Reviews of infectious diseases
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Review Clinical Trial
Role of aerobic gram-negative bacilli in endometritis after cesarean section.
Endometritis is considered to be a polymicrobial infection, involving aerobes, anaerobes, and genital mycoplasmas. Aerobic gram-negative rods make up 7%-25% of all genital isolates, but findings from studies in which special collection techniques were used suggest that many of these may be contaminants from the lower genital tract. Bacteremia occurs in 4%-30% of patients with endometritis, and aerobic gram-negative rods account for approximately 25% of blood isolates. ⋯ Klebsiella pneumoniae and Proteus mirabilis rank next, followed by Enterobacter species. Pseudomonas species account for fewer than 0.6% of genital isolates. Overall, aerobic gram-negative rods are causally involved in 10%-20% of cases of endometritis following cesarean section.
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Recent developments that influence patterns of antibiotic prescription for obstetric-gynecologic patients include a better understanding of the multibacterial dimensions of pelvic infections, the introduction of new antibiotics, and the pressures for cost-containment in medical care. Prophylaxis has become established as effective for prevention of infection following vaginal hysterectomy and cesarean section, but its success in abdominal hysterectomy has been less uniform. For patients with pelvic infections, the poorest clinical response occurs in those whose infection is well established before initiation of therapy. ⋯ Both metronidazole and clindamycin meet these criteria. Controlled studies of infections seen early in the clinical course are few. The initial selection of agents effective against gram-negative anaerobes seems important in the treatment of endomyometritis following cesarean section, whereas curettage seems the most significant therapy for infections following abortion.