Studies on the pathogenicity of anaerobes, especially Prevotella bivia, in a rat pyometra model

OBJECTIVE

Prevotella bivia is one of the anaerobic bacteria that resides in the flora of the female genital tract. We studied the pathogenicity of P. bivia in a rat pyometra model.

METHODS

The experimental animal (rat) model of pyometra was developed to investigate the pathogenicity of P. bivia in a rat pyometra model.

RESULTS

In the groups inoculated with aerobes alone, the infection rate was 10% (1/10) in the Staphylococcus aureus- or Staphylococcus agalactiae-inoculated group and 20% (2/10) in the Escherichia coli-inoculated group. Infection was not established in the groups inoculated with anaerobes alone. High infection rates were observed in all the mixed-infection groups. In the S. agalactiae- and Bacteroides fragilis-, S. agalactiae- and P. bivia-, F. coli- and B. fragilis-, and E. coli- and P. bivia-inoculated groups, an infection rate of 100% (10/10) was demonstrated. The efficacy of antibiotics such as flomoxef (FMOX) could be determined using a rat pyometra model. In relation to the alteration of vaginal microbial flora during the menstrual cycle, estrogen increased the growth of P. bivia.

CONCLUSION

Mixture of aerobic bacteria and P. bivia increased the pathogenicity of P. bivia. Estrogen would be useful for raising up the inflammatory change of the uterus in experimental models of genital tract infection due to P. bivia.

Ovarian abscess caused by Peptostreptococcus magnus following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol

BACKGROUND

Transvaginal ultrasound-guided aspiration of ovarian endometrioma has been applied and emphasized as a safe and simple procedure.

CASE

Two 27-year-old infertile women, both gravida 0, para 0, underwent medical follow-up examinations for cases of ovarian endometrioma. Both had undergone transvaginal ultrasound-guided aspiration of ovarian endometrioma. Because both were continuously febrile and had abdominal pain and cysts with tenderness in spite of antibiotic therapies, both underwent laparotomies for treatment. In both cases, enucleation of the ovarian abscess revealed purulent and malodorous fluid that demonstrated Peptostreptococcus magnus in culture.

CONCLUSION

We theorize that following transvaginal ultrasound-guided aspiration of ovarian endometrioma and fixation with pure ethanol, anaerobic infection by P. magnus occurred, and a cyst formed in the abscess.

Therapeutic effects of a new quinolone, DU-6859a, on polymicrobial infections in a newly designed model of rat uterine endometritis

We evaluated the efficacy of a new quinolone, DU-6859a, using a new model of rat uterine endometritis. Rats were infected with mixed inocula of Escherichia coli and Bacteroides fragilis. The MICs of DU-6859a and levofloxacin against E. coli were 0.025 and 0.05 mg/L, respectively; those against B. fragilis were 0.20 and 0.39 mg/L, respectively. Immediately after inoculating 10(5) cfu/rat of each organism, DU-6859a or levofloxacin (20 mg/kg po bid or tid, respectively, for 3 days) was administered and compared with the untreated group. The viable cell counts of E. coli and B. fragilis in the DU-6859a- and levofloxacin-treated groups were significantly lower than those in the untreated group. These results suggest that DU-6859a would be useful for treating polymicrobial infections in uterine endometritis.

Studies on the pathogenicity of anaerobes, especially Prevotella bivia, in a rat pyometra model

OBJECTIVE

Prevotella bivia is one of the anaerobic bacteria that resides in the flora of the female genital tract. We studied the pathogenicity of P. bivia in a rat pyometra model.

METHODS

The experimental animal (rat) model of pyometra was developed to investigate the pathogenicity of P. bivia in a rat pyometra model.

RESULTS

In the groups inoculated with aerobes alone, the infection rate was 10% (1/10) in the Staphylococcus aureus- or Staphylococcus agalactiae-inoculated group and 20% (2/10) in the Escherichia coli-inoculated group. Infection was not established in the groups inoculated with anaerobes alone. High infection rates were observed in all the mixed-infection groups. In the S. agalactiae- and Bacteroides fragilis-, S. agalactiae- and P. bivia-, F. coli- and B. fragilis-, and E. coli- and P. bivia-inoculated groups, an infection rate of 100% (10/10) was demonstrated. The efficacy of antibiotics such as flomoxef (FMOX) could be determined using a rat pyometra model. In relation to the alteration of vaginal microbial flora during the menstrual cycle, estrogen increased the growth of P. bivia.

CONCLUSION

Mixture of aerobic bacteria and P. bivia increased the pathogenicity of P. bivia. Estrogen would be useful for raising up the inflammatory change of the uterus in experimental models of genital tract infection due to P. bivia.

Blood supply to the latissimus dorsi muscle and muscle performance during co- or counterpulsatile stimulation for circulatory assist

For the application of the latissimus dorsi muscle (LDM) to circulatory assist, the muscle is stimulated with co- or counterpulsation during the cardiac cycle. The purpose of this study was to evaluate the blood supply to the LDM and its muscular performance during each respective stimulation. The origin of the LDM was connected to a tension gauge, a potentiometer, and 1 kg of weight in series. The LDM was stimulated at a ratio of 1:1 of heart to muscle contraction for 10 min. Copulsatile stimulation made thoracodorsal arterial flow (TDF) predominant during cardiac diastole. In counterpulsatile stimulation, TDF occurred predominantly during cardiac systole. Between the 2 patterns of stimulation, no significant differences were observed in the mean TDF rate during 1 cardiac cycle. The maximal force, maximal contraction length, and power of the LDM also did not differ significantly. These results suggest that despite the difference of the TDF profile, LDM performance may be comparable between co- and counterpulsatile stimulation for the application of the LDM to circulatory assist.

Effects of long-term administration of roxithromycin on neutrophil count and interleukin-8 level in endometrial cavity subjected to pyometra

We investigated the effect of long-term administration of roxithromycin (RXM) on clinical responses and immune responses to chronic intrauterine infection, pyometra. One hundred and fifty milligrams of RXM were orally administered once a day for 3 months to patients with pyometra. Neutrophils and interleukin-8 (IL-8), which is a neutrophil chemotactic factor, in the lavage fluid of the uterine endometrial cavity obtained from 5 normal women and 18 patients with pyometra were investigated. Sixteen (88.9%) of the 18 patients showed a clinical improvement at the end of treatment. The immune responses occurred in the lavage fluid from the uterine endometrial cavity. Neutrophils accumulated in the lavage fluid of the uterine endometrial cavity before RXM treatment (p < 0.001 vs. normal subjects and decreased after RXM treatment (p < 0.001). The levels of IL-8 were significantly higher in the lavage fluid of pyometra patients than in normal women (p < 0.001), and tended to decrease after RXM treatment (p < 0.01). These results indicate that RXM decreases uterine endometrial cavity inflammation through reduction of neutrophil migration in inflammatory sites and is effective in treating chronic intrauterine infection.

Therapeutic effects of cefluprenam (CFLP) on polymicrobial infections associated with Enterococcus faecalis in rat pyometra model

Enterococcus faecalis plays an important role as one of the pathogens in polymicrobial infections. We evaluated the efficacy of cefluprenam (CFLP) using a polymicrobial pyometra of a model rat. Rats were infected with a mixed intrauterine inoculation of E. faecalis plus either Bacteroides fragilis or Prevotella bivia (minimal inhibitory concentration of CFLP: E. faecalis, 3.13 mug/ml; B. fragilis, 3.13 mug/ml; P. bivia, 3.13 mug/ml). Immediately after inoculating 10(5) cfu/rat of each organism, CFLP (either 40 mg/kg, i.v., q.i.d. for 5 days or 80 mg/kg, i.v., b.i.d. for 5 days) was administered. The intrauterine inflammatory change and bacterial count in the treated group were compared with those in the non-treated control group. CFLP significantly (P < 0.01) decreased the bacterial counts except for B. fragilis in the regimen of 80 mg/kg, b.i.d. However, the regimen of 40 mg/kg, q.i.d. significantly (P < 0.05) reduced the bacterial counts more than did that of 80 mg/kg, b.i.d. CFLP proved to demonstrate a good tissue concentration above 3 mug/g for 1 h. These results suggest that CFLP in a more divided dose is efficacious for the treatment of polymicrobial infections associated with E. faecalis in pyometra.

Comparative study on vaginal or oral treatment of bacterial vaginosis

The bacterial epidemiology of bacterial vaginosis (BV) and the efficacy of vaginal or oral treatment of BV with clindamycin (CLDM) were investigated. The epidemiology of BV was investigated in 100 symptomatic women before CLDM therapy. Two groups consisting of 50 patients each with the diagnosis of symptomatic BV were treated with either oral administration of 450 mg CLDM three times daily or 2% CLDM phosphate in vaginal cream (self-made) 5 g once a day, for 7 days. There was no significant differences in efficacy among vaginal and oral therapies with CLDM. Vulvovaginal irritation occurred in 3 patients orally treated and in 1 patient vaginally treated. Gastrointestinal disturbances were observed in 4 orally treated patients. A slight abnormal elevation of the glutamine-oxaloacetic transaminase level was also found in 1 patient orally treated. Since there were no statistically significant differences in efficacy rates between vaginal and oral CLDM treatments, we favor vaginal treatment of BV, based on less adverse effects.

Pharmacokinetics of miconazole in serum and exudate of pelvic retroperitoneal space after radical hysterectomy and pelvic lymphadenectomy

Due to the increased number of compromised hosts with fungal infections, doctors have recently started prescribing antifungal agents. In the field of gynecology, however, the choice of which drug to use has been difficult. The efficacies of these drugs depend on their antifungal spectra, potencies and concentrations in tissues. The present study was designed to investigate the pharmacokinetics of miconazole in the exudate of the retroperitoneal space that is formed after radical hysterectomy and pelvic lymphadenectomy. A total of 600 mg of miconazole was administered to the patients for exactly 60 min using an automatic drip-infusion pump. The parameters of the formulas analyzed by the two-compartment model were determined using the least-squares method, and a simulation curve was made. The maximum drug concentration (Cmax) of miconazole in serum was 6.26 mg/l 1 h after drip infusion commencement and the t1/2 in serum was 8.86 h. The value of the area under the time-serum concentration curve (AUC) in serum was 19.13 mg/h per l. The Cmax of miconazole in the exudate of the retroperitoneal space was 0.13 mg/l 2.48 h after the drip infusion was started. The value of AUC in the exudate was 2.52 mg/h per l.

Bacteriological epidemiology and treatment of bacterial vaginosis

One hundred symptomatic women with clinical bacterial vaginosis (BV) were enrolled in this study. The bacteriological epidemiology of BV and efficacy of oral or vaginal administration of antimicrobial agents for treatment of BV were investigated. The epidemiology of BV was investigated before antimicrobial therapy. Fifty patients were treated with oral administration of metronidazole (MTN), 500 mg twice a day, and 50 patients with 2% clindamycin (CLDM) phosphate in a vaginal cream, 5 g once a day for 7 days. The major organisms occurring were Streptococcus agalactiae, Escherichia coli, Gardnerella vaginalis, Peptostreptococcus species, Bacteroides species, Prevotella species, and Mobiluncus species and opportunistic pathogens such as Staphylococcus epidermidis and Enterococcus faecalis. The therapeutic efficacy of CLDM cream on BV appeared to be preferable to oral MTN from clinical and bacteriological aspects. The clinical and bacteriological effectiveness of MTN and CLDM in the treatment of BV suggests that anaerobes might play a major role in causing the clinical symptoms in patients with BV.

Study on treatment of bacterial vaginosis with oral administration of metronidazole or cefdinir

Bacterial vaginosis (BV) is considered to be one of the most common vaginal infections in women. Fifteen symptomatic women with BV were enrolled in this study. Ten patients with the diagnosis of BV were treated with 10 days oral administration of metronidazole (MTN), 500 mg twice a day, and five patients with cefdinir (CFDN), 300 mg three times a day. In the MTN therapy, the rate of abnormal vaginal discharge subjectively decreased from 100 to 60%, the rate of abnormal vaginal discharges objectively decreased from 100 to 20%, the rate of positive amine tests decreased from 100 to 20%, the rate of genital malodor and abnormal pH of vaginal discharges decreased substantially from 100 to 10%, and the rate of the presence of clue cells also decreased notably from 90 to 10%. However, in the CFDN therapy, none of these factors improved. With respect to susceptibility to CFDN and MTN, CFDN demonstrated good antibacterial activity against almost all bacteria isolated except Gardnerella vaginalis. On the other hand, MTN demonstrated excellent activity against anaerobic bacteria except Peptostreptococcus spp., and had no antibacterial activity against aerobic bacteria. Since the therapeutic effect of MTN in BV appeared to be better than that of CFDN, anaerobes may play a major role in causing clinical symptoms in patients with BV.

In vitro antibacterial activity of FK037, a new parenteral broad-spectrum cephalosporin, against recent clinical isolates in the fields of obstetrics and gynecology

The antibacterial activity of a new parenteral cephalosporin, FK037 was assessed against recent aerobic and anaerobic strains isolated from patients in the fields of obstetrics and gynecology during the period between January 1992 and June 1993. The MICs of FK037 for 90% of the clinical isolates tested were 0.10 microgram/ml for Escherichia coli and Klebsiella pneumoniae, 0.20 microgram/ml for Streptococcus agalactiae, 0.39 microgram/ml for Gardnerella vaginalis, 0.78 microgram/ml for Staphylococcus epidermidis, Peptostreptococcus anaerobius and Mobiluncus spp., 1.56 micrograms/ml for Peptostreptococcus magnus, 3.13 micrograms/ml for methicillin-sensitive Staphylococcus aureus, 25 micrograms/ml for methicillin-resistant S. aureus (MRSA), Bacteroides fragilis and Prevotella disiens, 100 micrograms/ml for Bacteroides thetaiotaomicron and Prevotella bivia; and > 100 micrograms/ml for Enterococcus faecalis. FK037 was superior in potency to ceftazidime against all strains except E. faecalis, P. anaerobius and P. bivia. It was 4- to 16-fold more active than cefotaxime against aerobic gram-positive bacteria and P. disiens, and its activity was similar to that of cefotaxime against the other strains. FK037 had 4- to 16-fold stronger activity than flomoxef against MRSA, S. agalactiae and E. coli and a similar activity to flomoxef against the other strains except G. vaginalis and B. fragilis that were 4-fold more sensitive to flomoxef than to FK037.

Internal bacterial flora of solid uterine cervical cancer

Twenty-five patients with uterine cervical cancer (Two cases stage O; four cases stage Ia; five cases stage Ib; one case stage IIa; ten cases stage IIb; two cases stage IIIa; one case stage IVa) served as the subjects. The bacterial flora inside the cervical cancers was investigated using the optimal technique. There was mixed abnormal aerobic and anaerobic bacterial flora in all subjects. The average number of bacterial species isolated from inside the cervical cancers was 6.3. The predominant bacteria isolated were the aerobes, Staphylococcus haemolyticus, Streptococcus agalactiae, Escherichia coli and Gardnerella vaginalis, and Prevotella bivia. As the stages of cervical cancer progressed, G. vaginalis, B. distasonis and P. bivia were detected at higher rates and higher counts than other bacteria. These findings suggest that there is a relationship between G. vaginalis, B. distasonis and P. bivia and the onset and growth of cervical cancer.

Endometrial bacterial flora detected in patients with uterine endometrial cancer

Certain bacteria produce some carcinogens such as N-nitro compounds, n-butyric acid and n-valeric acid. From this point of view, the examination of intrauterine bacterial flora in patients with uterine endometrial cancer may provide important information. Twenty patients with the diagnosis of uterine endometrial cancer and 20 patients without complications other than myoma uteri were enrolled in the study. Enterobacteriaceae, Streptococcus agalactiae and anaerobic bacteria were mainly detected. The products of these bacteria might be considered to contribute to the initiation of endometrial carcinogenesis. Mixed abnormal flora between aerobic and anaerobic bacteria were detected in all patients with uterine endometrial cancer. It is suggested that uterine endometrial cancer provides favorable conditions for bacterial growth. Mixed abnormal bacterial flora also might influence the onset and growth of uterine endometrial cancer.

Bacterial flora detected of the uterine endometrial cavity of diabetic patients with myoma uteri

Patients with diabetes frequently suffer from various postoperative complications, especially infection. Diabetic patients also have a high incidence of uterine endometrial cancer. The nature of the intrauterine bacterial flora may be related to both infection and carcinogenesis. Therefore, identification of the intrauterine bacterial flora in diabetic patients may be useful. Bacteria were detected in the uterine endometrial cavity of 100% of ten diabetic patients with myoma uteri. However, among 20 non-diabetic control patients with myoma uteri, only three 15% harbored bacteria. Members of the Enterobacteriaceae (Escherichia coli, Proteus spp., Enterobacter cloacae, and Klebsiella pneumoniae) were the predominant bacteria. We speculate that bacterial products contribute to carcinogenesis, as has been proposed for colon carcinoma. Antimicrobial agents active against Enterobacteriaceae should be used to prevent postoperative infections in gynecologic procedures in diabetic patients.

Bacterial flora detected in the uterine endometrial cavity of normal puerperae on the puerperal first day and on the puerperal fifth day after incidental use of cefpodoxime proxetil

In Japan, oral antimicrobial agents are prophylactically used with oxytocics after normal delivery to prevent puerperal infections. The present study was designed to investigate bacterial floras in the endometrial cavity immediately after normal delivery and the effect of prophylactic use of anti-microbial agents on those floras. Sixty-six puerperae who underwent uneventful courses of pregnancy and delivery were subjected for this study. Intrauterine contents were collected on the first day and the fifth day of the puerperium and submitted to microbiological examinations. Cefpodoxime proxetil (CPDX-PR) was orally given to the puerperae for prophylaxis for 5 days after the initial sampling. On the puerperal first day, a total of 98 strains (71 strains of aerobic bacteria, 27 strains of anaerobic bacteria) was detected in the uteri of the 66 subjects. The incidences of aerobic Gram-positive cocci, aerobic Gram-negative bacilli and anaerobic bacteria were 59.2%, 12.2%, 27.6% of the 98 strains, respectively. On the puerperal fifth day, a total of 82 strains (51 strains of aerobic bacteria and 31 strains of anaerobic bacteria) were detected in the uteri of the 66 subjects. The incidences of aerobic Gram-positive cocci, aerobic Gram-negative bacilli and anaerobic bacteria were 52.5%, 8.6% and 37.7% of 82 strains, respectively.

[Incidence of Mobiluncus spp. from the patients with clinical bacterial vaginosis]

Aerobic and anaerobic cultures as well as a Gram stain and wet mount preparations were made of vaginal swabs in twenty patients with clinical bacterial vaginosis. Mobiluncus spp. were detected in 7 cases (35%). Cultures appeared to indicate that mixed abnormal flora between aerobic and anaerobic bacteria are found in bacterial vaginosis, and that Mobiluncus spp. may play a role in bacterial vaginosis.

[Pharmacokinetic and clinical studies on flomoxef in perinatal period]

Pharmacokinetic and clinical studies on flomoxef (FMOX) in the perinatal period were carried out. The results are summarized as follows. 1. The concentration of FMOX in umbilical cord serum was about 10 micrograms/ml in about 30 minutes after 1 g one shot intravenous injection. Amniotic fluid concentration was 7 micrograms/ml in 41 minutes after administration. By 1 hour intravenous drip infusion, FMOX concentration in umbilical cord serum was about 5 micrograms/ml in 2-3 hours after administration. Amniotic fluid concentration of about 20 micrograms/ml was found in 1 case. 2. FMOX 1-2 g x 2-3/day was given by intravenous drip infusion to 7 cases of perinatal infection for 4-26 days. Clinical efficacies were evaluated a good for all cases. Neither side effect nor abnormal laboratory test value was observed. Consequently, FMOX was considered to be highly effective and safe for its clinical use in perinatal period infections.