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Intra-Amniotic Infection and Antibiotic: A Systematic Review

Abstract

The intra-amniotic infections are one of the main reasons that are related to preterm birth, neonatal diseases, and even death of the newborn. The infections are mainly caused by a variety of different bacterias that previously reside in the vaginal premises and ascend upward to cause infections. The antibiotic interventions are effective in the management of the intra-amniotic disease. However, the antibiotic therapy is not sufficient for the complete infection removal. The accurate and early diagnosis of the microbes and broad-spectrum antibiotics with supplementary treatment methods can be effective in infection removal. The negative aspect of the anti-biotics is related to the resistance development in the bacteria. The resistance is based on the nature of antibiotic administered, there are antibiotics against which bacteria are naturally resistant. Reduced effectiveness and delay in the outcomes of the anti-biotics are mainly due to the antibiotic resistance developed in the bacteria. The awareness should be spread about the hygienic conditions and restraining from health-harming activities such as smoking and drinking.

Keywords: Intra-amniotic infection, Amniotic membranes, inflammation, resistance, microbiology.

Introduction

Neonatal and preterm birth related problem diagnosis and treatment are critical for the health of the mother and the newborn. Proper interventions are being explored to deal with the medical issue faced during this period effectively. The birth event occurred at less than 37 weeks of pregnancy is referred to as preterm (Gravett, 2019). Intraamniotic infections are mainly caused by the bacteria present in the amniotic membranes and fluid. Microbiological techniques used for the identification of micro-organisms and their diversity is utilized in the clinical diagnosis of the disease-causing agents. The inflammation is one of the main complexity of the intra-amniotic disease, and it is caused by the body’s response to the infection caused by micro-organisms, the inflammation and infection together contribute to conditions leading to preterm birth and damages in the fetus (Buhimschi et al., 2012. The preterm birth is the cause of one million annual newborn death and the reason for problems in one out of 10 pregnancy problems (Gravett, 2019). Intra-amniotic infection is usually present in 10-15 percent of patients having the episodic or eventual occurrence of the short pregnancy; however, the intra-amniotic infection has almost 50 percent presence in the patients with very early birth cases (Gravett, 2019). The diagnosis is further complicated due to the absence of infection symptom in this case (Gravett, 2019). Therefore from an epidemic point of view, especially in underdeveloped countries where there is a lack of access to medical facilities, it is crucial to identify the reasons for the infections which cause complications during birth. The infection is overall dangerous for maternal health as well as for fetal health at the global level. There are many regions in the world where the delivery and pregnancy is carried out at homes, and consulting a gynecologist or visiting a hospital for the delivery is considered as taboo. As mentioned previously, in these cases, the disease or infection can be fatal, as no diagnosis or treatment intervention is adopted, and the conventional methods treat the case, in these cases, neonatal death chances are enhanced.

The intra-amniotic infection, also referred to as chorioamnionitis, is a severe inflammatory infection of the membranes and chorionic region of the fetus, mainly caused by the varied community setting of the microorganisms, mainly bacteria at the location of damaged membranes. Still, it can also take place with the structurally stable membranes (Tita & Andrews, 2010). The inflammation mainly describes the infection within the physiological or anatomical involvement of amniotic fluid, membranes surrounding fetus or of the fetus, and placental structures (“Intrapartum Management of Intraamniotic Infection,” 2017). The nature and cause of infection are variable, and it can be related to the blood. It can be caused by the intervention infections, via uterus and placental infection, the newly born is prone to severe septic illnesses, meningitis, and the mother is also vulnerable to pelvic diseases (“Intrapartum Management of Intraamniotic Infection,” 2017). There are many predictions of the disease, which include early labor, membrane damage, bacterial vaginosis, and reduced immunity (NEWTON, 1993). Research suggests that in most of the women, the microbes which cause the amniotic infection are previously settled in the vaginal microbial colonies, and they ascend to the amniotic cavity to cause infections (Romero et al., 2019).

The intervention proposed in the study is mainly related to the antibiotic to deal with the bacterial infection. The antibiotic will help fight other microorganisms present in the region of infection, thus decreasing the quantity of overall harmful microorganisms. Timely introduction of the antibiotic treatment will result in a decrease in the problems related to the infection both in infants and mothers (Gibbs & Duff, 1991). Antibiotic treatment has a high success rate for the treatment of Intra-amniotic infections in the outcome-based study performed by the Joon Oh et al. (Oh et al., 2019).

The research gap is present in the studies and analysis performed in context with Intra-amniotic infection studies regarding outcome-based performance. The literature relevant to effectively of antibiotics related to this specific scenario is present in less quantity. Moreover, the effects of antibiotic treatment for preterm birth-related infections, especially the resistance developed against antibiotics is mostly ignored or not studied in the studies. The antibiotic resistance is being developed massively due to the higher usage rate of antibiotics for these types of complications, which would be ultimately harmful.

Objectives and PICOS

The objective of the study is to evaluate the resistance developed in the bacterial colonies when antibiotic is used against the treatment of the Intra-amniotic infection. As the antibiotic mostly used are of broad-spectrum ranges; therefore the resistance would be most likely to be developed among a variety of the range of organisms, especially bacteria.

The study is also aimed to explore the effects of antibiotic treatment for Intra-amniotic infections. The effects can be broadly described as the affectivity, duration of the administration, problems or complications developed as a consequence of treatment, and the maternal and neonatal health conditions.

The research area selected for the study will be helpful in reducing the knowledge gap available in the literature concerning outcome-based study. Moreover, this research highlights the complications and issues related to a standard treatment used for treating inflammatory and non-inflammatory intra-amniotic infections.

Participants

The participants of the study are mainly pregnant women in which the intra-amniotic complications have been developed, as these are directly related to the objective of the study. Moreover, to effectively study the population, the variable of pregnancy age has been excluded from the characterization of sample size. Women having intra-amniotic complications belonging to any age group can be declared as a participant if included in the research-based studies.

Interventions

The proposed intervention is based on the antibiotic treatment method. The antibiotic treatment duration is included in the scope of the study, as it would further complicate the research procedures, and additional variable of the time has to be added for the analytical procedures. Moreover, to keep the study diverse and focused on the method, no specific medicine has been selected for analytical purposes.

Outcome:

The outcome of the research will highlight different aspects related to the antibiotic resistance developed in the bacteria, which cause intra-amniotic infections. The outcome of the research will also identify the impacts of the introduction and management of antibiotics for the treatment of Intra-amniotic infection-related problems. For a broader context, the effects on the mother, as well as the infant’s health, should be determined.

Study Design.

The research is intended to answer the major research questions related to neonatal health infections through systematic and meta-analysis and literature study from an outcome-based point of view.

Methodology

The literature review is based on the pattern of the analysis performed by the Chapman et al. (Chapman et al., 2014) with additional consideration of the antibiotic resistance on the bacteria, and antibiotic impact on the Intra-amniotic infectious diseases. Gravett highlighted that patients who do not respond to the antibiotic administration within forty-eight to seventy-two hours should be checked for the presence of resistant colonies of microbes. Specific antibiotics of equivalent doses should be recommended to them, which have better performance and less likely to develop antibiotic resistance ( Gravett, 2009).

Title Authors Sample Size Antibiotic Affectivity Resistance
A Randomized Trial of Intrapartum Versus Immediate Postpartum Treatment of Women With Intra-Amniotic Infection Gibbs et al. 26 Valid for both fetal and maternal health Not Discussed
Diagnosis and Management of Clinical Chorioamnionitis Tita et al Not applicable Effective and optimal for clinical intra-amniotic or  chorioamnionitis Not Discussed
Intra-amniotic and Postpartum Infections. Gravett Not applicable Compared to different antibiotic types and efficacy Delayed response is due to the resistance developed in microorganisms
A Comparison of Intrapartum Versus Immediate Postpartum Treatment of Intra-Amniotic Infection Sperling et al 257 The Intrapartum and short Postpartum treatment timing has minimal outcome effect Not Discussed
Antibiotic Regimens for Management of Intra-Amniotic Infection Chapman et al. 1296 Events related to Neonatal complications are reduced. Not Discussed
Current understanding and treatment of intra-amniotic

infection with Ureaplasma spp.

Tantengco et al. Not applicable-Review Study Detailed analysis of the antibiotic types, along with the effect on Ureaplasma spp. Natural, as well as artificial resistance against the antibiotic, has been discussed.
Evidence that antibiotic administration is effective in the treatment of a subset of patients with intra-amniotic infection/inflammation presenting with cervical insufficiency

 

Oh et al 22 The success rate for antibiotic treatment was 60 percent. Not discussed
Antibiotic administration can eradicate intra-amniotic infection or intra-amniotic inflammation in a subset of patients with preterm labor and intact membranes Yoon et al 62 Infection was not present after the antibiotic treatment in 79 percent of the patients Not discussed
Eradication of intraamniotic infection with antibiotics in pPROM: success is a function of intraamniotic inflammation

 

Kim et al 50 Antibiotic treatment is effective for the patients in which inflammation was not present, yet the microbial invasion was evident by the analysis of amniotic fluid Not Discussed.
Antibiotics in the Management of PROM and Preterm Labor Brian Mercer Not Applicable-Literature The supplementary antibiotic treatment of Intra-Amniotic Infection and PROM management is more effective in elongation of pregnancy duration and infection removal as compared to antibiotic treatment alone Not discussed.
Antibiotic Administration to Patients With Preterm Premature Rupture of Membranes Does Not Eradicate Intra-Amniotic Infection Gomez et al 46 The antibiotics are hardly effective for the eradication and removal of Intra-Amniotic Infection. Inflammations can be developed even after the administration of antibiotics. For some patients, antibiotic therapy is effective in the reduction of inflammation intensity The treatment monitor, amniotic fluid analysis, and the prevalence of neonatal sepsis, along with the antibiotic resistance of microorganisms has been mentioned.
Optimizing Treatment of Intra-amniotic Infection and Early-Onset Postpartum Endometritis: Advantages of Single-Agent Therapy Stiglich et al 323 The effectiveness of single and multi-agent antibiotics was evaluated for treating Intra-Amniotic Infection, and it was concluded that both single and multi-agent antibiotics having the same dose are equally effective. Not Discussed
Clinical Management of Intra-Amniotic Infection and Chorioamnionitis: A Review of the Literature Jenifer O Fahey Not applicable The antibiotic is effective in fighting bacterial vaginosis and GBS. The broad-spectrum antibiotic should be administered to improve its effectiveness. Not discussed
Antibiotic Therapy for Chorioamnionitis to Reduce the Global Burden of Associated Disease Johnson et al., 2017 Not Applicable The antibiotic treatment is effective in the suppression of the infection effects and favorable maternal, as well as infant outcomes, will Not Discussed.

 

Conclusion

The literature review indicates that antibiotic treatment is effective against the long as well as short term complications caused by the Intra-Amniotic Infection agents. The negative aspects of these antibiotic medicines and treatments is the development of the resistance in the bacteria and other organisms. The resistance is highly dependent on the type of bacteria studied, the antibiotic medicine type and dosage, the structure of the bacteria, and the conditions in which the growth is taking place. As mentioned previously, some bacterial strains have the natural resistance against various antibiotic medicines, and for specific antibiotic agents, the resistance has been developed over time.

Studies have highlighted that a slight variation in administration initiation time of the antibiotic intervention does not affect. It is logical to consider that the microorganisms, mainly bacteria population, will multiply exponentially with time; therefore, immediately after diagnosis, antibiotics should be administered upon the recommendation of the doctor. The ruptured and intact membrane and antibiotic treatment effects have been related frequently in literature. The ruptured membrane can be attributed to the advanced stage of the infection. However, the presence of microorganisms in the amniotic fluid is categorized as the infection. The ruptured membranes aggravate the situation, and the health of the mother is damaged considerably. In the case of intact membranes, the treatment can be done easily. There is also research cited above, which reports that antibiotics are more effective in the case of intact membranes. The appropriate microbiological techniques should be adopted for the analysis of the microbial infection, as placental examination and tissue studies are inaccurate for determining the status of infection and inflammation (Pettker et al., 2007).

The factors that help in earlier identification of symptoms and infection for easy treatment include awareness about food hygiene, body hygiene, and avoidance of alcohol, smoking, etc. in case of pregnancy, as well as regular visits to the doctor and detailed examination of the gynecologist. The awareness about the effectiveness and strengths of proper medical treatment should be spread in underdeveloped countries to improve the maternal as well as the child’s health and reduce the disease and death rate. The risks associated with intra-amniotic infections are very damaging for health, such as sepsis, neurological disorders, and meningitis. The infection seriously damages the health of neonatal as well as the mother. Moreover, the availability of antibiotics should be ensured in the underdeveloped regions and the areas where the poverty level is significant. Governments should provide proper health facilities, especially for pregnant women. Resistance studies should be conducted by the microbiologists as well as the doctors during routine treatment of the patients having the intra-amniotic infection. This will help in gathering the real-time and most recent data, doctors should note down the duration of the antibiotic, type of the medicine, and the results should be applied to study the amniotic fluid. In this way, resistance studies performed will give valuable information.

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