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Biomedical subjects

F G Cunningham

Publications and source records attributed to F G Cunningham.

At least 109 records · Page 6Linked to original sources
PubMed1982

Continuing investigation of women at high risk for infection following cesarean delivery. Three-dose perioperative antimicrobial therapy.

At Parkland Memorial Hospital a group of women at high risk for infection following cesarean delivery was identified. These included nulliparas who underwent cesarean section for cephalopelvic disproportion 6 or more hours following membrane rupture. During the puerperium, uterine infection developed in 85 to 95% of such women, and one third of this high-risk group had associated complications. The authors have previously reported the efficacy antimicrobial agents given to these women at the time of cesarean section and continued for 4 days. The present prospective study was designed to assess the efficacy of a shorter course of perioperative antimicrobial therapy for these high-risk women. Three doses of antimicrobial agents were given perioperatively to 305 women randomly assigned to 1 of 3 treatment regimens: 115 were given penicillin plus gentamicin, 82 received 2, 1, and 1 g of cefamandole, respectively, and the remaining 108 were given 2, 2, and 2 g of cefamandole, respectively. The incidence of uterine infection in these 305 women was 24% and associated complications were identified in 7% of all women. Based upon a comparison of results with the progenitor study, the authors conclude that 3-dose perioperative antimicrobial therapy is preferred to 4 days of treatment for women at high risk for infection following cesarean delivery.

Anti-Bacterial Agents↗
PubMed1981

Renal infection and pregnancy outcome.

To evaluate the impact of renal infection on pregnancy outcome, we studied a group of pregnant women with asymptomatic renal bacteriuria and another group who had acute pyelonephritis. In 248 women with asymptomatic bacteriuria, infection was localized by the antibody-coated bacteria method. These women were prospectively matched with abacteriuric control subjects and we found no adverse effects of treated renal or bladder infection. Specifically, the number of women with hypertension and anemia in each group was similar, and infants born to these women were comparable regarding perinatal mortality, mean gestational age, and birth weight, as well as indices of maturity. A total of 487 women with acute pyelonephritis were evaluated in a case-control study and observations of the correlation of maternal anemia and pyelonephritis were confirmed. Women with antepartum infection had no increased adverse perinatal outcome; however, in some women with intrapartum infection, pyelonephritis appeared to have initiated premature labor. We concluded that treated renal infection, whether symptomatic or asymptomatic, does not significantly modify pregnancy outcome.

Acute Disease↗
PubMed1981

Moxalactam for obstetric and gynecologic infections. In vitro and dose-finding studies.

Moxalactam (LY 127935), a "third-generation" beta-lactam antimicrobial, has been shown to have promising in vitro activity against a wide spectrum of pathogens similar to those isolated from women with pelvic infections. Pharmacodynamic studies have shown that its serum half life is longer than 2 hours, which permits less frequent dosing. The current investigation was carried out in two parts: In the first phase, the minimal inhibitory concentration of moxalactam against 519 clinical isolates was determined and compared to antimicrobials used in infections caused by these microbes. In vitro activity of moxalactam comparable to that of clindamycin was demonstrated against B. fragilis and other Bacteroides species. There was similar activity to penicillin G and clindamycin against anaerobic gram-positive cocci and activity superior to amikacin was demonstrated against Enterobacteriaceae. The second part of this investigation was a clinical one and 100 women with pelvic infections were given treatment with moxalactam. With an initial dose of 3 gm/day, women with posthysterectomy cellulitis and pelvic inflammatory disease did well. Women with pelvic infections following cesarean section responded less readily to this dose; however, when the initial dose was increased to 6 gm/day, a 91% cure rate was effected. The results of these investigations indicate that moxalactam is useful as a single-agent antimicrobial for treatment of polymicrobial female pelvic infection.

Adolescent↗
PubMed1981

Bladder versus renal bacteriuria during pregnancy: recurrence after treatment.

Localization of bacteriuria has been shown to correlate with the pattern of recurrence after treatment. The immunofluorescent technique was used to localize infection in 233 pregnant women with asymptomatic bacteriuria to determine whether this would identify those who were at greater risk for recurrence. In both an indigent and a military population, the incidence of renal bacteriuria was 42%. Regardless of the site of infection, after one course of short-term (10-day) or long-term (21-day) antimicrobial therapy, almost two thirds of these women were abacteriuric for the remainder of gestation. Women given short-term treatment were more likely to have a recurrence within 2 weeks of completion of therapy than were women given long-term therapy (P less than 0.001). Moreover, these early recurrences were more frequent in women given short-term treatment for renal bacteriuria (P less than 0.05). Conversely, recurrences 6 or more weeks after completion of therapy, and regardless of site of infection, were more common in women given long-term treatment (P less than 0.01). Although the timing of recurrence varied significantly in relation to duration of treatment and site of infection, the ultimate risk of recurrence was not related to either. The conclusion is that localization of asymptomatic bacteriuria does not contribute to the management of pregnant women, since overall recurrence rates are independent of the site of infection.

Anti-Infective Agents, Urinary↗
PubMed1981

Acute pyelonephritis in pregnancy: an anterospective study.

During a 4.5-year period, over 2% of 24,000 obstetric patients at Parkland Memorial Hospital were admitted for acute pyelonephritis. Chills accompanying back pain was the most common presenting complaint in the se 656 women; lower urinary tract symptoms and nausea and vomiting were also common. All women had fever and, with few exceptions, costovertebral angle tenderness. In most cases, the clinical impression was confirmed by bacteriuria. Significant transient renal dysfunction was demonstrated in 60 (21%) of 282 women tested. Of 501 of the 656 women with antepartum pyelonephritis who delivered at Parkland Hospital, 23% developed recurrent pyelonephritis; in half of these patients, this recurrence was antepartum. Of 393 and of the 501 women tested, 20% had asymptomatic bacteriuria at delivery. An 8- to 13-year follow-up study was done on 208 of the 501 women following the index pregnancy; 42% were treated for 1 or more episodes of symptomatic urinary infection when not pregnant. In 140 of the 501 women, a subsequent pregnancy was cared for at Parkland Hospital. Thirty-eight percent of these patients had at least 1 urinary infection during 1 of these pregnancies: 29% had pyelonephritis, and 9% had either asymptomatic bacteriuria or cystitis.

Acute Disease↗
PubMed1981

Combination antimicrobial therapy for serious gynecological and obstetrical infections--obsolete?

The normal flora of the lower reproductive tract are the pathogens isolated from upper reproductive tract infections after cesarean section and hysterectomy and from intraperitoneal cultures taken from women treated for acute pelvic inflammatory disease. Because these infections are usually polymicrobial, traditional antimicrobial therapy has included various combinations of agents. During the last six years we used five different antimicrobial combinations to treat more than 600 women with one of the above infections. From 15% to 50% of cases required the addition of a third (anaerobic-specific) antimicrobial. Original therapy with clindamycin/gentamicin was unsuccessful in only 5% of the infections treated. Single-agent therapy with third-generation cephalosporins avoids most problems associated with combination therapy. Over the past 18 months we treated 237 women with cefotaxime; 94% required no further therapy.

Anaerobiosis↗
PubMed1980

Cefamandole for treatment of obstetrical and gynecological infections.

Cefamandole nafate has been shown to have good in vitro activity against a wide spectrum of aerobic and anaerobic pathogens frequently isolated from women with obstetrical and gynecological infections. One hundred and twenty seven women with these infections were treated with cefamandole: 78 had post-cesarean section metritis; 24 acute pelvic inflammatory disease; 18 post-hysterectomy cuff cellulitis/abscess; and 7 had vulvar or abdominal wound abscesses. All but 13% of these women had either polymicrobial aerobic/anaerobic bacterial infections, or had an anaerobic infection alone. Of these 127 women, 116 responded to cefamandole administration alone, and in the other 11 chloramphenicol was added. Of these 11, surgical therapy was necessary to eradicate infection in six women. Phlebitis, mild to severe, was demonstrated in 14% of the women and responded to conservative measures. Of 402 bacterial isolates from these women, 94% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level. Anaerobic streptococci were the most common isolate and 94% of these organisms were sensitive at 32 microgram/ml. Of the 43 Bacteroides species isolated, 90% were susceptible at 32 microgram/ml; 84% of Bacteroides fragilis were susceptible ast this concentration. Data now presented indicate that cefamandole given alone is safe and effective for treatment of women with polymicrobial mixed aerobic/anaerobic pelvic infections and approximately 5% will require surgical therapy for eradication of these infections.

Aerobiosis↗
PubMed1980

Cefoxitin for prophylaxis in premenopausal women undergoing vaginal hysterectomy.

To determine the unbiased incidence and types of postoperative infection and their alteration(s) by antimicrobial prophylaxis, a prospective double-blind study was performed using perioperative intramuscular cefoxitin or placebo given to premenopausal women undergoing vaginal hysterectomy at Parkland Memorial Hospital. The clinical and surgical profiles of the 2 groups of women were similar, but there were marked differences in their postoperative clinical courses. Only 8% of the 50 women given cefoxitin had major postoperative infection, compared to 57% of the 49 women given placebo (P < .001); this was associated with a 2.8-day reduction in the hospital stay for those given cefoxitin (P < .001). No clinically significant side effects were observed.

Adult↗
PubMed1979

Prophylactic transfusions of normal red blood cells during pregnancies complicated by sickle cell hemoglobinopathies.

Prophylactic transfusions of normal donor red cells were administered during 37 pregnancies to women with sickle cell anemia, sickle cell-hemoglobin C disease, or sickle cell-beta thalassemia disease. Once the diagnosis was confirmed, the transfusions were administered intermittently throughout the rest of the pregnancy in such amounts and at such frequencies that no more than 60% of the circulating red cells contained hemoglobin S and the hematocrit was above 25. The maternal mortality rate was zero and maternal morbidity as the consequence of the sickle cell hemoglobinopathy was minimal. The perinatal mortality rate was appreciably reduced when compared to that previously observed without prophylactic transfusions but perinatal morbidity was still excessive. Evidence that the intrauterine environment was compromised, in spite of the transfusions consisted of an increased frequency of growth-retarded fetuses, of meconium staining of amnionic fluid, and of ominous decelerations of fetal heart rate. Morbidity from the transfusions was troublesome. Nonetheless, it is concluded tentatively that both the mother with a sickle cell hemoglobinopathy and her fetus are likely to benefit from prophylactic transfusions of normal donor red cells administered during one pregnancy according to the protocol employed in this study.

Anemia, Sickle Cell↗
PubMed1979

Treatment of obstetric and gynecologic infections with cefamandole.

Cefamandole nafate is a derivative of 7-aminocephalosporanic acid which has been shown to have good in vitro activity against aerobes traditionally susceptible to cephalosporins as well as many anaerobes, including B. fragilis. One hundred women with obstetric or gynecologic infections completed treatment with cefamandole: 53 had post-cesarean section infections: 24, acute pelvic inflammatory disease: 16, posthysterectomy cuff cellulitis/abscess; and seven, vulvar or abdominal wound abscess. Almost 90% of these women had either polymicrobial aerobic/anaerobic bacterial infections or an anaerobic infection alone. Ninety women responded to cefamandole alone; in 10 cases chloramphenicol was added, but in addition five of these women required surgical therapy for eradication of infection. Mild to severe phlebitis at the infusion site that responded to conservative therapy was demonstrated in 14 women. Of 312 bacterial isolates from these women, 89% were sensitive to cefamandole at 32 microgram/ml, an easily achievable serum level; 93% of anaerobic streptococci, the most common isolates, were sensitive at 32 microgram/ml. Also, 90% of all Bacteroides species were susceptible at 32 microgram/ml; 82% of B. fragilis were susceptible at this concentration. These data indicate that cefamandole is safe and effective for treatment of women with polymicrobial pelvic infections but that approximately 5% of these women will require surgical exploration in addition to antimicrobial administration.

Abscess↗
PubMed1979

The bacterial pathogenesis of infection following cesarean section.

To further define the bacterial pathogenesis of infections following cesarean section, amnionic fluid was obtained transabdominally at the time of surgery from 56 women whose membranes were ruptured for more than 6 hours. In all specimens, bacterial growth was demonstrated, and 53 of these women developed postoperative myometritis. A mean of 2.5 pathogenic bacteria was isolated from each specimen. More than 90% of the amnionic fluid specimens had polymicrobial anaerobic/aerobic growth (63%) or anaerobes only (30%). Aerobic and anaerobic streptococci accounted for 72% of all bacterial isolates; Bacteroides and Escherichia coli were the next most commonly recovered species. In women treated for myometritis and who subsequently developed a wound or pelvic abscess, cultures from these wounds or abscesses were positive for 1-3 organisms present in amnionic fluid. These data indicate that ascending colonization of flora from the lower genital tract and inoculation into surgically traumatized tissues usually result in polymicrobial pelvic infection with a predominance of anaerobic pathogens. Moreover, abscess development in these women is probably associated with organisms identified in amnionic fluid. Bacterial isolates from these women are remarkably similar to those from women with other pelvic infections.

Adolescent↗
PubMed1978

Infectious morbidity following cesarean section. Comparison of two treatment regimens.

During a 4-month period 265 women delivered by cesarean section were studied to determine what effect membrane rupture has on the incidence and severity of postoperative infection. There was a definite correlation between the duration of ruptured membranes and the incidence as well as severity of postoperative infections. Only 29% of women with intact membranes subsequently developed endometritis with pelvic cellulitis, in contrast to 85% of those whose membranes were ruptured for less than 6 hours. Wound and pelvic abscesses were encountered in less than 1% of women delivered with intact membranes, yet these complications developed in over 30% of women with membranes ruptured for less than 6 hours. The incidence of septicemia was four times greater in those women whose membranes were ruptured for less than 6 hours. Women with endometritis were treated with one of two empirical antimicrobial regimens chosen randomly. Intravenous penicillin and tetracycline was found to be as effective as, and perhaps slightly more effective than, the combination of intravenous penicillin and intramuscular tobramycin.

Abscess↗
PubMed1978

The bacterial pathogenesis of acute pelvic inflammatory disease.

To study the bacterial pathogenesis of acute pelvic inflammatory disease, peritoneal fluid was obtained by culdocentesis in 133 of 344 women with this disease. In 104 of the specimens bacteria were identified both in the gram-stained smear and culture. Neisseria gonorrhoeae was isolated from the lower genital tract in over half of these women, and there were 3 patterns of bacterial recovery from peritoneal fluid: N gonorrhoeae alone (22%), N gonorrhoeae and other organisms (32%), and nongonococcal organisms alone (46%). In women without cervical gonorrhea only nongonococcal organisms were identified from peritoneal fluid. In both groups of women a similar number of nongonococcal organisms were isolated. The results of this study supported those reported prior to availability of antimicrobials and suggest that N gonorrhoeae initiates most cases of pelvic inflammatory disease. A significant number of these women have superinfection with nongonococcal organisms which may preclude recovery of gonococci.

Acute Disease↗