HIỆU QUẢ KHÁNG SINH DỰ PHÒNG ỐI VỠ NON TUỔI THAI 28-34 TUẦN TẠI BỆNH VIỆN HÙNG VƯƠNG

Abstract

Objective: To determine the rates of suspected chorioamnionitis, antibiotic escalation, and early-onset neonatal infection (EONI) in the management of preterm premature rupture of membranes (PPROM) and to identify factors associated with EONI. Methods: A retrospective study was conducted at Hung Vuong Hospital (January 2023–May 2024) on 281 singleton pregnancies with PPROM at 28–34 weeks, all managed with prophylactic ampicillin-sulbactam and azithromycin. Medical records were analyzed for suspected chorioamnionitis, antibiotic escalation, and EONI, and independent predictors were assessed using multivariable logistic regression. Results: The rate of suspected chorioamnionitis was 24.9%, mainly characterized by leukocytosis defined as greater than 15 K/µL without fever. Antibiotic escalation occurred in 11% and EONI in 16.4%. Multivariable analysis identified five independent predictors of EONI: leukocyte count greater than 15 K/µL at admission, an increase in leukocyte count above 15 K/µL during follow-up, maternal fever, abnormal amniotic fluid at delivery, and neonatal birthweight below 2000 g. Conclusion: Isolated maternal leukocytosis is a common sign of suspected chorioamnionitis after PPROM and an independent predictor of EONI. Close monitoring and timely escalation to therapeutic antibiotics after prophylaxis may improve maternal and neonatal outcomes while enhancing antibiotic stewardship.