European journal of obstetrics, gynecology, and reproductive biology · 2026
Antimicrobial susceptibility profiles of amniotic fluid microorganisms: limited ampicillin coverage and clinical implications for the management of intra-amniotic infection.
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Shimomura Takashi, Nomiyama Makoto, Iha Yusuke, Obata Mika, Ikeda Masazumi, Oshima Yuko, Kozuma Yutaka, Yamasaki Fumio, Nakura Yukiko, Yanagihara Itaru, Tsumura Keisuke
Аннотация
OBJECTIVE: To evaluate ampicillin (ABPC) susceptibility of microorganisms isolated from amniotic fluid and assess antimicrobial susceptibility patterns, including microorganisms not identified at baseline after antibiotics initiation.
STUDY DESIGN: Retrospective cohort study at a single tertiary center.
METHODS: We reviewed singleton pregnancies that underwent transabdominal amniocentesis for suspected intra-amniotic infection between 2014 and 2023, stratified by prior antibiotic exposure within 90 days. Amniotic fluid underwent Gram staining, aerobic and anaerobic cultures, and Ureaplasma/Mycoplasma-specific culture with molecular identification of Ureaplasma parvum, U. urealyticum, and Mycoplasma hominis. Minimum inhibitory concentrations were interpreted according to CLSI M100-S25. The primary outcome was the proportion of cases with exclusively ABPC-susceptible microorganisms. Secondary outcomes included susceptibility to other antibiotics, detection of microorganisms after antibiotic initiation, and findings among early-onset neonatal sepsis (EONS).
RESULTS: Among 631 eligible women, 137 without prior antibiotic use had positive cultures; only 17% harbored exclusively ABPC-susceptible organisms. Most ABPC-non-susceptible isolates were Ureaplasma spp. or M. hominis. Excluding these organisms and fungi, 28% of isolates were ABPC-non-susceptible, with < 50% susceptibility to other β-lactams or gentamicin. Microorganisms not identified at baseline were detected after antibiotic initiation as early as 2-7 days, and most were non-susceptible to administered agents. Microbial invasion of the amniotic cavity (MIAC) was confirmed in 9 of 10 patients with EONS; 3 involved ABPC + gentamicin-non-susceptible organisms.
CONCLUSIONS: ABPC susceptibility among MIAC-associated microorganisms was limited, and non-susceptible organisms may become detectable after antibiotic exposure. Culture-directed therapy should be prioritized, and optimized regimens targeting Ureaplasma spp. and M. hominis are needed.
STUDY DESIGN: Retrospective cohort study at a single tertiary center.
METHODS: We reviewed singleton pregnancies that underwent transabdominal amniocentesis for suspected intra-amniotic infection between 2014 and 2023, stratified by prior antibiotic exposure within 90 days. Amniotic fluid underwent Gram staining, aerobic and anaerobic cultures, and Ureaplasma/Mycoplasma-specific culture with molecular identification of Ureaplasma parvum, U. urealyticum, and Mycoplasma hominis. Minimum inhibitory concentrations were interpreted according to CLSI M100-S25. The primary outcome was the proportion of cases with exclusively ABPC-susceptible microorganisms. Secondary outcomes included susceptibility to other antibiotics, detection of microorganisms after antibiotic initiation, and findings among early-onset neonatal sepsis (EONS).
RESULTS: Among 631 eligible women, 137 without prior antibiotic use had positive cultures; only 17% harbored exclusively ABPC-susceptible organisms. Most ABPC-non-susceptible isolates were Ureaplasma spp. or M. hominis. Excluding these organisms and fungi, 28% of isolates were ABPC-non-susceptible, with < 50% susceptibility to other β-lactams or gentamicin. Microorganisms not identified at baseline were detected after antibiotic initiation as early as 2-7 days, and most were non-susceptible to administered agents. Microbial invasion of the amniotic cavity (MIAC) was confirmed in 9 of 10 patients with EONS; 3 involved ABPC + gentamicin-non-susceptible organisms.
CONCLUSIONS: ABPC susceptibility among MIAC-associated microorganisms was limited, and non-susceptible organisms may become detectable after antibiotic exposure. Culture-directed therapy should be prioritized, and optimized regimens targeting Ureaplasma spp. and M. hominis are needed.