***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The ORACLE I trial compared the use of erythromycin and /or amoxicillin-clavulanate ( co-amoxiclav ) with that of placebo for women with preterm rupture of the membranes without overt signs of clinical infection , by use of a factorial r and omised design . The aim of the present study --the ORACLE Children Study I -- was to determine the long-term effects on children of these interventions . METHODS We assessed children at age 7 years born to the 4148 women who had completed the ORACLE I trial and who were eligible for follow-up with a structured parental question naire to assess the child 's health status .  Functional impairment was defined as the presence of any level of functional impairment ( severe , moderate , or mild ) derived from the mark III Multi-Attribute Health Status classification system . Educational outcomes were assessed with national curriculum test results for children resident in Engl and . FINDINGS Outcome was determined for 3298 ( 75 % ) eligible children . There was no difference in the proportion of children with any functional impairment after prescription of erythromycin , with or without co-amoxiclav , compared with those born to mothers who received no erythromycin ( 594 [ 38.3 % ] of 1551 children vs 655 [ 40.4 % ] of 1620 ; odds ratio 0.91 , 95 % CI 0.79 - 1.05 ) or after prescription of co-amoxiclav , with or without erythromycin , compared with those born to mothers who received no co-amoxiclav ( 645 [ 40.6 % ] of 1587 vs 604 [ 38.1 % ] of 1584 ; 1.11 , 0.96 - 1.28 ) . Neither antibiotic had a significant effect on the overall level of behavioural difficulties experienced , on specific medical conditions , or on the proportions of children achieving each level in reading , writing , or mathematics at key stage one . INTERPRETATION The prescription of antibiotics for women with preterm rupture of the membranes seems to have little effect on the health of children at 7 years of age . FUNDING UK Medical Research Council OBJECTIVE This study aims to determine the incidence of  prelabor rupture of membranes ( PROM ) in a tertiary care institution , the bacterial pathogens involved in maternal and neonatal colonization , and the major bacterial pathogens of neonatal sepsis in PROM . METHODS This prospect i ve study was conducted over 2 years from March 1999 to February 2001 in Abha Maternity Hospital , Abha , Kingdom of Saudi Arabia . Consecutive admissions of infant- and -mother pairs with PROM constitute the subjects of this survey . Every mother had endocervical swab taken before delivery , and their infants had surface swabs and sepsis screening before starting antibiotic therapy . RESULTS The incidence of  PROM was 12.6 per 1000 live births .  Premature delivery rate was 54.6 % while , the overall prematurity rate was 7.2 % . The major microorganisms involved in genital colonization of the mothers were coagulase negative Staphylococcus ( CONS ) ( 24 % ) , Klebsiella pneumoniae ( 13 % ) , Pseudomonas aeruginosa ( 11.3 % ) and Enterococcus species ( 11.3 % ) . The infants were colonized largely with CONS ( 31 % ) , Klebsiella pneumoniae ( 18 % ) and Escherichia coli ( E.coli ) ( 17 % ) . Fourteen percent of the infants were infected but in only 6 % was septicemia documented ( Staphylococcus aureus , 3 cases and 1 case each with CONS , group B Streptococci ( GBS ) and E.coli ) . In contrast to Western experience , the incidence of GBS was uncommon in both mothers and infants . The bacterial pattern suggests vancomycin and cefotaxime or aminoglycoside combination as empirical antibiotic therapy for both infected infants and selected contaminated mothers with PROM . CONCLUSION Generally , it appears wasteful to routinely admit , screen and empirically treat all infants born after PROM ; only ill infants , febrile mothers , or either , with associated chorioamnionitis deserve antibiotic treatment Fifty-one babies with prolonged rupture of fetal membranes ( longer than 24 hours ) were studied for evidence of latent infection . Cord blood was taken from all babies for a full blood count and blood culture . Gastric aspirates were collected and vernix swabs were taken immediately after delivery . Microscopy , culture and antibiotic sensitivity tests were done on the appropriate specimens . Each baby had a thorough medical examination immediately after birth , and 3 and 7 days afterwards . After the initial investigation they were allocated to a treatment ( penicillin 50 000 U/kg/d and kanamycin 10 mg/kg/d ) or a non-treatment group by r and omised card selection . Six patients became infected , as was shown by a positive blood culture , while 4 of the 6 had clinical signs of infection as well . These infants were treated with penicillin and kanamycin , and all did well . None of the remaining babies showed any signs of infection . There were no deaths . Blood culture was found to correlate well with clinical infections , and many be used as a guide to latent infection and treatment Background : Few studies from developing countries have examined sensitivity , specificity , positive and negative predictive values of routine surface cultures . Objectives : The purpose of the study was to determine sensitivity , specificity , and positive predictive value ( PPV ) of skin cultures among preterm neonates admitted to Dhaka Shishu Hospital , Bangladesh . Methods : The study was nested within a prospect i ve , r and omized , controlled trial of  emollient treatment  in Dhaka Shishu Hospital , Bangladesh . A total of 497 preterm infants <33 weeks gestational age and < 72 h of chronological age were enrolled , and the sensitivity , specificity , and PPV of skin cultures  were analyzed among 3,765  blood-skin culture pairs , wherein the skin culture was obtained within 13 days before the blood culture . Results : Overall sensitivity , specificity , and PPV were 16 , 38 , and 5 % , respectively . PPV during Klebsiella pneumoniae outbreaks was about 9 % , and the inguinal site had the highest PPV ( 6 % ) among the three skin sites . Acinetobacter spp.- and K. pneumoniae-specific PPVs were 28 and 23 % , respectively . PPV was < 2 % for C and ida spp . , Enterobacter spp . , and Salmonella spp . Conclusion : Routine skin culture is inefficient in predicting the pathogen responsible for sepsis among premature neonates , even in a developing country setting , where the burden of bacterial infection is relatively high . Skin cultures are also of limited utility during K. pneumoniae outbreaks , and are not recommended CONTEXT Intrauterine infection is thought to be one cause of preterm premature rupture of the membranes ( PPROM ) .  Antibiotic therapy has been shown to prolong pregnancy , but the effect on infant morbidity has been inconsistent . OBJECTIVE To determine if antibiotic treatment during expectant management of PPROM will reduce infant morbidity . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING University hospitals of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network . PATIENTS A total of 614 of 804 eligible gravidas with PPROM between 24 weeks ' and 0 days ' and 32 weeks ' and 0 days ' gestation who were considered c and i date s for pregnancy prolongation and had not received corticosteroids for fetal maturation or antibiotic treatment within 1 week of r and omization . INTERVENTIONS Intravenous ampicillin ( 2-g dose every 6 hours ) and erythromycin ( 250-mg dose every 6 hours ) for 48 hours followed by oral amoxicillin ( 250-mg dose every 8 hours ) and erythromycin base ( 333-mg dose every 8 hours ) for 5 days vs a matching placebo regimen . Group B streptococcus ( GBS ) carriers were identified and treated . Tocolysis and corticosteroids were prohibited after r and omization . MAIN OUTCOME MEASURES The composite primary outcome included pregnancies complicated by at least one of the following : fetal or infant death , respiratory distress , severe intraventricular hemorrhage , stage 2 or 3 necrotizing enterocolitis , or sepsis within 72 hours of birth . These perinatal morbidities were also evaluated individually and pregnancy prolongation was assessed . RESULTS In the total study population , the primary outcome ( 44.1 % vs 52.9 % ; P=.04 ) , respiratory distress ( 40.5 % vs 48.7 % ; P=.04 ) , and necrotizing enterocolitis ( 2.3 % vs 5.8 % ; P=.03 ) were less frequent with antibiotics . In the GBS-negative cohort , the antibiotic group had less frequent primary outcome ( 44.5 % vs 54.5 % ; P=.03 ) , respiratory distress ( 40.8 % vs 50.6 % ; P=.03 ) , overall sepsis ( 8.4 % vs 15.6 % ; P=.01 ) , pneumonia ( 2.9 % vs 7.0 % ; P=.04 ) , and other morbidities . Among GBS-negative women , significant pregnancy prolongation was seen with antibiotics ( P<.001 ) . CONCLUSIONS We recommend that women with expectantly managed PPROM remote from term receive antibiotics to reduce infant morbidity BACKGROUND There is paucity of information on the pattern of bacterial colonization of a new neonatal intensive care unit . OBJECTIVE To study the pattern of bacterial colonization on the environmental surfaces in a new neonatal intensive care unit ( NICU ) and correlate it with infections in the infants . METHODS Environmental cultures from the faucets and computer keyboards in the NICU were obtained prospect ively every 2 weeks for 1 year . Positive blood , cerebrospinal fluid , and respiratory cultures from the infants in the NICU were also obtained . RESULTS A total of 175 swab cultures was collected , which were sterile for initial 6-week period . Subsequently , 31 cultures grew microbes : 26 ( 83.8 % ) from the faucets and 5 ( 16.2 % ) from the computers keyboard ( P < .001 ) . Of the 48 positive blood cultures in NICU patients , 6 ( 12.5 % ) matched the organism growing from the surveillance sites , but the correlation was not significant ( P = .076 ) . None of the 31 positive respiratory cultures and 1 positive cerebrospinal fluid culture correlated to the organisms grown from the NICU environment . CONCLUSION The environment was colonized after an initial period of sterile cultures in a new NICU . Once colonized , they can persist , increasing the risk of developing resistance to antibiotics . They did not correlate with the positive cultures from the infants admitted to the NICU during the study period Summary A prospect i ve case control study that was conducted at the University of Ilorin Teaching Hospital , Ilorin , Nigeria , between 1st January and 31st December 2002 . The purpose of this study was to determine the association and the pattern of bacteria/microorganisms in the aetiology of pre-labour premature rupture of membrane ( PROM ) in this centre . A total of 108 cases of PROM and 98 control cases that presented between 37 completed weeks ' and 40 weeks ' gestation were analysed . Pathogens were isolated in 48 patients , giving a recovery rate of 44.4 % . The common pathogens include Gardnerella vaginalis ( 29.1 % ) , C and ida ( 23.0 % ) and Staphylococcus aureus ( 18.7 % ) . Others were Streps . Pyogenes ( 16.6 % ) , coagulase negative staphylococcus ( CONS ) ( 6.3 % ) and Klebsiella ( 6.3 % ) . Only C and ida and S. aureus were isolated in the controls . Ofloxacin and azithromycin were 100 % active against all the isolated pathogens , while ampicillin was the least active . G. vaginalis was the most sensitive among the isolates while CONS and Klebsiella were the least sensitive . It is evident in this study that some pathogens were associated with PROM and that G. vaginalis was the most common organism and azithromycin was the only antibiotic with 100 % sensitivity . We suggest that metronidazole should be added to azithromycin to cover for anaerobes in cases of PROM , where facilities for screening for anaerobes are not available Editor 's Note : In order to encourage dissemination of the STROBE Statement , this article is being published simultaneously in Annals of Internal Medicine , Epidemiology , and PLoS Medicine . It is freely accessible on the Annals of Internal Medicine Web site ( www.annals.org ) and will also be published on the Web sites of Epidemiology and PLoS Medicine . The authors jointly hold the copyright of this article . For details on further use , see the STROBE Web site ( www 
    Output:
    
Subgroup analysis showed the distribution of microorganisms from the six regions of China varied .
The main pathogens derived from women with PROM and their newborns were Staphylococcus and E. coli , which differs from the pathogens in Western countries .