Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: results of a controlled trial of topical clindamycin cream.

OBJECTIVE: The pathogenesis of preterm birth and other adverse pregnancy outcomes linked with reproductive tract infection remains poorly understood. Mucolytic enzymes, including mucinases and sialidases (neuraminidase), are recognized virulence factors among enteropathogens and bacteria that cause periodontal infection. Perturbation of maternal cervicovaginal mucosa membrane host defenses by such enzyme-producing microorganisms may increase the risk of subclinical intrauterine infection during pregnancy and thus increase risks of preterm birth. STUDY DESIGN: We prospectively evaluated vaginal fluid mucinase and sialidase and selected cervicovaginal bacteria along with pregnancy outcomes in 271 women. Within this study, women with bacterial vaginosis (16 to 27 week' gestation) were treated with 2% clinadmycin vaginal cream or placebo. Enzyme, microbial findings, treatment effects, and pregnancy outcomes were compared among drug- and placebo-treated women and control women without bacterial vaginosis. RESULTS: Presence of bacterial vaginosis at intake was associated with increased risk of preterm birth (relative risk 3.3, 95% confidence interval 1.2 to 9.1, p = 0.02), premature rupture of membranes (relative risk 3.8, 95% confidence interval 1.6 to 9.0, p = 0.002), and preterm premature rupture of membranes. Mucinase and sialidase activities were more commonly identified, and they occurred in higher concentrations, if present, in women with bacterial vaginosis (mucinase: 44.3% with bacterial vaginosis vs 27.4% without, p = 0.007; sialidase: 45% with bacterial vaginosis vs 12% without p < 0.001). Sialidase activity was associated with bacterial vaginosis-linked organisms (Gardnerella vaginalis, Mobiluncus spp, and Mycoplasma hominis) and Chlamydia trachomatis and yeast species; mucinase activity was associated only with bacterial vaginosis-linked microorganisms. Clindamycin, 2% cream, was effective treatment for bacterial vaginosis and temporarily reduced mucinase and sialidase activities. Topical treatment of bacterial vaginosis did not reduce risks of perinatal morbidity. Women with persistent or recurrent sialidase 8 weeks after treatment were at increased risk of preterm birth (15.6% vs 7.4%) premature rupture of membranes (30% vs 15%), and low birth weight (20% vs 3%, relative risk 6.8, 95% confidence interval 1.6 to 28.1). CONCLUSIONS: Persistence of sialidase-producing vaginal microorganisms in numbers sufficient to increase vaginal fluid sialidase activity may be a risk factor for possibly preventable subclinical intrauterine infection and preterm birth. This study confirms and further informs our understanding of the association of bacterial vaginosis and preterm birth; studies to evaluate whether systemic treatment for bacterial vaginosis can effectively reduce vaginal mucolytic enzymes and risks of prematurity and other morbid outcomes are continuing.

Comparison of single-dose ceftizoxime with multidose cefoxitin chemoprophylaxis for patients undergoing hysterectomy.

A single dose of ceftizoxime was comparable to three perioperative doses of cefoxitin as adjunctive antibiotic chemoprophylaxis against infectious morbidity in women undergoing elective abdominal (60% of patients) or vaginal (40% of patients) hysterectomy. In a double-blind, randomized, prospective, controlled trial, patients were randomized to receive either a single 1-gm dose of ceftizoxime, a newer, broadly active cephalosporin, or three 2-gm doses of cefoxitin intravenously. Twenty-nine women treated with ceftizoxime and 33 women treated with cefoxitin were evaluated. Patient groups were similar for age, other demographic factors, indications for surgery, surgical procedures performed, and selected microbiologic findings. Postoperative infectious morbidity requiring antibiotic treatment was similar among women who received ceftizoxime (27.6%) and those receiving cefoxitin (33%) (P = 0.6). Women receiving ceftizoxime also required a similar number of days of hospitalization (ceftizoxime, 4.7 +/- 1.7 days; cefoxitin, 5.6 +/- 4.5 days; P = 0.3). Both study drugs appeared to be safe and well tolerated. Single-dose ceftizoxime appears to be as efficacious as and more cost-effective than multidose cefoxitin when used as adjunctive chemoprophylaxis in patients at risk for postoperative infection after hysterectomy.

Histocompatibility (HLA) antigens in keratoconus.

To determine if susceptibility to keratoconus is associated with the histocompatibility (HLA) system, we HLA-typed 39 keratoconic patients and 208 normal controls for 63 HLA-A, -B, and -C antigens. The antigen frequencies for the keratoconic patients did not differ significantly from the frequencies for the control patients. These results suggest that susceptibility to keratoconus is not associated with the HLA system.