Infektionsmanagement bei drohender Frühgeburt – eine Umfrage an deutschen Perinatalzentren

Zusammenfassung

Einleitung Internationalen und nationalen Leitlinien fehlt es an detaillierten Empfehlungen zur Infektionsdiagnostik und -therapie bei drohender Frühgeburt. Ziel der Studie war es, Daten zur Versorgungssituation an deutschen Perinatalzentren zu erheben.

Methoden Onlineumfrage zum Infektionsmanagement bei drohender Frühgeburt an allen 212 deutschen Perinatalzentren der Versorgungsstufen Level I und II.

Ergebnisse Die Rücklaufquote betrug 31,6% (n=67). Bei drohender Frühgeburt unter 34 vollendeten SSW ohne Blasensprung verzichten 78,8% auf eine kalkulierte Antibiotikagabe. Von den verbleibenden vierzehn Zentren (21,2%) würde die Hälfte generell bei klinischen Zeichen einer drohenden Frühgeburt antibiotisch behandeln. Fast alle Zentren (94%) führen eine vaginale Erregerdiagnostik durch. Eine mikroskopische Abstrichbeurteilung mittels Nugent- oder Amsel-Score erfolgt in 37,3%. Abweichungen von der physiologischen vaginalen Mikrobiota werden mehrheitlich antibiotisch behandelt (bakterielle Vaginose 79,1%, n=53, Candida spp. 77,6%, n=52, Ureaplasma spp. 49,3%, n=33). Kontrollabstriche erfolgen in 70,1%. Konsens besteht hinsichtlich einer Antibiotikagabe bei frühem vorzeitigem Blasensprung. 72,6% bevorzugen eine Monotherapie mit einem β-Laktam-Antibiotikum. Uneinheitlich waren hier die Angaben zur Dauer der Therapie, wobei 58% der Zentren länger als sieben Tage behandeln.

Schlussfolgerung An deutschen Perinatalzentren besteht eine hohe Bereitschaft zur Infektionsdiagnostik und -therapie bei drohender Frühgeburt. Das Infektionsmanagement ist jedoch uneinheitlich und partiell widersprüchlich zu den vorliegenden Leitlinien. Es besteht ein Bedarf an qualitativ hochwertigen Studien zu diesem Thema.

Abstract

Introduction In spite of insufficient evidence, we assume a high willingness to diagnose and treat vaginal infections in threatened preterm births in Germany.

Methods Online survey on the management of infection in threatened preterm birth in all 212 German perinatal centers.

Results The response rate was 31.6% (n=67). 78.8% disclaim an empirical antibiotic treatment in threatened preterm birth below 34 weeks of gestation. Half of the remaining 14 centers always start an antibiotic treatment in cases with signs or symptoms of threatened preterm birth. 94% perform vaginal swabs for culture. 37.3% use a microscopic assessment by vaginal Nugent score or Amsel score. An abnormal vaginal microbiota is mostly treated (bacterial vaginosis 79.1%, n=53, Candida spp. 77.6%, n=52, Ureaplasma spp. 49.3%, n=33). After treatment, 70.1% agree with repeating the culture diagnosis. There is common consensus for antibiotic treatment in cases with preterm premature rupture of membranes. 72.6% favor a monotherapy with a β-lactam antibiotic. Statements on duration of therapy were inconsistent, whereby 58% of centers treat for more than 7 days.

Conclusion In German perinatal centers, we observed a great willingness to diagnose and treat infections in threatened preterm birth. However, the management of infection is heterogeneous and partly contradicts the present guidelines.

Schlüsselwörter

Frühgeburt - Perinatalzentren - Infektion - Umfrage

Key words

preterm birth - perinatal centre - infection - survey

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