Treatment of PPROM with oligo/anhydramnion colonized by multi-resistant bacteria with continuous amnioinfusion and antibiotic administrations through subcutaneously implanted intrauterine port system: a case report

Objective: Bacterial infection is one of the main causes of preterm premature rupture of membranes (PPROM) leading to preterm delivery, pulmonary hypoplasia, sepsis, and joint deformities. Expectant management, broad-spectrum antibiotics and antenatal corticosteroids are routinely used in this condition with very limited success to prevent bacteraemia, chorioamnionitis, funisitis and intra-amniotic infection syndrome.

Method: Here we report a case in which we attempted to treat a PPROM at 26/3^th weeks of gestation with anhydramnion colonized by multi-resistant Klebsiella. The perinatal port- system was implanted subcutaneously at 28/0 weeks of gestation, enabling long-term continuous lavage of the amniotic cavity with a hypotonic aqueous composition similar to the human amniotic fluid combined with intraamniotic antibiotic application.

Result: The patient gave birth to a preterm female infant at 31/1^st without any signs of infection. The girl was discharged with a weight of 2730 g in very good condition. In a follow-up examination by the age of 5 months and one year there was no neurological disturbance, developmental delay or Klebsiella colonization apparent.

Conclusion: To further confirm these results, analyses will be carried out within the started 2015 trials where intrauterine port-systems and treatment regimens with intraamniotic antibiotic applications were randomized among trial subjects.

PPROM – bacteri...

Fig. 1: PPROM – bacteria colonisation antibiotic treatment