Cefamandole therapy of endomyometritis following cesarean section

Abstract

Sixty women with endometritis following cesarean section were treated with cefamandole (12 gm/day) alone. Specimens for culture were obtained by endometrial lavage and from peripheral blood. Minimum inhibitory concentrations were performed on anaerobes and enterococci by an agar dilution technique. Anaerobic organisms were isolated in 55 of 60 (91.7%) endometrial specimens. Bacteremia was documented in 12 patients (20%). Of 387 isolates from uterine cultures, 20 (5%) were resistant or had MIC's ≥ 32 μg/ml. Ten patients (17%) were judged clinical failures and responded to additional antibiotics. Of 19 patients with Bacteroides fragilis or related species∗∗Organisms designated Bacteriodes fragilis are widely recognized for their resistance to many antibiotics and their frequent occurrence in pelvic and abdominal infections. In 1976, four organisms previously accorded subspecies rank in the species Bacteroides fragilis were re-ranked as species of the genus Bacteroides. Thus Bacteroides fragilis subspecies thetaiotaomicron became Bacteroides thetaiotaomicron: Bacteroides fragilis subspecies vulgatis became Bacteroides vulgatis. Bacteroides fragilis subspecies distasonis became Bacteroides distasonis, and Bacteroides fragilis subspecies ovatus became Bacteroides ovatus (Cato, E. P. and Johnson, J. L.: Int. J. System. Bacteriol. 26:230. 1976). The expression “Bacteroides fragilis or related species” as used here refers to organisms identified as Bacteroides fragilis or any of the other four reinstated species. isolates in the uterus, three (15%) were judged as failures. Cefamandole was well tolerated and appears to be useful in the initial treatment of endomyometritis.