Document Detail


Effects of prophylactic antibiotics on endometrial flora in women with postcesarean endometritis.
MedLine Citation:
PMID:  9699764     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
E R Newton; P A Wallace
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  92     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  1998 Aug 
Date Detail:
Created Date:  1998-09-03     Completed Date:  1998-09-03     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  262-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio, USA. enewton@brody.med.ecu.edu
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MeSH Terms
Descriptor/Qualifier:
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:
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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