Alfredo Ovalle

Occurrence and Antimicrobial Susceptibility of Ureaplasma parvum (Ureaplasma urealyticum Biovar 1) and Ureaplasma urealyticum (Ureaplasma urealyticum Biovar 2) from Patients with Adverse Pregnancy Outcomes and Normal Pregnant Women

A recent phylogenetic analysis of Ureaplasma urealyticum resulted in the proposal to divide their 2 biovars into species. We used PCR to compare the distribution of species and the presence of the tet(M) and int-Tn resistance determinants in 63 strains of Ureaplasma spp. isolated from the amniotic fluid of patients with an adverse pregnancy outcome and in 22 strains obtained from the lower genital tract of healthy pregnant women. We also determined the antimicrobial susceptibility of the organisms to erythromycin and tetracycline. U. parvum was the most frequent Ureaplasma species detected in our study. Thus, 50/63 (79.4%) invasive isolates and 17/22 (77.3%) lower genital tract isolates corresponded to U. parvum, whereas 12/63 (19%) invasive isolates and 4/22 (18.2%) non-invasive strains corresponded to U. urealyticum. A mixture of species was found in 2 women. We found no significant differences in the antimicrobial susceptibility of isolates according to species or origin of isolation. Sixty-two strains of Ureaplasma spp. (74.7%) were susceptible to erythromycin, and 21 strains (25.3%) were intermediately susceptible. Sixty-eight isolates (81.9%) were susceptible to tetracycline, 2 strains (2.4%) were intermediate and 13 strains (15.7%) were resistant. DNA sequences related to the tet(M) determinant and the int-Tn gene were found in all tetracycline-resistant isolates.A recent phylogenetic analysis of Ureaplasma urealyticum resulted in the proposal to divide their 2 biovars into species. We used PCR to compare the distribution of species and the presence of the tet(M) and int-Tn resistance determinants in 63 strains of Ureaplasma spp. isolated from the amniotic fluid of patients with an adverse pregnancy outcome and in 22 strains obtained from the lower genital tract of healthy pregnant women. We also determined the antimicrobial susceptibility of the organisms to erythromycin and tetracycline. U. parvum was the most frequent Ureaplasma species detected in our study. Thus, 50/63 (79.4%) invasive isolates and 17/22 (77.3%) lower genital tract isolates corresponded to U. parvum, whereas 12/63 (19%) invasive isolates and 4/22 (18.2%) non-invasive strains corresponded to U. urealyticum. A mixture of species was found in 2 women. We found no significant differences in the antimicrobial susceptibility of isolates according to species or origin of isolation. Sixty-two strains of Ureaplasma spp. (74.7%) were susceptible to erythromycin, and 21 strains (25.3%) were intermediately susceptible. Sixty-eight isolates (81.9%) were susceptible to tetracycline, 2 strains (2.4%) were intermediate and 13 strains (15.7%) were resistant. DNA sequences related to the tet(M) determinant and the int-Tn gene were found in all tetracycline-resistant isolates.

Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study

Objective: To determine whether antibiotic administration in patients with preterm premature rupture of membranes is associated with a reduction in the rate of histological chorioamnionitis and funisitis. Methods: One hundred consecutive patients with preterm premature rupture of membranes and no labor between 24 and 34 weeks were invited to participate in this study. Eligible patients randomly received either clindamycin-gentamicin for 7 days or placebo, and were managed expectantly until 35 weeks unless fetal or maternal indications developed. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture obtained by transabdominal amniocentesis. Cervicovaginal infection was diagnosed when bacterial vaginosis or a positive culture for cervicovaginal pathogens or facultative bacteria associated with a significant increase in the white blood cell count were found. Histological chorioamnionitis was based on the observation of polymorphonuclear leukocyte infiltration of the chorionic plate or the extraplacental fetal membranes. Funisitis was diagnosed in the presence of polymorphonuclear leukocyte infiltration into the umbilical vessel walls or Wharton jelly. Statistics were performed using contingency tables. Results: Seventy-one patients with available histological study of the placenta were included. Thirty-five women received antibiotics and 36 were given placebo. Patients who received antibiotics had a significantly lower rate of histological chorioamnionitis than patients who received placebo (46% (16/35) vs. 69% (25/36), respectively; p < 0.05). This effect was more pronounced among women with microbial invasion of the amniotic cavity and/or cervicovaginal infection (58% vs. 89%, respectively; p < 0.01). Antibiotic therapy was associated with an increase in the frequency of placentas without histological abnormalities (29% vs. 6%; p < 0.01). The frequency of funisitis was not different between groups. Conclusion: Administration of antibiotics in patients with preterm premature rupture of membranes is associated with a significant reduction in the incidence of histological chorioamnionitis but it does not modify the frequency of funisitis.

Antibiotic administration to patients with preterm labor and intact membranes: Is there a beneficial effect in patients with endocervical inflammation?

Objective. To determine whether broad-spectrum antibiotic administration to patients with preterm labor and intact membranes is associated with an improvement in neonatal and maternal outcomes, particularly in patients with microbial invasion of the amniotic cavity (MIAC) or endocervical inflammation (ECI). Methods. A prospective clinical trial was conducted in which women in premature labor were alternately allocated to receive either antibiotics or placebo, and information about MIAC and ECI collected. Eighty-four pregnant women between 24 and 34 weeks of gestation with spontaneous preterm labor were enrolled. Exclusion criteria were cervical dilatation greater than 3 cm, clinical chorioamnionitis, abruption, rupture of membranes, vaginal bleeding, and several additional fetal and maternal conditions that may influence perinatal outcome. Amniocentesis was offered to all patients and the cervix and vagina were sampled for microbiological and cytological studies. Eligible patients were allocated to receive either clindamycin–gentamycin or placebo for 7 days. Corticosteroids and tocolysis with beta-adrenergic agents were used according to the standard management of our institution. MIAC was defined as the presence of a positive amniotic fluid culture obtained by trans-abdominal amniocentesis. ECI was diagnosed when a significant increase in the white blood cell count of the endocervical secretions was found. A composite neonatal morbidity/mortality outcome was created, including severe neonatal morbidity (respiratory distress syndrome, asphyxia, sepsis, pneumonia, intraventricular hemorrhage) and mortality. Results. Thirty-nine women received antibiotics and 40 received placebo. The prevalence of ECI and MIAC in both groups was comparable (antibiotic group ECI 61.5% (24/39) and MIAC 20.5% (8/39); placebo group ECI 62.5% (25/40) and MIAC 20% (8/40); p > 0.05). Overall, there were no significant differences in maternal infections and composite neonatal outcomes between antibiotic and placebo groups. Women who received antibiotics had a lower rate of subsequent rupture of membranes compared to patients who received placebo (2.6% (1/39) vs. 25% (10/40), respectively; p = 0.007). A sub-analysis showed that among patients with ECI, antibiotic administration was associated with a lower rate of composite neonatal morbidity/mortality outcome compared to those who received placebo (4.2% (1/24) vs. 28% (7/25), respectively; p < 0.05). This association was also present in patients with ECI without MIAC (0% (0/16) vs. 27.8% (5/18); p < 0.05), but not in patients with ECI and MIAC (antibiotic group 12.5% (1/8) vs. placebo group 28.6% (2/7); p > 0.05). Conclusions. The combination of antibiotics used in this study did not improve maternal or perinatal outcome in patients with preterm labor and intact membranes. Further studies are required to determine if women with endocervicitis presenting with preterm labor and intact membranes may benefit from antibiotic administration.

Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay

Background: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. Aim: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. Material and Methods: After discarding cases with Candidiasis, defi cient specimens or those lacking bacteria, a total of 348 Gram-stained smears vaginal specimens received for the diagnosis of BV, were analyzed. Results: Vaginal microbiota was classifi ed as normal in 203 and 237 samples (58 and 68% of samples), according to Nugent and Spiegel criteria, respectively. One hundred and fi ve (30%) and 111 samples (32%), were classifi ed as VB according to Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5%). The 40 (11.5%) discordant specimens were classifi ed as intermediate microfl ora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identifi ed four categories of microbiota. Ten (25%) specimens were classifi ed as grade II microbiota, confi rming their categorization by Nugent as intermediate microbiota, six (15%) were classifi ed in the III category, confi rming the diagnosis of BV by Spiegel, 13 (32.5%) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. Conclusions: The systems proposed by Spiegel, Nugent and Ison / Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/ Hay procedure to evaluate vaginal microbiota, due to its wider range of categories, allowing a better discrimination of the vaginal microbiota

Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile

INTRODUCTION The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. AIM Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. PATIENTS AND METHODS Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. trachomatis by culture in modified Diamonds broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. RESULTS Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. CONCLUSION The results show low prevalence of C. trachomatis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

Sepsis neonatal precoz causada por transmisión vertical de Morganella morganii, en un embarazo de término

We report a term neonate who developed early-onset sepsis due to Morganella morganii. The child was vaginally delivered after a short labor, and presented signs of perinatal asphyxia. Blood cultures taken soon after birth and from mother‘s lochia were positive for this microorganism. The infection was unresponsive to treatment with cefotaxime, to which the microorganism was susceptible, and the infant died at 17 days of age. M morganii is an opportunistic and uncommon pathogen, causing disease mainly in patients with underlying illness or after surgery. It is a rare perinatal pathogen, causing severe disease in premature infants, in association with maternal chorioamnionitis and premature rupture of the

Relación entre enfermedad periodontal, infección bacteriana ascendente y patología placentaria con parto prematuro

Objetivo: Determinar la relacion entre enfermedad periodontal, infeccion bacteriana ascendente y patologia placentaria, con parto prematuro. Pacientes y Metodos: Participaron embarazadas entre 24 y 34 semanas de gestacion, con trabajo de parto prematuro sin causa clinica evidente y membranas intactas o con el diagnostico de rotura prematura de membranas (RPM), sin trabajo de parto y sin corioamnionitis clinica. Todas las embarazadas tuvieron estudio periodontal clinico y evaluacion microbiologica de la placa subgingival, del liquido amniotico (LA) y cervicovaginal. R ecibieron corticoesteroides, antibioticos, tocolisis (casos con membranas intactas) y manejo expectante hasta las 35 semanas (casos con RPM) . Las placentas se enviaron a estudio y se diagnostico corioamnionitis, funisitis y vellositis. Se definio invasion microbiana de la cavidad amniotica ( IMCA) el cultivo positivo del liquido amniotico. Infeccion cervicovaginal (ICV) se diagnostico con vaginosis bacteriana (VB) o cultivo positivo para bacteria patogena u oportunista en cervix o vagina, con incremento significativo de los leucocitos polimorfonucleares. Se considero como infeccion bacteriana ascendente (IBA) la presencia de IMCA por bacterias ascendentes y/o ICV. Resultados: Se incluyeron 59 pacientes, 42 con membranas intactas y 17 con RPM . La frecuencia de la enfermedad periodontal fue 93.2%. La IMCA fue 27.1% Se aislaron bacterias patogenas periodontales del LA en el 18.6% y de la placa subgingival en el 71.2% de los casos. La IBA fue 83.1%. La asociacion IBA con enfermedad periodontal fue 72.9%. El parto prematuro ( 82.1% p=0.03 y con la presencia conjunta de infeccion bacteriana ascendente y enfermedad periodontal 74.4% p=0.03. Los casos con nacimiento prematuro y enfermedad periodontal generalizada tuvieron significativa mayor frecuencia de corioamnionitis y funisitis histologica 69.6% p=0.04. Conclusiones : L a enfermedad periodontal generalizada y la presencia conjunta de infeccion bacteriana ascendente y enfermedad periodontal se asocian con parto prematuro . En estos casos, son frecuentes l os marcadores histologicos placentarios de infeccion ascendente .

Infecciones vaginales en un Centro de Salud Familiar de la Región Metropolitana, Chile

Introduccion: Las infeccion vaginales constituyen un motivo frecuente de consulta, pero su prevalencia y etiologia varian en distintas poblaciones. Objetivos: Determinar la prevalencia y tipos de infeccion vaginal en mujeres atendidas en un centro de salud familiar de la Region Metropolitana. Metodos: El diagnostico microbiologico fue efectuado mediante examen microscopico al fresco y tincion de Gram y para tricomoniasis examen al fresco, cultivo y reaccion de la polimerasa en cadena. Resultados: Se incluyeron 101 mujeres de 15-54 anos, no seleccionadas por signos o sintomas, 46 de ellas embarazadas. En 47 mujeres (46,5%) se diagnosticaron infecciones vaginales. Se observo asociacion entre edad y frecuencia de infeccion vaginal. La proporcion de infecciones entre gestantes y no gestantes fue similar. Las infecciones mas frecuentes fueron vaginosis bacteriana (16,8%), candidiasis vulvo-vaginal (11,9%) y co-infecciones (6,9%). Se observo 5,9% casos de microbiota intermedia, 3% de tricomoniasis y 2% de vaginitis aerobica. Los sintomas de infeccion vaginal tuvieron mala concordancia con los hallazgos microbiologicos. A su vez, los signos fisicos tuvieron buena concordancia con la existencia de infeccion, pero escasa a moderada concordancia con una etiologia especifica. Conclusiones: Se encontro alta frecuencia de infecciones vaginales. Es necesario mejorar las definiciones y criterios de diagnostico microbiologico de las co-infecciones y microbiota intermedia, para ser diagnosticadas en la practica clinica. Se recomienda emplear cuestionarios mas descriptivos para mejorar la utilidad del examen clinico.

Chlamydia trachomatis genovars causing urogenital infections in Santiago, Chile.

Abstract Background: Chlamydia trachomatis is a common sexually transmitted infection in Chile, but little is known about the genovar distribution in genital infections. Thus, the objective of this study was to determine the distribution of C. trachomatis genovars in such cases. Methods: A total of 522 urogenital specimens, 403 from women and 119 from men, were analyzed for C. trachomatis by nested polymerase chain reaction (PCR) targeting of the ompA gene. Positive specimens were genotyped by DNA sequencing of the amplicons. Results: Sixty-two (11.9%) specimens were positive. Of these, 43 (69.4%) were collected from men and 19 (30.6%) from women (p < 0.0001). Eight genovars were identified in men and seven in women. Genovar E was the most common in both men and women, followed by genovar Da in men, and F in women. Together these three genovars accounted for 84% of infections. Genovar D was the third most common genovar (n = 4). Genovar G was detected in two samples, and sequences of genovars Ba, H, and Ja were each found in single samples. One sample (1.6%) contained mixed sequences. No association was found between gender and specific genovars. Fifty-six (92%) sequences were identical to those reported for the respective reference genovars and the other two have been described in several regions. Conclusions: Our findings add to the results of most studies, which indicate that genovars E, F, and D/Da are the most frequent. No association was found between gender and specific genovars. Despite the heterogeneous population of genovars, most ompA sequences were conserved.

Obesidad, factor de riesgo de infección bacteriana ascendente durante el embarazo

Background: Obesity in pregnancy is associated with significantly higher rates of infection. Aim: To compare the infectious morbidity in pregnant women with normal and altered body mass index (BMI). Material and Methods: Cross sectional retrospective study of 6,150 patients who had delivery or second trimester abortion during 2012. The patients were classified according to BMI as underweight, normal weight, overweight and obese. We compared the frequency of pregnancy and perinatal complications related to ascending bacterial infection (ABI). The data was obtained from the hospital’s databases. Results: Obese patients had higher rates of pregnancy and perinatal complications related to ABI compared to patients with normal weight. The odds ratios (OR) and 95% confidence intervals (CI) for second trimester abortion were 3.45 (1.63-7.31) p<0.01, for preterm delivery 2.42 (1.51-3.87) p<0.01, for labor and puerperium infections 3.42 (2.06-5.68) p<0.01 and for early neonatal infectious and perinatal mortality 4.46 (1.75-11.37) p<0.01. A logistic regression analysis revealed that obesity is an independent risk factor for second trimester abortion related to ABI with an OR of 3.18 (CI 95% 1.46-6.91), premature delivery related to ABI with an OR of 2.51 (CI 95% 1.54-4.09) and for delivery and postpartum infections with an OR of 4.44 (CI 95% 2.62 to 7.51). Conclusions: Obese pregnant women had a 2.5 to 4.5 times increased risk of infectious morbidity compared to normal weight patients. Obesity is an independent risk factor for second trimester abortion and preterm delivery related to ABI and delivery and postpartum infections.