RESUMEN
CASE HISTORY: A group of 39, 19-22-month-old Friesian bulls were administered an ivermectin/closantel anthelmintic via intended S/C injection in the ischiorectal fossa on 15 June 2017 (Day 0). Over the next 50 days, 22 affected bulls presented various degrees of anorexia, abdominal pain and urine dribbling. Seventeen bulls were examined by transrectal ultrasonography which revealed urinary bladder distension in all 17, and peritoneal fluid accumulation in some. Overall, eight bulls died or were subjected to euthanasia. On-farm postmortem examination of three bulls revealed urinary bladder rupture. CLINICAL FINDINGS: On Day 50 one affected live bull was admitted to Massey University for further investigation. This bull continuously dribbled urine and had an overtly distended urinary bladder as determined by rectal palpation and ultrasonography. PATHOLOGICAL FINDINGS: Postmortem examination of this bull revealed a markedly distended urinary bladder, massive subcapsular and pericapsular renal oedema with retroperitoneal fluid accumulation, minimal hydronephrosis and no evidence of mechanical urinary outflow obstruction. The right ischiorectal fossa contained multifocal areas of tissue fibrosis that extended into areas innervated by the distal cutaneous branch of the pudendal nerve and the pelvic nerve. Histopathological changes consisted of extensive fibrosis, myonecrosis and neurodegeneration, and evidence of granulation tissue and inflammation at the putative injection site and in surrounding tissues. DIAGNOSIS: A local inflammatory reaction at the presumed injection site together with localised peripheral neurodegeneration and myelopathy may have led to detrusor-sphincter dyssynergia causing urine retention. CLINICAL RELEVANCE: These cases of urine retention and bladder rupture in cattle were of putative iatrogenic origin. Veterinarians should be aware of this rare complication after S/C injections in the ischiorectal fossa.
Asunto(s)
Enfermedades de los Bovinos/inducido químicamente , Ivermectina/efectos adversos , Salicilanilidas/efectos adversos , Retención Urinaria/veterinaria , Animales , Antiparasitarios/administración & dosificación , Antiparasitarios/efectos adversos , Bovinos , Enfermedades de los Bovinos/etiología , Enfermedades de los Bovinos/mortalidad , Combinación de Medicamentos , Ivermectina/administración & dosificación , Masculino , Rotura , Salicilanilidas/administración & dosificación , Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria/etiología , Enfermedades de la Vejiga Urinaria/mortalidad , Enfermedades de la Vejiga Urinaria/patología , Enfermedades de la Vejiga Urinaria/veterinaria , Retención Urinaria/inducido químicamente , Retención Urinaria/complicaciones , Retención Urinaria/mortalidadRESUMEN
We performed a retrospective comparison between the findings from colposcopically directed biopsies and those from loop excision of the transformation zone (LETZ) specimens. The correlation was satisfactory. When a low grade squamous intraepithelial lesion (SIL) was predicted on a cytologic smear and biopsy specimen, no cases of invasive carcinoma were found. In two (0.8%) cases in which a high grade SIL was predicted on the cervical smear and biopsy, microinvasive carcinoma was found in the LETZ specimen.
Asunto(s)
Biopsia con Aguja/métodos , Colposcopía , Electrocoagulación/métodos , Displasia del Cuello del Útero/patología , Neoplasias del Cuello Uterino/patología , Adolescente , Adulto , Anciano , Colposcopía/métodos , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias del Cuello Uterino/cirugía , Frotis Vaginal/métodos , Displasia del Cuello del Útero/cirugíaRESUMEN
One hundred eighty-four postpartum patients with the diagnosis of endomyometritis underwent intrauterine culturing. Beta-Lactamase production was tested using nitrocephin-impregnated discs in 278 bacterial isolates from patients with postpartum endometritis. beta-Lactamase production was found to be present in 149 of 278 (54%) isolates tested: 0 of 39 Streptococcus faecalis (0%), 22 of 41 Escherichia coli (54%), 66 of 68 Bacteroides bivius (97%), 0 of 13 Proteus mirabilis (0%) and 15 of 42 Staphylococcus epidermidis (36%). Anaerobes, as a group, had the highest rate of beta-lactamase production, 94 of 102 (93%), followed by gram negatives, 34 of 84 (40%), then gram positives, 21 of 91 (23%). However, it was the beta-lactamase produced by the gram-negative bacteria that was most responsive to the addition of a beta-lactamase inhibitor. The frequent isolation of beta-lactamase-producing bacteria from patients with postpartum endometritis raises concern about the use of antibiotics not resistant to these enzymes. Therefore, antibiotics combined with a beta-lactamase inhibitor may have potential as single-agent therapy in obstetric and gynecologic infections.
Asunto(s)
Bacteroides/enzimología , Endometritis/microbiología , Escherichia coli/enzimología , Periodo Posparto , beta-Lactamasas/metabolismo , Ampicilina/administración & dosificación , Quimioterapia Combinada/uso terapéutico , Endometritis/tratamiento farmacológico , Femenino , Humanos , Estudios Prospectivos , Sulbactam/administración & dosificaciónRESUMEN
Previous animal experiments utilizing bowel flora have demonstrated synergy between various aerobes and anaerobes in the formation of intraabdominal abscesses. In these experiments, human female genital tract isolates were inserted into the abdominal and pelvic cavities of 151 female Sprague-Dawley rats. Inoculation with any single species of organism--Streptococcus faecalis, Enterobacter cloacae or Bacteroides bivius or a combination of two facultative organisms (S faecalis plus E cloacae)--did not result in a significant increase in abscess formation. Combination of a facultative organism or organisms with the anaerobe B bivius or S faecalis plus B bivius plus E cloacae resulted in 55% (P < .01) and 74% (P < .0005) rates of abscess formation, respectively, as compared with controls. Combinations including B fragilis demonstrated similar results. Thus, female genital tract facultative organisms demonstrate synergy in the presence of anaerobic organisms in the development of abscesses.
Asunto(s)
Absceso/microbiología , Infecciones por Bacteroides/microbiología , Modelos Animales de Enfermedad , Enterobacter cloacae , Infecciones por Enterobacteriaceae/microbiología , Enterococcus faecalis , Enfermedades de los Genitales Femeninos/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Absceso/sangre , Absceso/epidemiología , Animales , Infecciones por Bacteroides/sangre , Infecciones por Bacteroides/epidemiología , Comorbilidad , Enterobacter cloacae/aislamiento & purificación , Enterobacter cloacae/patogenicidad , Infecciones por Enterobacteriaceae/sangre , Infecciones por Enterobacteriaceae/epidemiología , Enterococcus faecalis/aislamiento & purificación , Enterococcus faecalis/patogenicidad , Femenino , Enfermedades de los Genitales Femeninos/sangre , Enfermedades de los Genitales Femeninos/epidemiología , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/epidemiología , Incidencia , Ratas , Ratas Sprague-Dawley , VirulenciaRESUMEN
Five different antibiotic susceptibility methods were utilized to test the effectiveness of cefotetan against 200 anaerobic bacteria recovered from patients with obstetrical or gynecological infections. The object of this study was to determine if a more economical and rapid method for anaerobic susceptibility testing was as acceptable as the reference agar dilution method. The five methods were: 1) broth disk elution, 2) microbroth technique, 3) a commercially available microbroth technique, 4) a commercially available spiral gradient technique, and 5) reference agar dilution. The minimal inhibitory concentrations (MICs) calculated from the spiral gradient technique were equal to or within one doubling dilution of the reference system in 99.5% of cases, while the percentage for the commercially available microbroth system was 96.8%, very similar to the microbroth technique used in our laboratory that yielded a percentage of 96.3. The disk elution method correlated to the reference agar dilution method in 95.3% cases. While the overall agreement between these techniques is good, especially for the spiral gradient system, clustering of certain organisms near the breakpoint of the antibiotic tested results in variability in the labeling of these organisms as susceptible or resistant. This problem appears to be particularly significant for the disk elution method. Therefore, further refinements in these methods of suscleptibility testing are needed in order to provide a more clinically useful assessment of the susceptibility or resistance of certain bacterial isolates.
RESUMEN
Penicillin class antibiotics have demonstrated varying degrees of in vivo and in vitro success when tested against Chlamydia trachomatis. The activity of ampicillin-sulbactam, an agent commonly utilized in the treatment of pelvic infections, was tested to ascertain if any antichlamydial activity is present. Up to six endocervical isolates of C. trachomatis were tested against each of five antibiotics including doxycycline, erythromycin, clindamycin, ampicillin/sulbactam, and sulbactam alone. McCoy cell monolayers were inoculated with high inclusion counts of 10,000-30,000 inclusion-forming units (IFU) per coverslip, and exposed to each antibiotic. Up to nine subsequent antibiotic free culture passes were performed to assess the viability of abnormal inclusions. Doxycycline, erythromycin, and clindamycin achieved 100% eradication of inclusions at concentrations of 4.0, 2.0, and 1.0 microg/mL. Exposure to ampicillin/sulbactam resulted in a greater than 99% reduction in the inclusion count at 32.0 microg/mL, while sulbactam by itself demonstrated considerably less activity. Abnormal inclusions were noted only in the ampicillin/sulbactam exposed cells, and these, plus all inclusions remaining following sublethal exposure to the other antibiotics, resulted in regrowth to control levels in subsequent passes. Doxycycline and erythromycin demonstrated excellent activity. Clindamycin and ampicillin/sulbactam also significantly reduced inclusion formation, and therefore may provide adequate C. trachomatis coverage in patients receiving these antibiotics for pelvic infections.
RESUMEN
OBJECTIVE: The purpose of our study was to compare the accuracy of clinical ultrasonographic techniques of amniotic fluid volume assessment with a dye-dilution technique. STUDY DESIGN: We compared amniotic fluid volume as measured by ultrasonographic techniques with a dye-dilution method in 50 women undergoing amniocentesis during the third trimester. Thirteen separate ultrasonographic techniques, including the amniotic fluid index, were evaluated with regression analysis. RESULTS: Amniotic fluid volumes as determined by dye-dilution ranged between 129 and 4444 ml. The amniotic fluid index overestimated the actual volume by as much as 88.7% at lower volumes and underestimated the actual volume by as much as 53.9% at higher volumes. CONCLUSIONS: Differences in measurement error between the other ultrasonographic methods and the amniotic fluid index did not appear to be sufficient to warrant changes in current clinical practice. A major source of error in ultrasonographic amniotic fluid volume assessment is that one-dimensional measurements are used to estimate the volume of a complex, three-dimensional object.
Asunto(s)
Líquido Amniótico , Técnicas de Dilución del Indicador , Ultrasonografía Prenatal , Errores Diagnósticos , Estudios de Evaluación como Asunto , Femenino , Predicción , Humanos , Oligohidramnios/diagnóstico , Polihidramnios/diagnóstico , Embarazo , Estadística como AsuntoRESUMEN
Kingella denitrificans and Streptococcus agalactiae were isolated from the amniotic fluid of a woman with chorioamnionitis. She was treated with intravenous ampicillin/sulbactam, with a good response.
Asunto(s)
Líquido Amniótico/microbiología , Corioamnionitis/microbiología , Neisseriaceae/aislamiento & purificación , Adulto , Ampicilina/uso terapéutico , Corioamnionitis/tratamiento farmacológico , Corioamnionitis/etiología , Quimioterapia Combinada , Femenino , Humanos , Inyecciones Intravenosas , Trabajo de Parto Inducido/efectos adversos , Embarazo , Embarazo Prolongado , Streptococcus agalactiae/aislamiento & purificación , Sulbactam/uso terapéuticoRESUMEN
Forty patients with cervical infection caused by Chlamydia trachomatis were treated with ofloxacin (20) or doxycycline (20). Ofloxacin was successful in eradicating C. trachomatis from all 20 (100%) patients. Doxycycline was effective in 18 of 20 (90%) patients. Three patients had a concomitant cervical gonococcal infection. All three were successfully treated: one with ofloxacin and two with doxycycline. Ofloxacin, 300 mg, taken twice daily for 7 days, is effective in eradicating endocervical C. trachomatis infection.
Asunto(s)
Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis , Gonorrea/tratamiento farmacológico , Ofloxacino/uso terapéutico , Cervicitis Uterina/tratamiento farmacológico , Adolescente , Adulto , Infecciones por Chlamydia/microbiología , Doxiciclina/uso terapéutico , Evaluación de Medicamentos , Femenino , Gonorrea/microbiología , Humanos , Distribución Aleatoria , Cervicitis Uterina/microbiologíaRESUMEN
Fifteen hundred patients were enrolled in a prospective, randomized study on the effect of antibiotic prophylaxis during cesarean section. Two hundred thirty-one patients developed postpartum endometritis, and the isolates obtained from the endometrium were tested for sensitivity to ampicillin, cefuroxime, ofloxacin, ciprofloxacin, and clindamycin. Minimum inhibitory concentrations of 50% and 90% of ampicillin, cefuroxime, and clindamycin were similar to previously reported values; however, slight differences were noted in the activity of the two quinolones to common pelvic isolates. The minimum inhibitory concentrations of 90% of ofloxacin and ciprofloxacin to 119 isolates of Enterococcus faecalis were 4.0 and 2.0, to 17 isolates of Staphylococcus aureus 1.0 and 0.5, to 39 isolates of Escherichia coli 0.5 and 1.0, to 46 isolates of Bacteroides bivius 4.0 and 8.0, to 57 isolates of Gardnerella vaginalis 1.0 and 2.0, to 71 isolates of Staphylococcus epidermidis 0.5 and 0.5, to 16 isolates of Proteus mirabilis 0.25 and 0.12, and to 50 isolates of Lactobacillus species 32.0 and 8.0 micrograms/ml, respectively. In summary, the quinolones have activity comparable with a variety of other oral agents versus female pelvic pathogens, with the quinolones ofloxacin and ciprofloxacin having better activity against most of the gram-negative isolates. Anaerobic activities were comparable with the beta-lactams, but inferior to clindamycin and metronidazole as expected.
Asunto(s)
Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Endometritis/etiología , Endometrio/microbiología , Premedicación , Infección Puerperal/etiología , Administración Oral , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Bacterias/aislamiento & purificación , Cesárea , Ciprofloxacina/farmacología , Endometritis/microbiología , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Ofloxacino/farmacología , Estudios Prospectivos , Infección Puerperal/microbiologíaRESUMEN
Our concept of the pathogenesis of acute salpingitis and advanced pelvic infection, such as tuboovarian abscess, is evolving. Although Neisseria gonorrhoeae and Chlamydia trachomatis are thought to play a significant role in acute pelvic inflammatory disease, other microorganisms, such as aerobes and anaerobes, have repeatedly been reported to play a significant role, also, particularly in the patient with advanced disease. A study was designed to evaluate the pathogenesis, and particularly any synergistic role, of some aerobes and anaerobes with N gonorrhoeae and C trachomatis abscess formation. Using the rat model developed by Weinstein and Onderdonk, the study demonstrated that N gonorrhoeae and C trachomatis alone do not produce abscesses. However, when combined with facultative or anaerobic bacteria, synergism with abscess formation is noted frequently. The data support the hypothesis that N gonorrhoeae and C trachomatis initiate infection and that aerobic and anaerobic bacteria act synergistically to produce abscesses. In addition, microorganisms not inoculated were found to be recruited into the infectious process. The organisms may gain access to the peritoneal cavity via the lower genital tract or from transmucosal migration from the intestinal flora.
Asunto(s)
Absceso/microbiología , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/patogenicidad , Gonorrea/microbiología , Neisseria gonorrhoeae/patogenicidad , Enfermedades Peritoneales/microbiología , Animales , Bacteroides/patogenicidad , Modelos Animales de Enfermedad , Método Doble Ciego , Enterococcus faecalis/patogenicidad , Escherichia coli/patogenicidad , Femenino , Ratas , Ratas Endogámicas , Salpingitis/microbiologíaRESUMEN
Patients with uncomplicated pelvic inflammatory disease (PID) (acute salpingitis and no pelvic masses) were randomly assigned for treatment with either cefotaxime or cefoxitin. A clinical cure was achieved in 17 of 20 cases (82%) and 19 of 22 cases (84%), respectively. Within the complicated PID group, patients were assigned to two subgroups: those with a tubo-ovarian complex (26 patients), and those with a tubo-ovarian abscess (32 patients), as confirmed by ultrasonography or surgery. Patients within each of these two subgroups were then randomly assigned for treatment with either cefotaxime or clindamycin plus gentamicin. Within the tubo-ovarian complex subgroup, a clinical cure was achieved in 11 of 13 cases (85%) treated with cefotaxime and 10 of 13 cases (77%) treated with clindamycin plus gentamicin. Within the tubo-ovarian abscess subgroup, a clinical cure was achieved in 12 of 16 cases (75%) treated with cefotaxime and 11 of 16 cases (69%) treated with clindamycin plus gentamicin. No differences in any category were statistically significant. Specimens for culture were obtained from the endocervix, endometrium, and when possible, the cul-de-sac, fallopian tubes, and abscess. Neisseria gonorrhoeae (33%) was isolated more frequently than Chlamydia trachomatis (12%) in patients with PID, and neither of these organisms was isolated with any increased frequency in patients with complicated PID. The majority of the patients were considered to have polymicrobial infection. Cefotaxime was as efficacious as cefoxitin and clindamycin plus gentamicin for the treatment of acute salpingitis, tubo-ovarian complex and tubo-ovarian abscess.
Asunto(s)
Cefotaxima/uso terapéutico , Cefoxitina/uso terapéutico , Clindamicina/administración & dosificación , Gentamicinas/administración & dosificación , Enfermedad Inflamatoria Pélvica/tratamiento farmacológico , Adolescente , Adulto , Bacterias/aislamiento & purificación , Bacteroides/efectos de los fármacos , Chlamydia trachomatis/aislamiento & purificación , Clindamicina/uso terapéutico , Quimioterapia Combinada/uso terapéutico , Femenino , Genitales Femeninos/microbiología , Gentamicinas/uso terapéutico , Humanos , Persona de Mediana Edad , Enfermedad Inflamatoria Pélvica/etiologíaRESUMEN
The importance of Chlamydia trachomatis as an etiologic agent in the development of pelvic inflammatory disease (PID) is well documented. Although there are numerous antimicrobial agents that are effective against C. trachomatis, one of the most frequent combinations that is used to treat PID is clindamycin and gentamicin. The efficacy of clindamycin as the sole treatment for chlamydial infections has been questioned. In fact, the Centers for Disease Control (Atlanta, Ga.) has recommended the use of doxycycline following clindamycin and gentamicin treatment of PID confirmed or suspected to be caused by C. trachomatis. This study was designed to determine whether there is any synergistic in vitro activity between clindamycin and gentamicin or tobramycin on inhibition of C. trachomatis replication. In this experiment, the MIC of clindamycin decreased two- to threefold when an aminoglycoside was added. This occurred even though aminoglycosides by themselves had essentially no effect against C. trachomatis. The mechanism of this interaction is uncertain.
Asunto(s)
Antibacterianos/farmacología , Chlamydia trachomatis/efectos de los fármacos , Clindamicina/farmacología , Sinergismo Farmacológico , Gentamicinas/farmacología , Pruebas de Sensibilidad Microbiana , Tobramicina/farmacologíaRESUMEN
We compared a new enzyme immunoassay (Ortho Diagnostics Systems, Inc., Raritan, N.J.) (EIA) with iodine and fluorescent-antibody staining of inoculated McCoy cell monolayers for detection of Chlamydia trachomatis in our female outpatient populations. EIA was more sensitive than iodine at a statistically significant level, but there were no statistically significant differences between EIA results and those for fluorescent-antibody staining.
Asunto(s)
Técnicas Bacteriológicas , Chlamydia trachomatis/aislamiento & purificación , Adolescente , Adulto , Antígenos Bacterianos/aislamiento & purificación , Infecciones por Chlamydia/diagnóstico , Chlamydia trachomatis/inmunología , Errores Diagnósticos , Estudios de Evaluación como Asunto , Femenino , Técnica del Anticuerpo Fluorescente , Humanos , Técnicas para Inmunoenzimas , Yodo , Embarazo , Coloración y EtiquetadoRESUMEN
Seven antibiotics, administered in 10 different regimens for prophylaxis, were randomly assigned to 1580 patients who were delivered by cesarean section. Cefazolin 1 gm, administered for three doses, served as the control group. Cefazolin 1 gm, cefazolin 2 gm, cefoxitin 1 gm, cefoxitin 2 gm, cefonicid 1 gm, cefotetan 1 gm, ceftizoxime 1 gm, ampicillin 2 gm, and piperacillin 4 gm were all administered in a single dose. Four antibiotics proved to be superior in preventing postpartum endometritis: ampicillin 2 gm (p = 0.03), cefazolin 2 gm (p = 0.005), piperacillin 4 gm (p = 0.0007), and cefotetan 1 gm (p = 0.0001). Single-dose cephalosporin antibiotic prophylaxis was found to result in approximately a twofold increase in Enterococcus faecalis colonization of the vagina (p less than 0.01). This may be significant in patients in whom postpartum endometritis develops and who have failure of initial treatment with a broad-spectrum cephalosporin, e.g., cefoxitin or cefotetan, or a combination such as clindamycin or metronidazole plus an aminoglycoside. Rupture of amniotic membranes for a half hour or more was associated with an increased risk for postpartum endometritis. The use of internal fetal monitoring was associated with an increased risk of soft tissue pelvic infection.
Asunto(s)
Cefazolina/uso terapéutico , Endometritis/prevención & control , Penicilinas/uso terapéutico , Adolescente , Adulto , Cesárea/efectos adversos , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Embarazo , Estudios Prospectivos , Trastornos Puerperales/prevención & control , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Sixty-eight patients with postpartum endomyometritis were enrolled in this open randomized comparative study. Forty-two patients received ampicillin/sulbactam and 26 received clindamycin. The cure rates were similar in the two groups: 83% in the ampicillin/sulbactam group and 88% in the clindamycin group. The most frequent endometrial bacterial isolates were Bacteroides bivius, Streptococcus faecalis, Escherichia coli, and Ureaplasma urealyticum. Bacteremia was present in 15 of 68 (22%), the most frequent isolates being Mycoplasma (four cases) and B bivius (three cases). Clindamycin-resistant species were S faecalis, E coli, and Proteus mirabilis. There were seven treatment failures in the ampicillin/sulbactam group; only one isolate (an E coli) was resistant to ampicillin/sulbactam. In a significant number of these failures, Mycoplasma was isolated. Ampicillin/sulbactam and clindamycin were found to be equally efficacious in the treatment of postpartum endometritis.
Asunto(s)
Ampicilina/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Clindamicina/uso terapéutico , Endometritis/tratamiento farmacológico , Infección Puerperal/tratamiento farmacológico , Sulbactam/uso terapéutico , Adulto , Ampicilina/administración & dosificación , Resistencia a la Ampicilina , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Esquema de Medicación , Evaluación de Medicamentos , Farmacorresistencia Microbiana , Quimioterapia Combinada/uso terapéutico , Endometritis/diagnóstico , Femenino , Humanos , Infusiones Intravenosas , Infección Puerperal/diagnóstico , Ensayos Clínicos Controlados Aleatorios como Asunto , Sulbactam/administración & dosificaciónRESUMEN
The potential for bacterial contamination during transvaginal recovery of endometrial samples in patients with postpartum endomyometritis spawned an investigation into various protective measures and techniques. The confirmation and determination of the extent of contamination was attempted in 120 postpartum women with the diagnosis of postpartum endometritis. Each woman underwent endometrial sampling for bacterial culturing utilizing two devices--an unprotected, cotton-tipped swab and a protective, double-lumen catheter with a brush. Although a statistically greater number of bacterial species were recovered with the swab than with the brush (2.4 vs. 1.6, respectively [P less than .001]), they were not representative of species commonly thought of as causing cervicovaginal contamination. Individual species found with greater frequency with the swab were Streptococcus faecalis (P = .023), Escherichia coli (P = .007), Proteus mirabilis (P = .025), Bacteroides bivius (P less than .001 and Bacteroides melaninogenicus (P = .02). Thus, with proper cervical preparation and an extended-reach, transvaginal, cotton-tipped swab, true fundal specimens were obtained that provided a representative and cost-efficient sample of the infected endometrial cavity.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Endometritis/diagnóstico , Endometrio/microbiología , Infección Puerperal/diagnóstico , Manejo de Especímenes/normas , Infecciones Bacterianas/etiología , Endometritis/etiología , Femenino , Humanos , Embarazo , Estudios Prospectivos , Infección Puerperal/etiología , Manejo de Especímenes/economía , Manejo de Especímenes/métodosRESUMEN
The potential for cervicovaginal contamination has precluded direct sampling of the endometrial cavity and has led to the development of multi-lumen protected catheter systems, among other techniques. The extent of this presumed contamination was examined using three different techniques in 55 postpartum women with the diagnosis of endometritis. Each woman had the endometrium sampled with an unprotected cotton-tipped swab, a double-lumen catheter with brush, and a flexible endometrial suction curette. A statistically larger number of bacterial species was recovered with the cotton swab (2.4) than with the double-lumen catheter (1.3) or the suction curette (1.7) (P less than .001). A difference was also noted between the double-lumen catheter and the suction curette (P = .006); however, this represented less than one-third of a single bacterial species. The larger number of bacterial species recovered by the unprotected methods was found to result not from cervicovaginal contamination, as suspected, but from a significant increase in the recovery of bacteria commonly regarded as potential pathogens, such as Bacteroides bivius, Streptococcus faecalis, Proteus mirabilis, and Bacteroides melaninogenicus.
Asunto(s)
Dilatación y Legrado Uterino/instrumentación , Endometritis/microbiología , Infección Puerperal/microbiología , Manejo de Especímenes/instrumentación , Útero/microbiología , Legrado por Aspiración/instrumentación , Femenino , Humanos , EmbarazoRESUMEN
Sixty-seven patients diagnosed with post-cesarean-section endometritis were studied in a prospective comparative randomized trial of sulbactam/ampicillin, a new beta-lactamase inhibitor drug combination, versus treatment with metronidazole/gentamicin. The success rate was 91% for each antibiotic regimen. Mycoplasma spp. or Ureaplasma spp. were isolated from all treatment failures. Endometrial cultures revealed 2.3 aerobes as well as anaerobes per patient, with Enterococcus faecalis, Bacteroides bivius, and Escherichia coli the most frequently reported bacterial isolates in 64, 40, and 28% of all patients, respectively. Positive blood cultures were noted in 11 (15%) patients with Mycoplasma sp. the most commonly found isolate (45.5%). Sulbactam/ampicillin appears to be safe and equally effective as a metronidazole/aminoglycoside drug regimen in the treatment of postpartum endometritis.
Asunto(s)
Cesárea/efectos adversos , Quimioterapia Combinada/administración & dosificación , Endometritis/tratamiento farmacológico , Infección Puerperal/tratamiento farmacológico , Adulto , Ampicilina/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/etiología , Endometritis/etiología , Femenino , Gentamicinas/administración & dosificación , Humanos , Metronidazol/administración & dosificación , Embarazo , Estudios Prospectivos , Infección Puerperal/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Sulbactam/administración & dosificaciónRESUMEN
One hundred fifty-two women who received cefazolin prophylaxis and subsequently developed postpartum endometritis were randomized to treatment with either ticarcillin/clavulanic acid (75) or clindamycin-gentamicin (77). Bacteria isolated from the endometrium were predominantly facultative anaerobic bacteria. The ratio of facultative anaerobes to obligate anaerobes was 3:1. Nineteen percent of the women were bacteremic, with mycoplasma the organism most frequently isolated from venous blood specimens. Cure rates were similar for both groups: ticarcillin/clavulanic acid 85% and clindamycin-gentamicin 81%. The advantages of ticarcillin/clavulanic acid are an increased spectrum of activity against beta-lactamase-producing bacteria, less toxicity, and lower cost.