Zusammenfassung
Zielsetzung: Die Wertigkeit von bakteriologischen Plazentaabstrichen zur Diagnose intrauteriner Infektionen bei Früh- und Reifgeborenen. Methoden: Insgesamt wurden 1483 Plazenten nach Frühgeburt oder Geburt am Endtermin untersucht. Die Kulturergebnisse wurden mit den neonatalen Oberflächenabstrichen und Blutkulturen in Bezug auf eine perinatale Infektion verglichen. Die Abstriche wurden entweder zwischen den Kotyledonen, im Zwischenraum Plazenta und Amnion, oder zwischen Amnion und Chorion nach Separation der Eihäute entnommen. Ergebnisse: Einundsechzig von 1438 (4,2 %) Bakterienkulturen der Plazentaabstriche waren positiv: davon 21 Bacteroides spezies, 13 Eschericia coli (E. coli), 11 Streptokokken der Gruppe B (GBS), 4 Enterococcus faecalis und 12 andere Species. Siebzehn der 61 Neugeborenen mit positiver Plazentakultur zeigten klinische Zeichen einer Infektion oder Sepsis (5 E. coli, 6 GBS, 2 Enterococcus faecalis, 1 Klebsiella pneumoniae, 1 Staphylococcus aureus, 1 Candida albicans, 1 Gardnerella vaginalis). Nur 4 dieser Neugeborenen hatten eine positive Blutkultur. 123 von 1438 (8,6 %) Plazentaabbstrichen waren kontaminiert. Die Sensitivität bzw. der positive Vorhersagewert der Plazentaabstriche in Bezug auf die Diagnose einer neonatalen Infektion waren 62,5 bzw. 38,5 % für E. coli und 60 bzw. 54,5 % für GBS. Schlussfolgerung: Der Plazentaabstrich erscheint zur retrospektiven Identifikation des ursächlichen Erregers bei Chorioamnionitis mit oder ohne neonatale Infektion hilfreich. Die Aussagekraft von Plazentaabstrichen sollte sich jedoch durch die Entwicklung einer standardisierten Abstrichtechnik verbessern lassen.
Abstract
Aims: To evaluate the performance of bacterial culture of placental swabs for the diagnosis of intrauterine infections in preterm and term infants. Methods: A total of 1438 placentas were examined after preterm and term deliveries and the results were compared with neonatal surface swabs and blood cultures, with respect to the diagnosis of perinatal infection. Swabs were inserted between the cotyledones into the space between placenta and amnion, or obtained from the membranes after separation of the amnion from the chorion. Results: Sixty-one of 1438 (4.2 %) cultures of placental swabs were positive including 21 Bacteroides species, 13 Eschericia coli (E. coli), 11 group B streptococcus (GBS), 4 Enterococcus faecalis, and 12 other species. Seventeen of the 61 neonates with positive placental cultures showed clinical signs of infection or sepsis (5 E. coli, 6 GBS, 2 Enterococcus faecalis, 1 Klebsiella pneumoniae, 1 Staphylococcus aureus, 1 Candida albicans, 1 Gardnerella vaginalis), but only 4 of these neonates had a positive blood culture. 123 of 1438 (8.6 %) placental swabs were contaminated. Sensitivity and positive predictive value of placental swabs for the diagnosis of neonatal infection were 62.5 % and 38.5 % for E. coli and 60 % and 54.5 % for GBS, respectively. Conclusion: Placental swabs appear to be helpful for the retrospective identification of the causative bacteria in case of chorioamnionitis with or without neonatal infection. However, the performance of placental swabs should be improved by developing a standardized technique.
Schlüsselwörter
Plazentaabstriche - intrauterine Infektion - Oberflächenabstriche - Sepsis
Key words
Placental swab - intrauterine infection - amniotic cavity cultures - neonatal sepsis - preterm infant - surface swab
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MD Mirjam Kunze
Dept. of Obstetrics and Gynecology
University of Freiburg
Hugstetter Straße 55
79106 Freiburg
Germany
Email: mkunze@frk.ukl.uni-freiburg.de
