Upper genital tract isolates at delivery as predictors of post-cesarean infections among women receiving antibiotic prophylaxis

Article Abstract:

Prophylactic (preventive) antibiotic usage for women undergoing cesarean section is very effective in preventing endometritis (inflammation of the uterine lining) and infection of the surgical wound. However, infections develop in about 15 percent of women who undergo nonelective (emergency) cesareans, a higher rate than the 5 percent associated with general abdominal surgery. The reasons for this difference are unclear, but one possible cause is the presence of infective organisms in the upper genital tract at the time of delivery. This was evaluated in 102 women delivered by cesarean section after labor or membrane rupture. Patients were given either cefotetan (50 subjects) or cefoxitin (52 subjects) prophylactically after the infant's umbilical cord was clamped. Cultures were grown from urine specimens obtained via bladder catheter, as well as from samples of amniotic fluid (in which the fetus floats) and of placental tissue. Nineteen women developed endometritis or wound infections, with a similar infection rate in the two drug groups. Endometritis was significantly associated with group B streptococcus even though the organism was susceptible to the antibiotics in laboratory tests. Infection with an antibiotic-resistant enterococcus (a type of bacteria) was also significantly associated with endometritis, as was the presence of bacteria associated with vaginosis (nonspecific inflammation; organisms include Gardnerella vaginalis and Bacteroides species). The results suggest that factors other than antibiotic resistance contribute to postpartum infections in patients who have received antibiotics prophylactically. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Complications and side effects, Risk factors, Surgical wound infections, Cesarean section, Reproductive organs, Female, Female genitalia, Endometritis

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Amoxicillin treatment of bacterial vaginosis during pregnancy

Article Abstract:

Bacterial vaginosis, a vaginal infection characterized by a foul-smelling, acidic discharge containing bacteria-covered vaginal cells (clue cells), affects approximately 14 to 21 percent of pregnant women and is associated with low birth weight and amniotic fluid infection. Yet doctors do not routinely screen for the condition, primarily because a suitable treatment is not known. Certain antibiotic drugs, such as ampicillin and amoxicillin, are safe to administer during pregnancy with no evidence of harm to the fetus, but their effectiveness against vaginosis is variable. A study was conducted to determine the efficacy of amoxicillin for treatment of bacterial vaginosis during pregnancy. A group of 108 pregnant women (15 to 25 weeks gestation) with vaginosis were treated with either oral amoxicillin (54 women) or placebo, an inactive substance, (54 women) for 14 days. Subjects were evaluated three different times (two weeks after treatment, at 34 to 36 weeks gestation, and at delivery) for the infection. It is important to recognize that the frequency of complications, such as low birth weight, preterm delivery, or maternal or fetal infections, was not different between the two groups. In this study, amoxicillin was not an effective treatment for vaginal bacterial infections in pregnant women. The authors conclude that additional studies need to be conducted in order to find a safe and effective treatment for bacterial vaginosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Drug therapy, Bacterial infections, Vaginosis, Pregnancy, Complications of, Pregnancy complications, Amoxicillin

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