Danilo Buonsenso, Davide Pata, Arianna Turriziani Colonna, Mariella Iademarco, Marco De Santis, Lucia Masini, Guido Conti, Fernando Molle, Antonio Baldascino, Anna Acampora, Rita Luciano, Francesca Gallini, Piero Valentini
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In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). Results were confirmed when the analyses were corrected by trimester of infection and by type of maternal treatment (OR 7.72; 95% CI 3.40-17.53, P value <0.001).</p><p><strong>Conclusions: </strong>The combination of Spy+TMP-SMX may be more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to Spy alone; furthermore, this combination is not inferior to P/S, the current international standard-of-care maternal treatment for the prevention of CT. 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In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). 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引用次数: 7
摘要
背景:关于孕妇弓形虫感染的最佳治疗，以防止垂直传播给胎儿的证据不足。方法:我们进行了一项为期28年的回顾性研究，旨在比较三种治疗方案[Spiramicyn (Spy)与Pyrimethamine-Sulfadiazine (P/S)与Spiramicyn联合trimethop啶-磺胺甲恶唑(Spy+TMP-SMX)]预防弓形虫感染母婴传播的疗效。结果:170例妇女中，58例(34.1%)有先天性弓形虫病(CT)， 61例(35.9%)可能感染，41例(24.1%)可能感染。Spy+TMP-SMX联合治疗97例(57.1%)，Spy单独治疗64例(37.6%)，P/S联合治疗8例(4.7%)。感染婴儿为20/170(11.7%)。然而，8.2%(8/97)接受Spy+TMP-SMX治疗的母亲所生的婴儿感染，20%(11/55)接受Spy治疗的母亲所生的婴儿感染，12.5%(1/8)接受P/S治疗的母亲所生的婴儿感染。Logistic回归分析显示，与Spy+TMP-SMX联合治疗相比，Spy单独治疗与CT风险增加相关(OR, 2.78, 95% CI 1.04-7.41, P值0.041)。Spy+TMP-SMX与P/S组合比较无差异(OR 1.59;95% ci 0.17 - 14.58;P值为0.682)。当按感染的三个月和产妇治疗的类型对分析进行校正时，结果得到证实(OR 7.72;结论:Spy联合TMP-SMX可能比单独使用Spy更有效地降低母胎弓形虫病传播的风险;此外，这种组合并不逊色于P/S，目前国际标准的产妇治疗预防CT。有必要进行一项前瞻性试验，比较Spy+TMP-SMX与P/S联合用药，为弓形虫感染孕妇的最佳治疗方案提供明确的证据。
Spyramicine and Trimethoprim-Sulfamethoxazole Combination to Prevent Mother-To-Fetus Transmission of Toxoplasma gondii Infection in Pregnant Women: A 28-Years Single-center Experience.
Background: There is weak evidence on the best treatment of pregnant women with Toxoplasma gondii infection to prevent the vertical transmission to the fetus.
Methods: We conducted a 28-year retrospective study aiming to compare the efficacy of three therapeutic regimens [Spiramicyn alone (Spy) vs. Pyrimethamine-Sulfadiazine (P/S) vs. Spiramicyn with Trimethoprim-Sulfamethoxazole (Spy+TMP-SMX)] for the prevention of mother-to-fetus transmission of T. gondii infection.
Results: 170 women were included: 58 (34.1%) had certain congenital toxoplasmosis (CT), 61 (35.9%) a probable infection and 41 (24.1%) possible infection. In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). Results were confirmed when the analyses were corrected by trimester of infection and by type of maternal treatment (OR 7.72; 95% CI 3.40-17.53, P value <0.001).
Conclusions: The combination of Spy+TMP-SMX may be more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to Spy alone; furthermore, this combination is not inferior to P/S, the current international standard-of-care maternal treatment for the prevention of CT. A prospective trial comparing the combination Spy+TMP-SMX with P/S would be necessary to provide definitive evidence on the best regimen for pregnant women with T. gondii infection.
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