born before 30 completed weeks gestation following PPROM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Retrospective cohort study of mother\u2010infant dyads who delivered at\u00a0&lt;\u00a030 completed weeks gestation following PPROM in a South Australian tertiary perinatal centre between January 2012 and December 2015. Main outcome measures included placental and neonatal culture and sensitivities within 72\u00a0h of delivery and histologic chorioamnionitis. Categorical characteristics were analysed using two\u2010sided Fisher\u2019s exact test and numerical characteristics via analysis of variance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the four years studied, 126 infant\u2010mother dyads were identified. Where a placental swab was taken, 23.9% cultured Gram\u2010negative organisms and the majority (58.8%) were antimicrobial\u2010resistant. Those that received erythromycin had increased incidence of antimicrobial\u2010resistant Gram\u2010negative organisms on placental swab (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.02). All cases of neonatal early\u2010onset sepsis (EOS), including two cases of multi\u2010resistant Gram\u2010negative EOS, occurred in those who received erythromycin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The current antibiotic recommendations for PPROM may promote selection of unhindered antimicrobial\u2010resistant Gram\u2010negative organisms and may increase risk of Gram\u2010negative EOS in very and extremely preterm newborns. Further wide\u2010scale examination of antibiotic recommendations in PPROM is necessary.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13087","type":"journal-article","created":{"date-parts":[[2019,10,25]],"date-time":"2019-10-25T05:13:02Z","timestamp":1571980382000},"page":"509-513","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Patterns of placental antimicrobial resistance in preterm birth before 30 completed weeks gestation complicated by preterm prelabour rupture of membranes"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7106-316X","authenticated-orcid":false,"given":"Samuel B.","family":"Axford","sequence":"first","affiliation":[{"name":"Department of Neonatal Medicine Women\u2019s and Children\u2019s Hospital Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad C.","family":"Andersen","sequence":"additional","affiliation":[{"name":"Department of Neonatal Medicine Women\u2019s and Children\u2019s Hospital Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Stark","sequence":"additional","affiliation":[{"name":"Department of Neonatal Medicine Women\u2019s and Children\u2019s Hospital Adelaide South Australia Australia"},{"name":"Neonatal Medicine Group Robinson Research Institute School of Medicine University of Adelaide Adelaide South Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,10,24]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-017-0999-x"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0035-1552935"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.1398"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200005183422007"},{"key":"e_1_2_5_6_1","first-page":"316","article-title":"Amniocentesis for gram stain and culture in preterm premature rupture of the membranes","volume":"66","author":"Broekhuizen FF","year":"1985","journal-title":"Obstet Gynecol"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix661"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/OGX.0000000000000567"},{"key":"e_1_2_5_9_1","unstructured":"Preterm Labour and Birth.National Institute for Health and Care Excellence: Clinical Guidelines.London 2015."},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)04233-1"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61202-7"},{"key":"e_1_2_5_12_1","first-page":"CD001058","article-title":"Antibiotics for preterm rupture of membranes","volume":"12","author":"Kenyon S","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2010-2217"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2009.178798"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012657"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2011.40"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000128782.20060.79"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1479-828X.2004.00304.x"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000168749.82105.64"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-3083"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2003.07.004"},{"key":"e_1_2_5_22_1","unstructured":"Workgroup SAPPG.Preterm prelabour rupture of membranes clinical guideline 2015. 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