Death from pseudomembranous enterocolitis

Double-blind, multicenter, prospective randomized study of trospectomycin vs. Clindamycin, both with aztreonam, in non-community acquired obstetric and gynecologic infections

OBJECTIVE

The purpose of this study was to compare the clinical efficacy and safety of trospectomycin sulfate with that of clindamycin phosphate, both with aztreonam, for the treatment of obstetric and gynecologic infections.

METHODS

In a double-blind, multicenter, prospective randomized study, 579 patients with either endometritis following cesarean delivery or pelvic cellulitis following hysterectomy were enrolled and received medication. Administered was either trospectomycin sulfate 500 mg IV every 8 h or clindamycin phosphate 900 mg IV every 8 h in a 1:1 randomization ratio. Both groups of patients received aztreonam 1 g IV every 8 h. The patients were followed for clinical responses and side effects.

RESULTS

The cure rate for the trospectomycin sulfate arm was 91.8% and for clindamycin phosphate arm it was 88.4% (P = 0.218). The adverse events were similar in both groups.

CONCLUSIONS

Trospectomycin was as effective as clindamycin, when both were combined with aztreonam, in treatment of obstetric and gynecologic infections.

Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon

The seventh case of probable cefazolin-induced pseudomembranous colitis is reported. Perforation of the colon necessitated sigmoid resection. The postoperative course was protracted, and illustrates the difficulty of managing advanced pseudomembranous colitis when the oral route of antibiotic administration is not available. Although rare, pseudomembranous colitis related to cefazolin administration is a potentially fatal complication. The routine use of prophylactic antibiotics must be weighed against this possibility.

Prophylactic antibiotics in obstetrics and gynecology

Studies throughout the world demonstrate the effectiveness of prophylactic antibiotics in vaginal hysterectomy and cesarean section. Febrile morbidity is reduced by more than one half, and pelvic infections are reduced one third to one fifth, respectively. Prophylactic antibiotics are most beneficial in high-risk cesarean section, such as in patients in labor and with ruptured membranes. In abdominal hysterectomy, the effect of prophylactic antibiotics is less pronounced, and the results of the individual studies are more controversial. Prophylactic antibiotics are commonly used in extensive oncologic surgery, infertility surgery, and in other procedures, but data for adequate evaluation are lacking. First- and second-generation cephalosporins are the antibiotics most frequently used. In vaginal hysterectomies, a single preoperative dose, and in cesarean section, three perioperative doses seem to be adequate. Infections occurring despite prophylactic antibiotics are often caused by resistant organisms.

Clindamycin in the treatment of soft tissue infections: a review of 15 019 patients

A retrospective survey of 15 019 patients treated with clindamycin for a soft tissue infection was carried out to determine whether the incidence of serious side effects was sufficient to preclude the continuing use of this antibiotic. Thirteen patients were found to have had severe diarrhoea and 2 of these required inpatient treatment for pseudomembranous colitis. Certain limitations of the use of clindamycin are suggested but, in view of the recently improved understanding of the nature of pseudomembranous colitis and more effective methods of treatment of this complication, it is concluded that this antibiotic still has a useful role to play in the treatment of acute soft tissue infection.

Simplified antibiotic prophylaxis for vaginal hysterectomy

Single dose administration of antibiotics prior to vaginal hysterectomy was found to be an efficient and safe way of providing prophylaxis against infection. Metronidazole was as efficient as ampicillin in achieving a significant reduction in major morbidity, pelvic sepsis, and the "quantity" of postoperative fever. Antibiotic prophylaxis reduced hospital stay by an average of 3 days.

Antibiotic-associated pseudomembranous colitis in children

Antibiotic-associated colitis is a rare complication of antimicrobial therapy in children. Ampicillin, penicillin, and clindamycin are the drugs most frequently reported to cause pseudomembranous colitis in pediatric patients. This diagnosis should be suspected in any child with significant diarrhea during or after a course of antimicrobial therapy, especially if the diarrhea persists after the drug has been discontinued. The diagnosis is established by proctoscopic findings of typical plaques of pseudomembranes. Most cases resolve promptly when the implicated antibiotic is stopped; however, the disease can be fulminant, progressing to toxic megacolon, peritonitis, and shock. Therapy of patients who have persistent diarrhea after the offending antibiotic has been discontinued should include oral vancomycin. Close fluid management is crucial for survival.

Preoperative hot conization of the cervix: a possible method to reduce postoperative febrile morbidity following vaginal hysterectomy

Laboratory results indicate that the endocervix may be a source of bacterial contamination when vaginal hysterectomy is performed. In a series of 160 consecutive vaginal hysterectomies in premenopausal women, hot conization of the cervix was performed prior to the scrub with an iodophore. No preoperative antibiotics were used in this series. The postoperative febrile morbidity rate was 4.3 per cent and the average stay was 4.5 days. These results are compared with those of three other groups: (1) patients who received a three-dose parenteral prophylactic antibiotic course with the first dose two hours prior to surgery had a febrile morbidity rate of 8.6 per cent. (2) In patients who had prophylactic antibiotics for five days with the first dose given intraoperatively, the febrile morbidity rate was 10.1 per cent. (3) The febrile morbidity rate in the group with no antibiotic prophylaxis or hot conization was 49.1 per cent. Laboratory and clinical data suggest that preoperative conization may be effective in the reduction of postoperative febrile morbidity.

The effect of prophylactic ampicillin on pelvic infection following vaginal hysterectomy

One hundred patients undergoing vaginal hysterectomy at the University of Kentucky Medical Center were given prophylactic ampicillin and compared to one hundred control patients. The use of prophylactic ampicillin caused significant reduction in both postoperative pelvic infection and hospital stay. However, two patients in the prophylactic antibiotic group later required readmission for infections resistant to ampicillin. Prophylactic antibiotics are beneficial in vaginal hysterectomy, but careful follow-up of all patients is mandatory.