Effects of Prophylactic Antibiotics on Endometrial Flora in Women With Postcesarean Endometritis

Newton, Edward R.; Wallace, Patricia A.

doi:10.1097/00006250-199808000-00021

Cited by 7 publications

(10 citation statements)

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“…Post-cesarean infections are polymicrobial, involving aerobes, anaerobes and Ureaplasma (or Mycoplasmas ). The most frequent microbes isolated from endometrial cultures of women with post-cesarean endometritis include Ureaplasmas/Mycoplasmas , aerobic gram-negative rods, enterococci, Gardnerella and anaerobes 38–41. The most common organisms isolated from wound infections also include Ureaplasma as well as staphylococci and enterococci.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, the recommended narrow-spectrum regimen of cefazolin alone does not cover frequent isolates or risk factors such as Ureaplasma and anaerobic bacteria. Indeed, narrow-spectrum antibiotic prophylaxis modifies flora towards the increased presence of resistant organisms such as anaerobes 38,50. While azithromycin or metronidazol appropriately suppresses ureaplasma or anaerobes respectively, it is likely that the origin of the observed benefits extends to the suppression of other susceptible organisms.…”

Section: Resultsmentioning

confidence: 99%

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Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery

Tita

Rouse

Blackwell

et al. 2009

Obstetrics &Amp; Gynecology

124

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Objective-To review the current status of antibiotic prophylaxis for cesarean delivery, newly evolving strategies to enhance the effectiveness of antibiotic prophylaxis in reducing post-cesarean infection, and the implications of the emerging practices.Data Sources-We conducted a full PubMed (January 1966-July 2008) search using the key words "cesarean section" and "antibiotic prophylaxis." A total of 277 articles were identified and supplemented by a bibliographic search.Methods of Study Selection-We selected a total of 15 studies which included all published clinical trials, meta-analyses of clinical trials, and observational studies evaluating either the timing of antibiotics or the use of extended-spectrum prophylaxis. We also reviewed nine reports involving national recommendations or technical reviews supporting current standards for antibiotic prophylaxis.Tabulation, Integration, and Results-We conducted an analytic review and tabulation of selected studies without further meta-analysis. Although current guidelines for antibiotic prophylaxis recommend the administration of narrow-spectrum antibiotics (cefazolin) after clamping of the umbilical cord, the data suggest that antibiotic administration prior to surgical incision or the use of extended-spectrum regimens (involving azithromycin or metronidazole) after cord clamp may reduce postcesarean maternal infection by up to 50%. However, their impact relative to each other has not been studied. In addition, their impact on neonatal infection or infection with resistant organisms warrants further study. Conclusion-The use of either cefazolin alone prior to surgical incision or an extended-spectrum regimen after cord clamp appears to be associated with a reduction in postcesarean maternal infection. Confirmatory studies focusing additionally on neonatal outcomes and the impact on resistant organisms, as well as studies comparing both strategies, are needed.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery

Tita

Rouse

Blackwell

et al. 2009

Obstetrics &Amp; Gynecology

124

View full text Add to dashboard Cite

show abstract

“…The use of first generation cephalosporins such as cefazolin90 provides antibiotic activity against Ureaplasmas and Mycoplasmas but may cause an increase in resistant organisms like anaerobes 138148 Hence, there is rationale for adding agents such as metronidazole, clindamycin, or azithromycin to extend the cover.…”

Section: Choice Of Antibiotic and Rationale For The Use Of Broad-specmentioning

confidence: 99%

Current debate on the use of antibiotic prophylaxis for caesarean section

Lamont

Sobel

Kusanovic

et al. 2010

BJOG

114

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Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tract infection. Most surgical site infections occur after discharge from the hospital, and are increasingly being used as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics before surgical incision. An exception is made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage to the neonate.

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“…These reasons make this organism a risk factor for pregnancy outcome and fetus development. Our study findings suggest that the concentrations of P. bivia and LPS in the vaginal fluid may contribute to the severity of BV and to the development of complications in pregnancy, such as preterm labor, premature rupture of membranes, postpartum endometritis, and postoperative pelvic infection [26, 27]. …”

Section: 1 Discussionmentioning

confidence: 99%

Prevotella bivia as a source of lipopolysaccharide in the vagina

2008

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Objectives-To compare vaginal lipopolysaccharides (LPS) concentrations between patients with and without bacterial vaginosis (BV), to evaluate the correlation between Prevotella bivia colonization density and LPS concentration, and to determine the impact of LPS on loss of dopamine neurons (DA).Methods-Vaginal washes obtained from patients with (n=43) and without (n=59) BV were tested for quantity of P. bivia cells using quantitative PCR and for concentrations of LPS using the Limulus Amebocyte Lysate gel clot method. Prevotella bivia, Gardnerella vaginalis and Escherichia coli sonicated cell extracts were also tested for LPS production. DA neuron cells obtained from embryonic day (E) 14.5 pregnant rats were exposed to fluid from eight vaginal washes; tyrosine hydrolase immunoreactive staining was applied for visualization and cell counts.Results-The median LPS concentrations were dramatically higher among patients who had symptoms of BV compared to those who did not have symptoms (3235.0 vs 46.4 EU/ml, respectively, P<0.001); patients who had BV also had much higher colonization densities of P. bivia (0.06±0.36 vs 5.4±2.2 log 10 CFU/ml, respectively, P<0.001).Prevotella bivia cell lysates resulted in a higher LPS concentration (10,713.0±306.6 EU/ml) than either E. coli (4,679.0± 585.3 EU/ml) or G. vaginalis (0.07±0.01 EU/ml of LPS).The loss of DA neuron was 20-27% in cultures treated with vaginal washes from BV-negative patients and 58-97% in cultures treated with vaginal washes from patients with BV. Fax: (312) 864-9522, E-mail: aaroutch@rush.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. It has been shown that an increased rate of premature labor and preterm delivery [1-3] occurrs among women with P. bivia at a concentration of >10 4 bacteria/ml of vaginal fluid [4]. An experimental rabbit model also confirmed an association between P. bivia and preterm birth, increased level of TNF-α, and chronic intrauterine and fetal infection [5]. A persistent intrauterine inflammatory state that can occur in chronic conditions such as BV suggests that preterm delivery may follow chronic exposure to organisms, perhaps with resulting fetal brain damage [6,7]. Conclusion-P. bivia produces high LPS concentration NIH Public AccessPrevotella bivia and other Prevotella species contain endotoxin, lipopolysaccharides (LPS), on their outer membranes; LPS is the most potent antigenic component of the Gram-negative bacterial cell wall. Some species of Prevotella produce LPS that is much more potent in inducing a rapid platelet response than the LPS found in Escherichia coli a...

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Effects of Prophylactic Antibiotics on Endometrial Flora in Women With Postcesarean Endometritis

Cited by 7 publications

References 0 publications

Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery

Emerging Concepts in Antibiotic Prophylaxis for Cesarean Delivery

Current debate on the use of antibiotic prophylaxis for caesarean section

Prevotella bivia as a source of lipopolysaccharide in the vagina

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