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Biomedical subjects

J D Blanco

Publications and source records attributed to J D Blanco.

72 records · Page 4Linked to original sources
PubMed1982

A double-blind, randomized comparison of clindamycin-gentamicin versus cefamandole for treatment of post-cesarean section endomyometritis.

Among patients with endomyometritis after cesarean section, a double-blind comparison of clindamycin-gentamicin versus cefamandole-placebo therapy was performed. Study criteria were: exclusion--use of prophylactic antibiotics or allergy to the drugs used; entry--uterine tenderness, oral temperature greater than or equal to 101 degrees F, and leukocytosis. Uterine specimens for culture were obtained via a single-lumen transcervical catheter. Most common isolates were Bacteroides bivius, Escherichia coli, and anaerobic cocci. Bacteremia occurred in 9.0%. Therapy results were: [Chart: see text]. Therapeutic failures were defined as persistent fever despite 3 or more days of treatment. Among the six clindamycin-gentamicin therapeutic failures, one patient had a resistant organism, and one had a pelvic mass. Among the 13 cefamandole-placebo therapeutic failures, three patients had resistant organisms, and one had a pelvic mass. Cause of persistent fever was not evident in the other patients. Side effects that necessitated discontinuation of therapy were: clindamycin-gentamicin group--diarrhea (six), allergic response (one); cefamandole-placebo group--diarrhea (two), allergic response (one). If the common practice of excluding side-effect failures is followed, there were more cures in the clindamycin-gentamicin group (P = 0.06).

Adult↗
PubMed1982

Correlation of quantitative amniotic fluid cultures with endometritis after cesarean section.

At the time cesarean section, amniotic fluid was collected transabdominally from 60 patients, and quantitative cultures were performed on the amniotic fluid. A culture was defined as positive if greater than or equal to 10(2) colony-forming units per milliliter of a high-virulence organism were isolated. Any other result was defined as negative. In 24 patients with no labor or rupture of the membranes, no positive cultures were found, but there was a 25% incidence of endometritis. Among 36 patients with labor or rupture of the membranes, or both, 13 (36%) had a positive culture. Twelve of the 13 (92%) developed endometritis, whereas nine of the 23 (39%) patients with a negative culture had endometritis (p less than 0.002). The usual clinical risk factors for endometritis were not different between the positive and negative culture groups. However, the patients with positive cultures had a significantly shorter time interval from cesarean section to endometritis than did the patients with negative cultures (p less than 0.02). There was an excellent correlation between a positive amniotic fluid culture and endometritis after cesarean section.

Adult↗
PubMed1982

The association between the absence of amniotic fluid bacterial inhibitory activity and intra-amniotic infection.

We studied the relationship of amniotic fluid bacterial inhibition in 50 patients with intra-amniotic infection to that in 50 matched control patients. Amniotic fluid was collected through a transcervical intrauterine catheter. All infected patients had clinical signs of intra-amniotic infection and greater than or equal to 10 2 colony-forming units per milliliter of a high-virulence organism. None of the control patients became infected. The matching characteristics for the intra-amniotic infection group versus the control group were: interval from rupture of the membranes to delivery (14.30 +/- 7.96 versus 15.00 +/- 7.19 hours, NS), interval from rupture of the membranes to collection of amniotic fluid (12.41 +/- 6.37 versus 12.16 +/- 6.46 hours NS), and gestational age (40.3 +/- 1.6 versus 40.0 +/- 1.6 weeks, NS). All patients were in labor. We tested each sample of amniotic fluid for inhibitory activity to Escherichia coli by a plate-count technique. Thirty-five samples (70%) of intra-amniotic infection fluid were noninhibitory, whereas 16 samples (32%) of control fluid were noninhibitory. The conclusion was that amniotic fluid from patients with intra-amniotic infection was significantly less likely to be inhibitory to E. coli (p less than 0.001).

Adolescent↗
PubMed1982

Inorganic phosphorus and zinc concentrations in amniotic fluid: correlation with intra-amniotic infection and bacterial inhibitory activity.

Concentrations of zinc and inorganic phosphorus were determined in amniotic fluid from 41 patients with intra-amniotic infection and from 40 uninfected, control patients. Also determined was amniotic fluid inhibitory activity to an Escherichia coli test organism. Compared to amniotic fluid from control patients, that from patients with intra-amniotic infection had significantly higher mean concentrations of phosphorus. In specimens free of meconium, the mean concentrations of phosphorus were still significantly higher. Assays for inhibitory activity were performed with 62 samples of fluid (25 noninhibitory, 37 inhibitory). Although noninhibitory fluid had higher mean concentrations of phosphorus and zinc, these differences did not hold after meconium-stained samples were excluded. No correlation was found between phosphorus-to-zinc ratio and either intra-amniotic infection or inhibitory activity. However, there are important differences in population and techniques between this and related studies.

Amniotic Fluid↗
PubMed1982

Vaginal colonization with resistant aerobic bacteria after antibiotic therapy for endometritis.

To assess the effect of broad-spectrum antibiotic therapy upon vaginal colonization, we collected vaginal specimens for culturing at the end of therapy from 50 patients treated for postcesarean section endometritis. Infected patients had participated in a double-blind therapy protocol and had received either clindamycin plus gentamicin or cefamandole plus placebo. Repeat vaginal culturing was performed 6 weeks later. Similar vaginal specimens for culturing were collected from 25 control patients who also had undergone cesarean section but had not received antibiotics. Of 26 patients treated with cefamandole, 16 (62%) developed vaginal colonization with isolates resistant to that drug; of 24 patients treated with clindamycin-gentamicin, two (8%) developed isolates resistant to these agents (p less than 0.001). Among 25 control patients, there was only one isolate resistant to cefamandole and none resistant to clindamycin-gentamicin. Compared to controls, more antibiotic-treated patients developed isolates resistant to cefamandole (p = 0.001) and to clindamycin-gentamicin (p = 0.06). Colonization did not persist, and there were no late infections in this population.

Adult↗
PubMed1982

Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term.

Amniotic fluid was collected through an intrauterine catheter from 52 women with clinical intraamniotic infection and from 52 uninfected matched control women. The amniotic fluid was cultured quantitatively for anaerobes and aerobes. Patients with intraamniotic infection were matched with the control women on the basis of gestational age, interval from membrane rupture to specimen collection, and interval from membrane rupture to delivery. The patients with intraamniotic infection had a significantly higher mean temperature (38.4 vs. 37.1 C) and a higher mean leukocyte count (15,740 vs. 11,740 cells/mm3). In 80.6% of specimens from the women with intraamniotic infection and 30.8% of those from the control subjects, greater than or equal to 10(2) colony-forming units (cfu)/ml were isolated from the amniotic fluid (P less than 0.001). Also, in 69.2% of the former and 7.7% of the latter, there were greater than or equal to 10(2) cfu of isolates considered to be "high-virulence" isolates/ml (P less than 0.001).

Adolescent↗
PubMed1982

Premature rupture of the membranes.

Since 1970 there have been many changes in our knowledge of premature rupture of the membranes (PROM). Studies of its causes have focused on clinical variables, physical properties of the membranes, and subclinical infection, while new diagnostic techniques have included biochemical and histochemical tests, as well as intrauterine dye injection. Within the last decade, new approaches in management have employed corticosteroids, tocolytics, and amniocentesis. Because of limitations of current studies, however, it is difficult to compare one study to another. Consequently, management of PROM remains a major dilemma. This review provides a summary and commentary on recent works.

Anti-Bacterial Agents↗
PubMed1981

Streptococcal infections in pregnancy. A study of 48 bacteremias.

During a 4-year period, 48 obstetric patients with aerobic streptococcal bacteremia were identified. The isolates were group B (31); group D, enterococci (5); group A (4); group D, not enterococci (3); Streptococcus pneumoniae (3); and viridans streptococci (2). The most common diagnoses were endometritis (36) and chorioamnionitis (8). For all streptococcal genital infections, the clinical presentation included early-onset fever, often with few localizing signs. Only one patient had a chronic debilitating disease. There was an excellent correlation between genital and bloodstream isolates (36 of 42). Maternal response to therapy was good, with no deaths nor episodes of septic shock. Possible infectious complications developed in two fetuses and four neonates. The microbiologic and clinical features of aerobic streptococci were reviewed, and the outcome in obstetric patients and that in other adults were compared.

Adolescent↗
PubMed1981

Bacteremia in obstetrics: clinical course.

The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). No deaths, clinical evidence of septic shock, or cases of postinfection endocarditis were found. The most common bloodstream isolates were Escherichia coli (57), group B streptococcus (28), and Bacteroides sp (26). The patients with endoparametritis had a fever index of 86.2 +/- 47.1F-hours, an average hospital stay of 6.5 +/- 3.1 days, a 7.3% rate of complications, and a 19.5% rate of failure of primary antibiotics. The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.

Adolescent↗
PubMed1980

Therapy of obstetrical infections with moxalactam.

We evaluated moxalactam in 62 patients with puerperal or postabortal genital infections. In all patients, the initial dose was 6 g/day. In 84% of patients, we found anaerobes in genital specimens. Of aerobic isolates, only enterococci were resistant. Among anaerobes tested, only two isolates (a Clostridium leptum and a Bacteroides disiens) had minimal inhibitory concentrations of greater than or equal to microgram/ml. Good clinical responses occurred in 56 of 62 (90%). Moxalactam was well tolerated with little local irritation and minimal hepatic, renal, or hematological abnormalities.

Abortion, Spontaneous↗
PubMed1980

Infections following classical cesarean section.

A study was undertaken to evaluate the postoperative morbidity of classical cesarean section (CCS). Eighty-nine such procedures, performed between 1970 and 1977, were reviewed. All cases in which prophylactic antibiotics were used were excluded from the study. Forty-seven patients (53%) developed standard morbidity, and 46 patients (52%) had a clinical diagnosis of infection. Of these, 30 patients (34%) had endoparametritis, 5 patients (6%) had abdominal wound infection, and 11 patients (12%) had urinary tract or pulmonary infection. Two patients (2%) had pelvic thrombophlebitis, but no patient was found to have an abscess or pelvic hematoma. In comparison with matched patients who had a low cervical transverse cesarean section (LCTCS) performed during the same time, patients with a CCS had a comparable incidence of standard morbidity and operative site infection. These infections responded promptly to vigorous antibiotic therapy with no apparent increased risk of amjor postoperative complications in the population studied.

Bacterial Infections↗
PubMedDate not supplied

Water immersion and the effect on labor.

The use of warm water immersion (WI) by women for relaxation during labor is being used around the world; however, there is little available research as to the effects of WI. We conducted this prospective, randomized, and controlled study to determine the safety and effect of WI on the woman in labor. We studied 93 subjects between 36 and 41 weeks' gestation, in active labor, with intact membranes, and without major medical or obstetric complications. Subjects in the WI group utilized a tub in labor along with other pain relief measures such as ambulation, rest, showers, and analgesics. Subjects in the no-WI group could use all available methods of pain relief except WI. Water immersion did not alter the rate of cervical dilation, change the contraction pattern, change the length of labor, or alter the use of analgesia. The rates of chorioamnionitis and endometritis were not altered by WI. Although we did not demonstrate an improvement in progression of labor by WI, there was no evidence of increased maternal, neonatal, or infectious morbidity.

Adult↗
PubMedDate not supplied

Effect of meconium on delivery of chorioamniotic membranes.

A decrease in stress tolerance of chorioamniotic membranes when exposed to meconium has previously been demonstrated. Clinically, variations in elastic qualities of membranes can be appreciated during their removal following spontaneous vaginal deliveries. The purpose of this study was to determine if there is a relationship between the presence of meconium-stained amniotic fluid and difficulty in removal of chorioamniotic membranes in spontaneous vaginal deliveries. All deliveries over four months (n = 400) were evaluated for color of amniotic fluid and method of delivery of membranes. Overall, the CNMs used significantly more intervention to deliver the membranes if any meconium was present in the amniotic fluid prior to delivery (Fisher's exact test, P = .000004, df = 1). These results suggest that the accoucheur should be prepared for difficulty in membrane removal in deliveries complicated by meconium-stained fluid.

Adult↗
PubMedDate not supplied

Role of aerobic gram-negative bacilli in endometritis after cesarean section.

Endometritis is considered to be a polymicrobial infection, involving aerobes, anaerobes, and genital mycoplasmas. Aerobic gram-negative rods make up 7%-25% of all genital isolates, but findings from studies in which special collection techniques were used suggest that many of these may be contaminants from the lower genital tract. Bacteremia occurs in 4%-30% of patients with endometritis, and aerobic gram-negative rods account for approximately 25% of blood isolates. Both selected therapy studies and studies of intrauterine cultures collected at surgery from patients at risk for endometritis suggest the significant role of aerobic gram-negative rods. Among them Escherichia coli is the most common isolate in both genital and blood cultures. Klebsiella pneumoniae and Proteus mirabilis rank next, followed by Enterobacter species. Pseudomonas species account for fewer than 0.6% of genital isolates. Overall, aerobic gram-negative rods are causally involved in 10%-20% of cases of endometritis following cesarean section.

Anti-Bacterial Agents↗
PubMedDate not supplied

Clindamycin and ibuprofen effects on chlamydial salpingitis in mice.

To evaluate the effects of clindamycin and ibuprofen on a model of upper genital tract chlamydial infection in mice, 64 Swiss Webster white mice were inoculated in the left ovarian bursa with a mouse pneumonitis strain of Chlamydia trachomatis. Chlamydia-inoculated mice received clindamycin, ibuprofen, clindamycin and ibuprofen, or no treatment. Mice were killed at intervals, and their genital tracts were examined grossly and microscopically for evidence of infection and cultured for Chlamydia. Sixty-seven per cent of inoculated, untreated mice manifested gross evidence of inflammation compared with 22.4% of mice in any treatment group (P less than .025). C. trachomatis was isolated in 10.2% of mice treated with any drug regimen, whereas 46.7% of untreated mice were culture-positive (P less than .025). In this model, therapy with clindamycin, ibuprofen, or both drugs in combination decreased gross and histologic evidence of inflammation as well as the rate of recovery of C. trachomatis from the genital tract.

Animals↗
PubMedDate not supplied

Mycoplasma hominis and intrauterine infection in late pregnancy.

Amniotic fluid was collected via a transcervical intrauterine catheter from patients with clinical evidence of intrauterine infection and from uninfected comparison patients. The amniotic fluid was cultured for Mycoplasma hominis and Ureaplasma urealyticum, as well as for aerobic and anaerobic bacteria. Two series of patients are reported. In the first, there were 52 patients with intraamniotic infection and 52 matched controls. Eighteen patients (35%) with intraamniotic infection and four control patients (8%) had M. hominis in the amniotic fluid (P less than .001). Twenty-six patients (50%) with intraamniotic infection and 26 control patients (50%) had U. urealyticum in the amniotic fluid. In the second series, samples were collected consecutively. M. hominis was isolated from 32% (19/60) of specimens from patients with signs of infection and from 14% (8/56) of afebrile comparison patients (P less than .02). U. urealyticum was recovered from 43% and 39% of these fluids, respectively; the difference was not significant. When M. hominis was found in amniotic fluids of patients with signs of infection, the amniotic fluid usually contained greater than or equal to 10(2) cfu of a high virulent bacterial isolate per milliliter. Qualitative cultures showed that M. hominis in the amniotic fluid is associated with clinical intrauterine infection.

Adolescent↗