Frequency and treatment of methicillin resistant staphylococcus aureus in obstetric and gynaecological sepsis

To perform culture and sensitivity for pathogens causing puerperal and postoperative wound sepsis and determine the frequency of Methicillin Resistant Staphylococcus aureus [MRSA] in such infections. Observational study. Obstetrics and Gynaecology Ward, Jinnah Postgraduate Medical Centre, Karachi, from December 2008 to May 2010. All patients presenting with puerperal sepsis or postoperative wound infection were enrolled. Pus was collected for culture and sensitivity using standard technique. Two samples were taken from each patient; one before starting the treatment and one at the end of treatment. Ames transport medium was used. Empirical treatment with triple regimen [Ampicillin, Metronidazole and Gentamicin] was started immediately to cover Gram positive as well as negative bacteria in addition to anaerobic infection. After receiving the sensitivity report, antimicrobial agent were changed accordingly. Samples from ward and theater staff and environment were also taken to look for possible mode of transmission. Data was recorded on a proforma. Discrete variables are expressed as percentages. Staphylococcus aureus was the most frequent organism isolated in 34% cases. Methicillin sensitive Staphylococcus aureus was seen in 20% cases and methicillin resistant Staphylococcus aureus was seen in 14.6%. Out of these 14.6% MRSA, [17] 77% was associated with puerperal sepsis and rest [5] 23% was associated with post-operative wound infection. It showed best sensitivity to vancomycin. Staphylococcus aureus and E.coli were common agent of postoperative infections and puerperal sepsis

Insertion of intrauterine contraceptive device at caesarean section

To determine the safety [infection, conception rate and perforation] of intrauterine contraceptive device [IUCD, Multiload Cu 375] insertion at caesarean section and compare their postoperative period [in term of pain, amount of bleeding and expulsion rate] of women who had caesarean section without IUCD insertion and to women who had IUCD inserted as an interval procedure. A case control study. Jinnah Postgraduate Medical Centre, Karachi, from November 2006 to October 2007. Group 1 [cases] were 50 women who had IUCD inserted at caesarean section. Groups 2 and 3 were controls, group 2 consisted of 50 matched women who had a caesarean section without IUCD insertion and group 3 consisting of 50 women who had IUCD inserted as an interval procedure. Degree of pain was assessed by doses of analgesics needed and amount of bleeding by the soaked pads, which were observed by doctor. Infection and expulsion was observed in immediate postoperative period during admission and at follow-up visits at 6 weeks and 6 months and conception was also checked. Analysis of variance was undertaken to compare characteristics at baseline on SPSS version 13. Data were analyzed using univariate methods, two-tailed t-test for continuous variables and chi-square test or Fisher's exact test as appropriate for dichotomous variables. Hospital stay of group 1 was 3.48 days as compared to 3.46 in group 2 [p=0.93]. Wound was infected in 10% women in group 1 and 2% in group 2 [F-test=0.10]; lochia was heavy in 4% in group 1 and 0% in group 2 [F-test=0.25]. Thread was visible in 92% in group1 and 96% in group 3 [p=0.50]. Eighty two percent women were willing to continue with IUCD in group 1 and 86% in group 3 after 6 months. Women undergoing caesarean section, who are desirous of, and suitable for using this method, should be given the option of IUCD insertion at the same time