Bacteriologic aspects of pelvic inflammatory disease in gynecologic patients.

The bacteriology of acute pelvic inflammatory disease (PID) was studied in 65 women. Endometrial, endocervical and vaginal cuff cultures were taken. In some cases blood cultures and cultures from the cul-de-sac or pelvic abscess were also obtained. Mixed organisms (aerobes and anaerobes) were the most common isolates from the endometrial, endocervical or vaginal cuff cultures, present in 40%. Neiseria gonorrhoeae was isolated in 8 (12.30%) endocervical specimens. Anaerobes were the most common bacteria recovered from cul-de-sac aspirates, pelvic abscesses and blood cultures. The combination of gentamicin, penicillin and metronidazole was the most common antibiotic scheme used. However, other antibiotics as cefoxitin and clindamycin were also used according to the sensitivity test. These data support the polymicrobial etiology of the disease and suggest: (1) the high incidence of anaerobic or mixed infections, and (2) the relatively low incidence of gonococcus in the studied cases.

Clindamycin phosphate in the treatment of endometritis due to anaerobic bacteria.

Treatment of endometritis due to anaerobic pathogens demands early isolation and identification of the offending pathogen by the appropriate culture and optimum use of antibiotics according to the sensitivity test. Clindamycin phosphate has been used as a highly active antibiotic against both gram-positive and gram-negative anaerobic pathogens, including bacteroides fragilis. The concentration of clindamycin phosphate in blood from the uterus was tested in 30 women after administration of one single dose (600 mg) intramuscularly. The levels of clindamycin in the above-mentioned tests state how samples were compared with the minimal inhibitory concentration of the offending anaerobic pathogens in cases of endometritis.

Bacterial contamination of the cervix and premature rupture of membranes.

The endocervical flora was examined in 32 women with premature rupture of membranes (PROM). Sixty-six pregnant women served as controls. Ten patients with PROM who later developed chorioamnionitis were also included in the study. Samples for culturing were obtained from the endocervix on admission and at delivery and later from the fetal surface of the placenta. Blood for culturing was also taken in cases of chorioamnionitis. The total number of bacteria in the endocervix and placenta was higher in patients with PROM. Anaerobes were the most common, except for the fetal surface of the placenta, where aerobes were found in greater numbers. Cultures of blood from women with chorioamnionitis were positive in seven cases. These findings suggest that the high incidence of pathogenic or potentially pathogenic cervical bacteria in pregnancy is related to chorioamnionitis and PROM.

A study of the kinetics of cephapirin and cephalexin in pregnancy.

The kinetics of cephapirin and cephalexin were studied in 60 pregnant women after the administration of single 1 g doses of the antibiotics given by the intramuscular and oral route, respectively. Maternal serum, amniotic fluid and cord serum concentrations were measured at intervals after the dose by the agar diffusion method. The results showed that the mean peak concentration of cephalexin in maternal serum, after 1 hour, was significantly greater than that of cephapirin. Both antibiotics crossed the placenta barrier and reached levels in the amniotic fluid and cord serum adequate for the in vitro inhibition of pathogens involved in materno-foetal infections.

Bacteriology of amniotic fluid.

The incidence of aerobic and anaerobic bacteria in the amniotic fluid and the cervix of 101 healthy parturients, with intact membranes, was studied. Pharynx, urine and umbilical cord of the newborns were also examined for the same pathogens. Although positive cultures from the cervix were found in 41.58% of the cases, the contamination of the amniotic fluid was only 1.98%. Our results support the view of the antibacterial activity of amniotic fluid.

Ampicillin and gemtamicin in the treatment of fetal intrauterine infections.

The optimum clinical results in the treatment of fetal intrauterine infections are obtained by the administration of the appropriate antibiotic, which reaches an adequate concentration in the fetal serum. The pharmacokinetics of ampicillin and gentamicin were studied in 60 pregnant women. Ampicillin and gentamicin were given intramuscularly prior to cesarean section. At delivery maternal serum, amniotic fluid and cord serum antibiotic levels were tested. Assays of the levels of antibiotic were performed by agar diffusion method using Staph. aureus A.C.T.C. 25923 (American Type Control Collection) and E. coli N.C.T.C 1346, as standard organisms. During peak time, concentration of ampicillin in the maternal serum was found to be significantly higher than those of the amniotic fluid and cord serum (p less than 0.001). Peak levels of the antibiotic in the amniotic fluid was also significantly higher than in the cord serum (p less than 0.001). Our results, also showed that the determined levels of ampicillin, especially during peak time, are sufficient to inhibit in vitro, a high proportion of infecting pathogens in the maternal serum and amniotic fluid, but have little effect against organisms in the fetal serum. Concentration of gentamicin in the maternal serum during peak time was found higher than those of the amniotic fluid, but there was not a significant difference. Maternal serum peak levels of the drug were also higher than in cord serum, with a very significant difference (p less than 0.001). Maximum levels of gentamicin in amniotic fluid were higher than in cord serum, also with a very significant difference, (p less than 0.001). Gentamicin levels in amniotic fluid and fetal serum, especially, during peak time, would be adequate to inhibit in vitro the most common pathogens, sensitive to the drug.

[Clindamycin levels in the cervical mucus after intramuscular administration of the drug (author's transl)]. / Le taux de clindamycine dans la glaire cervicale après injection intramusculaire.

Female genital tract is a major area of anaerobic infections. Clindamycin has been used as a highly active antibiotic against both gram positive and negative anaerobic pathogens including bacteroides fragilis. Concentration of clindamycin in cervical mucus has been tested in 30 women after administration of one single dose (600 mg) of the antibiotic intramuscularly. Antibiotic levels were tested by agar diffusion method employing a strain of alpha-hemolytic streptococcus. Levels of clindamycin in cervical mucus were found to be sufficient to inhibit "in vitro" a significant proportion of anaerobic bacteria present in cervical mucus.

Gentamicin in the treatment of lower genital tract infections: level of the drug in menses, cervical mucus and vaginal fluid.

The concentration of gentamicin in serum, menses, cervical mucus and vaginal fluid of 39 women under treatment with this antibiotic (80 mg every 8 hr i. m.) was tested by the agar diffusion method. The levels of the drug in the serum varied from 1.88-5.41 micrograms/ml with a peak one hour after the last dosage. In the menses the levels ranged from 2.06-5.87 micrograms/ml with a peak also one hour after the last dosage. The concentration of gentamicin in the cervical mucus and vaginal fluid varied from 0.67-5.14 micrograms/ml and 0.63-6.43 micrograms/ml with a peak three hours after the last administration of the drug. Results are briefly discussed.