[Severe pelvic inflammatory disease. Response to ertapenem]

Pelvic inflammatory disease (PID) is an important health problem. Delay in diagnosis and effective treatment contributes to inflammatory sequelae with risk of future fertility problems and chronic pelvic pain. Treatment regimens must provide empiric, broad-spectrum coverage of likely pathogens but also take into account patient's risk profile. In this article we report the case of a young woman affected by a rare genital malformation who required the creation of a neovagina made of abdominal skin. Years later, the patient presented with symptoms that support the diagnosis of PID. There was no clinical analytical response to classical parenteral antimicrobial regimen, even after surgical intervention for tubal abscess. Peptostreptococci isolated in abdominal cavity culture showed an infrequent clindamycin resistance, so we started monotherapy treatment with ertapenem, with excellent results. In conclusion, more clinical trials are needed to discover the pathogens usually involved in PID in our setting and their antibiotic resistance to re-evaluate standard antimicrobial regimens and perhaps recommend new agents, such as ertapenem.

New studies on placental transfer of fosfomycin

Passage of fosfomycin across the placental barrier and the dynamics of maternal and fetal levels were determined in a group of ten mothers in active labor. To obtain a series of intrauterine fetal samples the Saling technique was used. There exists a clear relation between the levels reached in the mother and in the fetus and in function of time, as well as between the amount of antibiotic in the fetal blood 90 min after injection, and the weight of the placenta.

Fosfomycin in the treatment of gynecological infections

Here we present the results obtained in the treatment with fosfomycin of 58 patients of diverse obstetric-gynecological infections manifested by clinical symptomology and by the initial isolation of 70 strains of different germs, all of them sensitive to this antibiotic. The types of infections were urinary, abdominal wall, perennial septicemias, and endometritis; 45 of them motivated by or resulting from pregnancy, and the remaining 13 from gynecological causes. The most frequent treatment was 1 g/6h during 10 days, using sodium salt intramuscularly in 33 cases, and calcium salt taken orally in 26. The clinical results were good in 50 cases (86.2%) with improvement in 3 (5.1%) and persistency of the infection in 5. The bacteriological evolution was good on 34 occasions (58.6%), partial in 4 (6.8%), and poor in 6 (10.3%). In 14 cases no control could be made since the wound healed. The tolerance to the antibiotic was good and no manifestations of toxicity were observed.

Placental transfer of phosphomycin

The transfer of phosphomycin across the placental barrier was studied after a single injection of the sodium salt of phosphomycin to the mother during active labour. The concentrations of the antibiotic in maternal and fetal blood were determined and a high and rapid transfer of the antibiotic, reaching 50<i>%</i> of the maternal blood level after 1.5 h, was observed, which theoretically could be effective in the fetus against a large number of the germs which can be responsible for intrauterine infections.