Repeated maternal intramuscular or intraamniotic erythromycin incompletely resolves intrauterine Ureaplasma parvum infection in a sheep model of pregnancy

Matthew W. Kemp, Yuichiro Miura, Matthew S. Payne, Rory Watts, Smruthi Megharaj, Alan H. Jobe, Suhas G. Kallapur, Masatoshi Saito, O. Brad Spiller, Jeffrey A. Keelan, John P. Newnham

Research output: Contribution to journalArticlepeer-review

27 Citations (Scopus)

Abstract

Objective Ureaplasma spp are the most commonly isolated microorganisms in association with preterm birth. Maternal erythromycin administration is a standard treatment for preterm prelabor rupture of membranes. There is little evidence of its effectiveness in eradicating Ureaplasma spp from the intrauterine cavity and fetus. We used a sheep model of intrauterine Ureaplasma spp infection to investigate the efficacy of repeated maternal intramuscular and intraamniotic erythromycin treatment to eradicate such an infection. Study Design Thirty ewes with singleton pregnancies received an intraamniotic injection of 107 color change units of erythromycin-sensitive Ureaplasma parvum serovar 3 at 55 days' gestation. At 116 days' gestation, 28 ewes with viable fetuses were randomized to receive (1) intraamniotic and maternal intramuscular saline solution treatment (n = 8), (2) single intraamniotic and repeated maternal intramuscular erythromycin treatment (n = 10), or (3) single maternal intramuscular and repeated intraamniotic erythromycin treatment (n = 10). Fetuses were surgically delivered at 125 days' gestation. Treatment efficacy was assessed by culture, quantitative polymerase chain reaction, and histopathologic evaluation. Results Animals treated with intraamniotic erythromycin had significantly less viable U parvum serovar 3 in the amniotic fluid at delivery. However, neither combination of maternal intramuscular and intraamniotic erythromycin treatment successfully cleared U parvum serovar 3 from the amniotic fluid or fetal tissues. Three de novo erythromycin-resistant U parvum isolates were identified in erythromycin-treated animals. Conclusion Erythromycin treatment, given both to the ewe and into the amniotic cavity, fails to eradicate intrauterine and fetal U parvum serovar 3 infection and may lead to development of erythromycin resistant U parvum.

Original languageEnglish
Pages (from-to)134.e1-134.e9
JournalAmerican Journal of Obstetrics and Gynecology
Volume211
Issue number2
DOIs
Publication statusPublished - 2014 Aug

Keywords

  • Ureaplasma parvum
  • erythromycin
  • infection
  • preterm birth
  • sheep

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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