References: Cesarean Infection; Volume 3 Issue 10

1. AUTHOR	Henderson-E, Love-E-J.
INSTITUTION	Department of Community Health Sciences University of Calgary, Alberta, Canada.
TITLE	Incidence of hospital-acquired infections associated with caesarean section.
SOURCE	J-Hosp-Infect 1995 Apr, VOL: 29 (4), P: 245-55, ISSN: 0195-6701.
ABSTRACT	A retrospective cohort study was conducted to determine the incidence of post-caesarean infections in a Canadian community teaching hospital using computer algorithms designed for the diagnosis of nosocomial infections. Inferential chart review was done on 1335 women delivered by lower-segment caesarean section (793 primary and 542 secondary) at the Calgary General Hospital between January 1985 and April 1988. The overall infection rates were 42.1 and 46.1% for women delivered by primary and secondary caesarean section, respectively. Incisional surgical wound infection accounted for the largest proportion of post-caesarean infections found. Women delivered by primary caesarean section had significantly higher rates of endometritis, deep surgical wound infection and bacteraemia than those delivered by secondary section. All types of post-caesarean infection, except asymptomatic bacteriuria, caused the duration of the post-partum hospital stay to be significantly increased. Author.

2. AUTHOR	Chang-P-L, Newton-E-R.
INSTITUTION	Department of Obstetrics and Gynecology, University of Texas Health Science Center, San Antonio.
TITLE	Predictors of antibiotic prophylactic failure in post-cesarean endometritis.
SOURCE	Obstet-Gynecol 1992 Jul, VOL: 80 (1), P: 117-22, ISSN: 0029-7844.
ABSTRACT	Despite the use of prophylactic antibiotics, endometritis occurs in 1-31% of patients after cesarean delivery. We sought to identify predictors of prophylactic antibiotic failure. In a retrospective review of 1800 cesarean deliveries, 766 patients had either ampicillin or cefazolin prophylaxis; 240 (31.3%) developed endometritis. Stepwise logistic regression identified the number of vaginal examinations (P less than .001), nulliparity (P = .001), low gestational age (P = .033), and cefazolin use (P = .002) as predictors of endometritis. One in two women with six or more vaginal examinations before cesarean delivery will have prophylactic failure. In preterm gestations (N = 177), the number of vaginal examinations was the single predictor of prophylactic antibiotic failure (P = .002). The number of vaginal examinations can be used to design new strategies to prevent a high rate of prophylactic failure. Author.

3. AUTHOR	Soper-D-E.
INSTITUTION	Department of Obstetrics and Gynecology, Medical College of Virginia, Virginia Commonwealth University, Richmond.
TITLE	Infections following cesarean section.
SOURCE	Curr-Opin-Obstet-Gynecol 1993 Aug, VOL: 5 (4), P: 517-20, ISSN: 1040-872X 13 Refs.
ABSTRACT	Postpartum endomyometritis and abdominal wound infection remain the most common infectious complications following childbirth. New information now suggests that incipient infection of the myometrium explains why patients develop postpartum endometritis despite antibiotic prophylaxis. Clinical predictors of postpartum endometritis continue to suffer from low sensitivity. However, use of a Gram stain of the amniotic fluid may be helpful in identifying a subset of women that may benefit from a therapeutic course of antibiotics initiated immediately after cesarean section. Broad-spectrum antimicrobial therapy is the mainstay of therapy for postpartum endometritis. Two newer extended spectrum cephalosporins, cefotetan and ceftizoxime, appear to be as effective as cefoxitin in the treatment of these infections. Abdominal wound infection is a common cause of antimicrobial failure in patients treated for post-cesarean endomyometritis. The genital mycoplasmas, usually resistant to the penicillins and cephalosporins, are commonly isolated from infected wounds following cesarean section. Wound infection surveillance has been shown to decrease infection incidence rates by providing feedback to the operating surgeon. Author.

4. AUTHOR	Yip-S-K, Lau-T-K, Rogers-M-S.
INSTITUTION	Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong.
TITLE	A study on prophylactic antibiotics in cesarean sections--is it worthwhile?
SOURCE	Acta-Obstet-Gynecol-Scand 1997 Jul, VOL: 76 (6), P: 547-9, ISSN: 0001-6349.
ABSTRACT	BACKGROUND: To study the effect of single-dose prophylactic Augmentin on patients undergoing cesarean section. METHODS AND MATERIAL: Three hundred and twenty women undergoing cesarean section were randomized into two groups in a prospective, double-blind, placebo-controlled study. One hundred and sixty women were allocated to receive a single-dose of 1.2 g Augmentin at induction of anesthesia and 160 were allocated to a control group who received placebo. The following post-cesarean outcome parameters were compared between the two groups: duration of hospital stay, febrile morbidity, urine microscopy, bacteriuria, endometritis, and wound infection. RESULTS: There was no significant difference between the two groups with respect to the duration of post-operative hospital stay or the incidence of febrile morbidity, endometritis, and wound infection. However, the study group had fewer post-operative abnormalities in urine microscopy (p < 0.05) and bacteriuria (p < 0.01). The bacterial flora were also different between the two groups. CONCLUSION: Single-dose prophylactic Augmentin did not produce any clinically significant improvement in the post-operative course of patients undergoing cesarean section. If proper surgical techniques are followed in association with closed rectus sheath drainage, it is unlikely that any trial of antibiotics will be able to demonstrate any clinically significant outcome. Author.

5. AUTHOR	Escobedo-Lobaton-J-M, Rodriguez-Hinojosa-D-E, Kistner-Garza-A-M, Benavides-de-Anda-L.
INSTITUTION	Hospital, Clinica y Maternidad Conchita, A.C., Monterrey, N.L.
TITLE	(Prophylactic use of antibiotics in cesarean section). TT Uso profilactico de antibioticos en operacion cesarea.
SOURCE	Ginecol-Obstet-Mex 1991 Jan, VOL: 59 (1), P: 35-8, ISSN: 0300-9041.
ABSTRACT	The objective of this investigation was to determine the effectiveness of ampicillin administration as a prophylactic regime in patients undergoing cesarean section. A double blind randomized study compared a long course of ampicillin (7 days) to a short course of ampicillin (three doses) to placebo. Thirty one patients were included in the placebo group and sixty patients in the drug groups. Only one patient in the placebo group and one in the drug group developed infectious morbidity. There was no significant difference (p less than 0.001) between the placebo and ampicillin groups. Author.

6. AUTHOR	Gibbs-R-S.
INSTITUTION	Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio.
TITLE	Clinical risk factors for puerperal infection.
SOURCE	Obstet-Gynecol 1980 May, VOL: 55 (5 Suppl), P: 178S-184S, ISSN: 0029-7844 36 Refs.
ABSTRACT	Recent studies have identified clinical features that are major risk factors for puerperal infection. Patients of low socioeconomic status undergoing cesarean section who have had prolonged labor and rupture of membranes (ROM) incur a 40 to 85% risk of endometritis. Infection occurs generally in less than 10% of women undergoing vaginal delivery, even when complicated by prolonged ROM, and often in considerably fewer cases. Other features such as internal monitoring, obesity, anemia, and general anesthesia have not been consistent determinants in recent studies. Author.

7. AUTHOR	Gerstner-G, Leodolter-S, Rotter-M.
INSTITUTION	Universitats-Frauenklinik, Wien.
TITLE	(Endometrial bacteriology in puerperal infections (author's transl)). TT Mikrobiologie des Endometriums bei puerperalen Infektionen.
SOURCE	Z-Geburtshilfe-Perinatol 1981 Oct, VOL: 185 (5), P: 276-9, ISSN: 0300-967X.
ABSTRACT	From the third to the sixth day postpartum transcervical endometrial swabs were taken from 51 women with the clinical signs of endometritis, like fever over 38 degree C, uterine tenderness and purulent lochia using prereduced anaerobic transport-media. The specimens were cultured aerobically and anaerobically. 27 women had an endometritis following vaginal delivery, 24 following caesarian section. Following vaginal delivery aerobic bacteria were isolated in 85.2% of the cases and anaerobic bacteria in 62.9%, post caesarian section in 75.1% aerobic and in 83.3% anaerobic bacteria. A mixed aerobic/anaerobic infection was found in 48.1% following vaginal delivery and in 58.4% post caesarian section. The aerobes most frequently recovered were Staphylococcus epidermidis, E. coli, Enterocococci and Streptococci, the prevalent anaerobes were the grampositive anaerobic cocci, Peptostreptococcus and Peptococcus, and Bacteroides species. Our results suggest that anaerobic bacterial play an important role in the endometritis post partum and that frequently a polymicrobial aerobic/anaerobic infection is present. Therapeutically, anaerobes should be taken into consideration especially for the treatment of severer infections following caesarian section. In such cases the 5-Nitroimidazoles, such as Metronidazole or antibiotics effective against anaerobes as Clindamycin or Cefoxitin should be administered. Author.

8. AUTHOR	Walss-Rodriguez-R, Gonzalez-Marquez-J-A, Fonseca-Sanchez-J.
INSTITUTION	Departamento Clinico de Gineco-Obstetricia, Centro Medico Nacional de Torreon, Instituto Mexicano del Seguro Social.
TITLE	(Antibiotic therapy in post-cesarean endomyometritis. Comparison of ampicillin-gentamicin and ampicillin-metronidazole regimens). TT Antibioticoterapia en endomiometritis postcesarea. Comparacion de los esquemas ampicilina-gentamicina y ampicilina-metronidazol.
SOURCE	Gac-Med-Mex 1990 Mar-Apr, VOL: 126 (2), P: 102-7, ISSN: 0016-3813.
ABSTRACT	Two therapeutic combinations for the treatment of post-cesarean endomyometritis are compared: A, ampicillin plus gentamycin; B, penicillin plus metronidazole, in 40 patients. There were no failures with any of the combinations. However, hospital stay and the time elapsed for resuturing a dehiscent surgical wound, as well as the average cost of treatment, were significantly less for combination B. Author.

9. AUTHOR	Stovall-T-G, Thorpe-E-M-Jr, Ling-F-W.
INSTITUTION	Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
TITLE	Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.
SOURCE	J-Reprod-Med 1993 Nov, VOL: 38 (11), P: 843-8, ISSN: 0024-7758.
ABSTRACT	Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. One or more organisms was recovered from the endometrium in 90% of the patients using a double- lumen sampling device. The most frequent endometrial isolates were Peptostreptococcus and Bacteroides species, followed by Gardnerella vaginalis and enterococci. Thirty (81%) of 37 patients receiving ampicillin/sulbactam and 33 (83%) of 40 receiving gentamicin and clindamycin responded to therapy. There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin /gentamicin are similarly effective for the treatment of post- cesarean section endometritis. Author.