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Biomedical subjects

J D Blanco

Publications and source records attributed to J D Blanco.

At least 55 records · Page 3Linked to original sources
PubMed1986

The in vivo effect of amniotic fluid on endocervical microflora.

To test the in vivo effect of amniotic fluid on endocervical microflora, we performed endocervical cultures before and after rupture of the membranes in 20 patients in term labor. There were no significant qualitative or quantitative differences in aerobic or anaerobic isolates for up to 4 hours after membrane rupture. Group B streptococci, isolated in two patients (10%), persisted after rupture of the membranes. These data suggest that endocervical cultures are minimally influenced by rupture of the chorioamnion for at least 4 hours.

Amniotic Fluid↗
PubMed1986

Sperm washing and swim-up technique using antibiotics removes microbes from human semen.

Pelvic infections may follow intrauterine or intratubal insemination with washed semen. In this study, we determined whether sperm washing removes microorganisms from human semen. Before and after semen wash, we cultured 15 ejaculates for aerobic and anaerobic bacteria, genital mycoplasma, and chlamydia. All semen samples had from one to five organisms isolated (total, 40 isolates) before the semen wash preparation. The mean number (+/- standard deviation) of isolates per sample was 2.67 +/- 1.35. After the semen were prepared, none of the samples showed a positive culture. The decrease in the number of samples with positive cultures and the decrease in the number of isolates is significant (P less than 0.0001). After sperm washing, electronmicroscopic studies did not show any microbes attached to any portion of the spermatozoa. We conclude that the method of sperm wash preparation used is effective in removing microbes present in human semen.

Anti-Bacterial Agents↗
PubMed1985

Asymptomatic parturient women with high-virulence bacteria in the amniotic fluid.

This study describes the postpartum course of asymptomatic parturient women who had greater than or equal to 10(2) cfu of high-virulence (HV) bacteria per milliliter of amniotic fluid. Of 60 asymptomatic parturient women with greater than or equal to 10(2) cfu of HV bacteria per milliliter of amniotic fluid, 27 (48%) remained asymptomatic in the puerperium, 16 (27%) developed fever only, and 17 (28%) developed endometritis. In asymptomatic versus symptomatic women, there were no statistically significant differences in number or type of isolates or in length of membrane rupture or labor-to-collection interval. However, there were significant differences in the intervals from collection to delivery and in the rate of cesarean section delivery. For comparison, 40 of these patients were matched with women in whom only low-virulence organisms were detected in the amniotic fluid. In the HV group, 16 women (40%) remained asymptomatic, 15 (37.5%) developed fever only, and nine (22.5%) had endometritis. In the low-virulence group, 27 women (67.5%) remained asymptomatic, 10 (25%) developed fever only, one (2.5%) developed endometritis 10 days post partum, and two (5%) had other infections (p less than 0.01). Clinically evident uterine infection depends upon type and numbers of bacteria in utero, duration of bacteria in utero, and route of delivery.

Adult↗
PubMed1985

Aminoglycoside dosing in obese puerperal women.

We compared serum aminoglycoside levels in two groups of obese puerperal women being treated for endometritis. In these obese puerperal women (weights as much as 100 kg), the aminoglycoside dose did not have to be adjusted for excess weight initially, but it seems that determination of antibiotic levels should be performed in view of the large doses.

Adult↗
PubMed1985

Aztreonam versus gentamicin, each with clindamycin, in the treatment of endometritis.

A randomized comparison of aztreonam (2 g intravenously every eight hours) versus gentamicin (1.5 mg/kg intravenously every eight hours), each with clindamycin (600 mg intravenously every six hours), was performed in 119 patients with endometritis after cesarean section. Patients in both groups had similar risk factors. Genital cultures revealed an average of 3.0 isolates per specimen. Eighty-five aerobic gram-negative rods were isolated from 57 (48%) patients. All were susceptible to both aztreonam and gentamicin. Of 133 anaerobic isolates, 131 (98%) were susceptible to clindamycin. The failures in the aztreonam group were associated with a wound abscess and with an enterococcal bacteremia. Of the six failures in the gentamicin group, two were associated with persistent isolation of enteric bacilli. In the other four failures, no explanation was evident. Side effects occurred in four patients, (three diarrhea, one allergic reaction). All were self-limited and appeared to be due to clindamycin. No patient showed nephrotoxicity. When used in combination with clindamycin, aztreonam gave clinical results similar to gentamicin.

Adult↗
PubMed1983

Inhibition of group B streptococci by amniotic fluid from patients with intra-amniotic infection and from control subjects.

This study describes the inhibition of group B streptococci by amniotic fluid from 50 patients with intra-amniotic infection and 50 matched, noninfected control subjects. Patients were matched for gestational age, time from rupture of membranes to delivery, and time from rupture of membranes to collection of the sample of fluid. Study patients had the clinical diagnosis of intra-amniotic infection and greater than or equal to 10(2) colony-forming units of a high-virulence organism per milliliter. None of the control patients became infected or received antibiotics. We collected the amniotic fluid in the study patients prior to antibiotic therapy. A comparison of bacterial growth in the amniotic fluid versus the amniotic fluid plus phosphate showed that only eight (16%) of the intra-amniotic infection samples of fluid were inhibitory, whereas 18 (36%) of the control samples of fluid were inhibitory (X2 = 5.20, p less than 0.02). However, a comparison of group B streptococci growth in amniotic fluid and Todd-Hewitt broth did not show a statistically significant difference. We conclude that the amniotic fluid bacterial inhibitory assay with group B streptococci is technically more difficult to perform and interpret.

Adult↗
PubMed1983

A double-blind, randomized comparison of moxalactam versus clindamycin-gentamicin in treatment of endomyometritis after cesarean section delivery.

A double-blind comparison of clindamycin plus gentamicin versus moxalactam plus placebo was performed for the treatment of endomyometritis after cesarean section delivery. Entry criteria were uterine tenderness, temperature greater than or equal to 101 degrees F, and leukocytosis. Uterine specimens were obtained for culture via a single-lumen transcervical catheter. Bacteremia occurred in 10% of patients. Among the 57 patients treated with clindamycin plus gentamicin, there were two clinical failures and four side effect failures (diarrhea in two, allergic reaction in two). Among the 56 patients in the moxalactam group, there were four clinical failures and one side effect failure (diarrhea). Both regimens had good cure rates, with no significant differences in cures or postoperative hospital stay.

Adult↗
PubMed1983

A prospective, controlled study of maternal and perinatal outcome after intra-amniotic infection at term.

A study was made of the outcome for mothers and their neonates with both clinical and bacteriologic evidence of intra-amniotic infection at term. Samples of amniotic fluid from patients with intra-amniotic infection showed greater than 10(2) colony-forming units per milliliter of a high-virulence isolate, whereas samples from control patients showed no growth or low-virulence isolates only. Control patients were uninfected during labor and were matched on the basis of gestational age, interval from rupture of membranes to delivery, and mode of delivery. There were 67 matched pairs. The mean interval from diagnosis of intra-amniotic infection to delivery was 3.1 +/- 2.2 hours (+/- SD). Mothers with intra-amniotic infection had a significantly longer hospital stay and greater fever index after delivery than did control patients. Intrapartum bacteremia was documented in six of 50 (12%) women with intra-amniotic infection. The cesarean birth rate was 36%. There was one case of probable septic shock and one of postpartum hemorrhage among women with intra-amniotic infection. Infants in the intra-amniotic infection group had a significantly longer hospital stay than did the control infants. Among 59 infants for whom blood culture results were available, bacteremia was documented in five (8%) with intra-amniotic infection. Definite radiographic evidence of pneumonia was present in 4%; there were no cases of meningitis. There was one perinatal death in the intra-amniotic infection group. Overall, the maternal and perinatal outcome after intra-amniotic infection at term was excellent.

Adult↗
PubMed1983

A controlled study of genital mycoplasmas in amniotic fluid from patients with intra-amniotic infection.

Amniotic fluid (AF) was collected via a transcervical, intrauterine catheter from 52 patients with clinical intra-amniotic infection (IAI) and from 52 matched, uninfected controls. The AF was cultured for Mycoplasma hominis and Ureaplasma urealyticum as well as for aerobic and anaerobic bacteria. Eighteen (35%) patients with IAI and four (8%) controls had M. hominis in AF (P less than 0.001). Twenty-six (50%) patients with IAI and 26 (50%) control patients had U. urealyticum in AF (difference not significant). In the AF specimens of patients with IAI, 15 (83%) of the 18 with M. hominis also contained greater than or equal to 10(2) colony-forming units (cfu) of a high-virulence bacterial isolate/ml (P less than 0.05). Within the limitations of the experimental design, U. urealyticum in AF is not associated with clinical IAI, whereas, with qualitative cultures, M. hominis in AF is. However, in IAI, M. hominis is isolated most commonly from the AF of patients with greater than or equal to 10(2) cfu of a high-virulence bacterial isolate/ml.

Amniotic Fluid↗
PubMed1983

Ceftazidime levels in human breast milk.

Ceftazidime in the breast milk of 11 puerperal women were determined by bioassay. Each patient received 2 g of ceftazidime intravenously every 8 h for 5 days. The mean (+/- standard deviation) ceftazidime concentrations in the milk were: 3.8 +/- 2.0 (before the next dose), 5.2 +/- 3.0 (1 h after), and 4.5 +/- 1.7 micrograms/ml (3 h after). Ceftazidime was excreted in breast milk at relatively constant levels between days 2 and 4 of therapy.

Anti-Bacterial Agents↗
PubMed1983

Randomized comparison of ceftazidime versus clindamycin-tobramycin in the treatment of obstetrical and gynecological infections.

A randomized comparison of ceftazidime versus clindamycin-tobramycin was performed for the treatment of obstetrical and gynecological infections. Entry criteria were an oral temperature of greater than or equal to 38 degrees C and a clinical diagnosis of endometritis, salpingitis, or pelvic cellulitis after hysterectomy. All patients with endometritis had cultures of intrauterine material obtained via a transcervical single-lumen catheter. The patients with pelvic cellulitis had material from the vaginal apex aspirated for culture, and all patients with salpingitis had a culdocentesis for culture of intraperitoneal material. Of 38 patients who received ceftazidime, 34 had endometritis after cesarean section, 3 had endometritis after abortion, and 1 had pelvic cellulitis. Of 39 patients who received clindamycin-tobramycin, 35 had endometritis after cesarean section, 3 had salpingitis, and 1 had pelvic cellulitis. The most common bacterial isolates were Lactobacillus sp., Bacteroides bivius, Escherichia coli, other gram-negative aerobic bacilli, group B streptococci, and other aerobic streptococci. Bacteremia occurred in 9.0% of the patients. Of the patients receiving clindamycin-tobramycin and ceftazidime, 34 (87.2%) and 34 (89.5%), respectively, responded to therapy. All the clinical failures occurred in patients with endometritis after cesarean section. Clinical failures had persistent fever despite 3 or more days of treatment. One of the patients receiving clindamycin-tobramycin developed an urticarial rash after her infection had resolved. No patient in either group developed diarrhea. In these small groups of patients, there were no significant differences in cure rate, side effects, or length of hospital stay.

Bacterial Infections↗
PubMed1983

Endometrial culture techniques in puerperal patients.

Four techniques for obtaining endometrial cultures in puerperal patients were compared in 18 uninfected women undergoing postpartum tubal ligation. Four culture specimens were obtained from each patient in the following sequence: transfundal aspiration, transcervical brush biopsy of the endometrium through a double-lumen catheter, transcervical lavage of the endometrial cavity through a double-lumen catheter, and aspiration of the secretions from the lower uterine segment through a single-lumen catheter. Quantitative cultures for aerobic and anaerobic bacteria were performed on all specimens. Cultures from the single-lumen aspirate had the greatest variety of different organisms and the highest colony counts of individual organisms. The brush and lavage techniques were equally effective in reducing, but not eliminating, contamination of endometrial specimens with cervical organisms. The authors conclude that, of the techniques evaluated in these uninfected patients, the most satisfactory procedure for routinely obtaining endometrial cultures is brush biopsy or lavage through a double-lumen catheter.

Adult↗
PubMed1983

A controlled study of amniotic fluid immunoglobulin levels in intraamniotic infection.

The authors studied the levels of immunoglobulins (Ig) in the amniotic fluid of 46 patients with intraamniotic infection and of 46 matched controls. Amniotic fluid was collected through a transcervical intrauterine catheter. All infected patients had clinical signs of intraamniotic infection and at least 10(2) colony-forming units/milliliter of a high-virulence organism. None of the controls became infected. The matching criteria were gestational age, labor, interval from rupture of the membranes to delivery, and interval from rupture of the membranes to amniotic fluid collection. The authors tested each amniotic fluid sample for immunoglobulins G, M, and A by a single radial immunodiffusion technique. The mean IgG level in amniotic fluid for the intraamniotic infection group was 33.9 +/- 38.5 mg/dl, and the mean level for the control group was 17.9 +/- 11.1 mg/dl. The authors concluded that the mean IgG level in amniotic fluid from patients with intraamniotic infection is significantly higher than in controls (P less than .02).

Amniotic Fluid↗
PubMed1983

Serum gentamicin levels in patients with post-cesarean endomyometritis.

Serum gentamicin levels were measured by agar diffusion bioassay in 38 patients undergoing treatment with clindamycin-gentamicin for post-cesarean endomyometritis. Patients received intravenous gentamicin in a dose of 1 mg/kg actual body weight every eight hours. All trough levels were less than 1 microgram/ml. The mean 30-minute postinfusion level was 5.78 +/- 2.43 micrograms/ml (mean +/- SD). The range of postinfusion concentrations was 1 to 12 micrograms/ml. Postinfusion concentrations were less than 5 micrograms/ml in 13 patients, but none of these individuals experienced a clinical failure of antimicrobial therapy. There were no statistically significant differences in mean age, weight, hematocrit, serum creatinine, estimated creatinine clearance, or administered dose in patients with therapeutic gentamicin levels and patients with apparent subtherapeutic levels. The authors conclude that postinfusion gentamicin concentrations fluctuate widely in obstetric patients receiving 1 mg/kg/dose and that apparent subtherapeutic postinfusion levels still may be clinically efficacious, depending upon the antimicrobial susceptibility of the infecting microorganisms.

Adult↗
PubMed1983

A case-control study of wound abscess after cesarean delivery.

A retrospective, case-control study was performed to determine risk factors for, and complications of, wound abscess after cesarean delivery. The records of 64 patients with abscess and 64 controls were examined. The following variables were significantly associated with wound abscess: labor duration, interval from rupture of membranes to delivery, number of vaginal examinations, duration of internal fetal monitoring, operating time, and estimated blood loss. Also strongly associated were presence of endometritis or chorioamnionitis, fever in labor, and an indication of dystocia. The mean hospital stay was six days longer in patients with wound abscess. Fascial dehiscence requiring repair was present in 4.7%.

Abscess↗