The correlation between placental histology and microbiologic infection in the diagnosis of chorioamnionitis in preterm delivery

INTRODUCTION

This study sought to investigate the correlation between histologically proven chorioamnionitis and placental bacteriologic infection in preterm births.

METHODS

Women who gave birth before 34 + 0 weeks' gestation at a tertiary medical center between the years 2018-2019 were identified by a database review. Data was collected on clinical characteristics and findings on placental histology, cultures, and polymerase chain reaction. The correlation between histologically confirmed chorioamnionitis and bacteriologic infection was evaluated.

RESULTS

Of 183 placentas included in the study, 88 (48.1%) were histologically positive for chorioamnionitis and 95 (51.9%) were negative. Baseline characteristics were similar in the patients with and without chorioamnionitis. Concordance rates between the histology and microbiology results in the two groups were 51.1% and 64.2%, respectively. Similar types of bacterial microorganisms were isolated in both groups, though at different rates. On chi-square analysis of association, a positive microbiological study had a sensitivity of 51.1%, specificity of 64.2%, and positive predictive value of 56.9% for predicting histologically confirmed chorioamnionitis. Histologically confirmed chorioamnionitis was associated with higher antepartum white blood cell count (14.2 ± 4.6 vs 12.3 ± 3.3 K/μL; p = 0.01), higher rate of clinically suspected chorioamnionitis (10.2% vs 1.1%, p = 0.02), and higher rate of neonatal adverse composite outcome (36.4% vs. 22.1%, p = 0.009).

DISCUSSION

The correlation between histologic and bacteriologic placental findings in the setting of early premature delivery is not high, nor is the clinical yield of placental bacteriology. The discordant results might be explained by early stage of bacterial infection, hard-to-cultivate bacterial species, noninfectious conditions, or contamination of the placental surfaces during passage through the vaginal tract.

A novel extended prophylactic antibiotic regimen in preterm pre-labor rupture of membranes: A randomized trial

OBJECTIVES

Prophylactic antibiotic use in preterm pre-labor rupture of membranes (PPROM) is associated with a significant reduction in intra-amniotic infection and improved neonatal outcome. However, data is insufficient to determine the optimal antibiotic regimen. Considering the rise in Escherichia coli and Klebsiella pneumonia early-onset sepsis rate and the emergence of ampicillin resistance, our aim is to compare the efficiency of two antibiotic regimens in prolonging pregnancy and reducing infectious morbidity.

DESIGN

This multicenter randomized unblinded controlled prospective trial compared two antibiotic prophylactic protocols in PPROM: ampicillin + roxithromycin vs. cefuroxime + roxithromycin in 84 women with PPROM, from 12/2015-12/2019.

RESULTS

The median latency period was significantly longer (p = 0.039) in the cefuroxime + roxithromycin group (4.63 [0.59-50.18] days) than in the ampicillin + roxithromycin group (2.3 [0.15-58.3] days). Neonatal admission to neonatal intensive care unit rate, hospitalization length, neonatal respiratory distress syndrome, neonatal fever, and need for respiratory support or mechanical ventilation, were similar between the groups. K. pneumonia cultures were significantly more frequent in the ampicillin + roxithromycin group. None of the cultures were group B Streptococcus positive.

CONCLUSIONS

To prolong latency period and reduce gram-negative early-onset sepsis, cefuroxime + roxithromycin is recommended as the first-line protocol in PPROM.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02819570.

Ultrafine particles in airways: a novel marker of COPD exacerbation risk and inflammatory status

Purpose

Ultrafine particles (UFP) are toxic due to their small size and penetration into deeper lung compartments. We aimed to evaluate the exhaled breath condensate (EBC)-UFP content as a reflection of inflammation and oxidative stress status in COPD patients and as an exacerbation risk marker.

Methods

EBC was collected by conventional methods. Particles were analyzed with NanoSight LM20. EBC carbonyl and 8-hydroxydeoxyguanosine (8-OHdG) levels were measured using ELISA kits. Study population (58 COPD patients and 40 healthy smoker and non-smoker controls) underwent spirometry, diffusion capacity, EBC testing, and blood sampling.

Results

Absolute eosinophil count, C-reactive protein (CRP), and lactate dehydrogenase in serum were elevated in the COPD group compared with the controls (224 U/L, 5 mg/L, and 391 U/L vs 154 U/L, 3 mg/L, and 330 U/L, P=0.009, P=0.05, and P=0.004, respectively). COPD patients had lower UFP concentrations in EBC compared with controls (0.24 E8/mL vs 0.51 E8/mL, P≤0.001). A mirror image was detected in serum: COPD patients had higher UFP concentrations compared with controls (9.8 E8/mL vs 6.7 E8/mL, respectively, P=0.03). EBC carbonyl and 8-OHdG levels were higher among COPD patients compared with controls (5.1 per 1 µg/mL protein and 0.036 ng/mL vs 0.41 per 1 µg/mL protein and 0.003 ng/mL, P=0.001 and P≤0.001, respectively). EBC UFP concentrations were negatively correlated with pack years (R=−0.44, P ≤0.001) and positively correlated with FEV₁ and diffusing lung capacity for carbon monoxide (R=0.46, 0.23, P ≤0.001 and P=0.04, respectively). Low EBC UFP concentrations (≤0.18 E8/mL) and CRP levels ≥5 mg/L were independent predictors of the frequent exacerbator phenotype (OR 3.6; 95% CI: 1.06–7.97; P=0.04 and OR 4.4; 95% CI: 1.24–10.2; P=0.02, respectively).

Conclusion

UFP content in EBC reflects the inflammatory state of airways. Low UFP concentrations in EBC and high in serum of COPD patients support our hypothesis that increased epithelial permeability could be the mechanism behind those findings.