Indications of antibiotic withdrawal in patients with preterm premature rupture of membranes

Objective To explore the indications of prenatal antibiotic withdrawal and its correlation with maternal and infant outcomes of preterm premature rupture of membranes (PPROM) without infection. Methods Clinical data of 121 patients with PPROM between 24 and 33+6 gestational weeks expecting to prolong latency in our hospital between January 2015 and December 2019 were collected and retrospectively analyzed. According to having high risk factors for infection or not and maternal and infant outcomes, they were divided into group A (low-risk but without adverse outcome), group B (low-risk with adverse outcome), group C (high-risk but without adverse outcome) and group D (high-risk with adverse outcome). Univariate analysis and multivariate logistic regression analysis were performed for statistical analysis. Results The results of univariate analysis showed that there were statistical differences in procalcitonin (PCT), C-reactive protein (CRP) and hemeglobin (Hb) between group A and B at discontinuation of antibiotics (P < 0.05). Significant differences were seen in duration of antibiotics use, neutrophil-lymphocyte ratio (NLR) and CRP between group C and D at antibiotics discontinuation (P < 0.05). Multivariate analysis indicated that when antibiotics were discontinued, the low-risk groups had CRP (5~30 mg/L, >30 mg/L) increased and increased risk of adverse maternal and infant outcomes (OR=2.227, 95%CI: 0.689~7.205; OR=14.000, 95%CI: 1.471~133.233); while for the high-risk groups, CRP was elevated (5~30 mg/L, >30 mg/L) or short course of treatment (< 3 d), and the incidence of adverse maternal and child outcomes was increased (OR=1.508, 95%CI: 0.452~5.024; OR=14.278, 95%CI: 1.526~133.570; OR=4.045, 95%CI: 1.341~12.199). Conclusion CRP can be used to guide the use of antibiotics in PPROM patients. For those at high risk of infection, the duration of anti-infection therapy is associated with maternal and infant outcomes and should be maintained at least longer than 3 d.