| Effects of prophylactic antibiotics on endometrial flora in women with postcesarean endometritis. | |
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MedLine Citation:
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PMID: 9699764 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine the effect of prophylactic antibiotics on endometrial and endocervical microflora upon diagnosis of postcesarean endometritis. METHODS: The medical records of patients enrolled in open-label comparative trials of therapeutic antibiotics for postpartum endometritis between 1989 and 1994 were reviewed (n = 682). Endometritis was diagnosed by a standard definition that included fever and localizing signs. Endometrial cultures were obtained by a sheathed injection/aspiration technique. Aerobes and anaerobes were isolated by standard microbiologic techniques. The primary outcome, endometrial and endocervical microflora, was compared in women who received intravenous ampicillin (2 g every 6 hours for 1-3 doses), cephalosporin (2 g every 6 hours for 1-3 doses), or no prophylaxis. Secondary outcomes included the cure of endometritis and the prevalence of wound infection in the three groups. RESULTS: Four hundred sixty-five of 682 patients (67%) had a cesarean delivery. One hundred fifty-one patients received ampicillin prophylaxis, 100 patients received cefazolin prophylaxis, 18 patients received extended-spectrum antibiotics, and 196 patients received no prophylaxis. Patients who received cefazolin prophylaxis had a significant increase in enterococcus (P < .05) and a significant decrease in Proteus species (P < .05) from endometrial samples. Patients who received ampicillin prophylaxis had a significant increase of Mycoplasma species (P < .05), Klebsiella pneumoniae (P < .0001), Escherichia coli (P = .04), and any aerobic gram-negative rod (P = .003) from endometrial samples. Ampicillin prophylaxis was associated with a decrease in Prevotella bivia (P < .05) and any anaerobe (P < .01). Endometritis cure rates were similar between prophylaxis groups and between prophylaxis and treatment groups. However, the cefazolin prophylaxis followed by cephalosporin treatment was associated with more wound infections (19%) than other prophylaxis and treatment groups, (6%, P < .01). CONCLUSION: Ampicillin and cefazolin prophylaxis alters endometrial and endocervical microflora of women who develop endometritis. Whereas these changes had no effect on endometritis cure rate (power > 80%), the association between cefazolin prophylaxis followed by an extended-spectrum cephalosporin and wound infection may warrant caution against the use of the combination. |
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Authors:
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E R Newton; P A Wallace |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Obstetrics and gynecology Volume: 92 ISSN: 0029-7844 ISO Abbreviation: Obstet Gynecol Publication Date: 1998 Aug |
Date Detail:
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Created Date: 1998-09-03 Completed Date: 1998-09-03 Revised Date: 2009-10-26 |
Medline Journal Info:
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Nlm Unique ID: 0401101 Medline TA: Obstet Gynecol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 262-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, USA. enewton@brody.med.ecu.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Ampicillin / pharmacology*, therapeutic use Antibiotic Prophylaxis* Cefazolin / pharmacology*, therapeutic use Cephalosporins / pharmacology*, therapeutic use Cervix Uteri / drug effects, microbiology* Cesarean Section / adverse effects* Endometritis / etiology, microbiology*, prevention & control* Endometrium / drug effects, microbiology* Female Humans Penicillins / pharmacology*, therapeutic use Puerperal Infection / etiology, microbiology*, prevention & control* |
| Chemical | |
Reg. No./Substance:
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0/Cephalosporins; 0/Penicillins; 25953-19-9/Cefazolin; 69-53-4/Ampicillin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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