Pelvic surgical site infections in gynecologic surgery.

The development of surgical site infection (SSI) remains the most common complication of gynecologic surgical procedures and results in significant patient morbidity. Gynecologic procedures pose a unique challenge in that potential pathogenic microorganisms from the skin or vagina and endocervix may migrate to operative sites and can result in vaginal cuff cellulitis, pelvic cellulitis, and pelvic abscesses. Multiple host and surgical risk factors have been identified as risks that increase infectious sequelae after pelvic surgery. This paper will review these risk factors as many are modifiable and care should be taken to address such factors in order to decrease the chance of infection. We will also review the definitions, microbiology, pathogenesis, diagnosis, and management of pelvic SSIs after gynecologic surgery.

Haemophilus influenzae in genitourinary tract infections.

Haemophilus influenzae was isolated in pure or predominant culture from genital specimens from nine females and two males. Four of the females had vaginitis, two had IUD-related endometritis, one had an incomplete septic abortion, and one had probable urethral syndrome. Two males had urethritis.

PIP: This report was prompted by the isolation of Haemophilus influenza from cultures of specimens from genital sites in 11 patients. All cervical, vaginal, and urethral specimens submitted to the Section of Clinical Microbiology Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, for bacterial culture are routinely inoculated onto blood agar, eosinmethylene blue (EMB) agar, chocolate blood agar, Columbia colistin-nalidixic acid (CNA) blood agar, and unless previously directly inoculated by the attending physician, modified Thayer-Martin medium. As a rule, identification and reporting of isolates is limited to Neisseria gonorrhoeae, N. meningitidis, Gardnerella vaginalis, beta-hemolytic streptococci, Listeria monocytogenes, and Staphylococcus aureus. Cultures for anaerobic bacteria are restricted to endocervical or endometrial aspirates which are submitted to the laboratory in anaerobic transport vials. Cultures for fungi, Chlamydia trachomatis, and Ureaplasma urealyticum are performed by specific request, as is miscroscopic examination for Trichomonas vaginalis. Haemophilus influenzae was identified with the porphyrin test according to the Kilian's taxonomic system. Genital tract specimens from 11 patients yielded H. influenzae in pure or predominant culture. 9 patients were females, of whom 4 had vaginitis, usually with a yellowish, foul smelling discharge. 2 had IUD-related endometritis and parametritis, 1 had an incomplete septic abortion, and 1 had probable urethral syndrome. 2 males had urethritis. Cultures were negative for N. gonorrhoeae in every case and for C. trachomatis in the 6 patients whose specimens were cultured for this agent. Only 2 women -- 1 with vaginitis and 1 with probable urethral syndrome -- had G. vaginalis in cultures of vaginal secretions, while U. urealyticum was isolated from vaginal or cervical secretions of 3 of 4 women cultured for the organism.

Experimental infection of the upper genital tract of female grivet monkeys with Mycoplasma fermentans.

Mycoplasma fermentans inoculated directly into the uterine tubes of female grivet monkeys produced a self-limiting acute salpingitis and parametritis. The inflammation was accompanied by a significant rise in titre of specific indirect haemagglutinating antibodies. Inoculation of M. fermentans into the uterine cavity through the cervical canal without dilatation of the cervix produced practically no signs of inflammation and no antibody response. However, when the intrauterine inoculation of mycoplasmas was followed by currettage of the endometrium, in animals whose uterine tubes had been closed by ligatures, pronounced upper genital-tract inflammation developed, together with a significant antibody response.

Monkey animal model for study of mycoplasmal infections of the urogenital tract.

Various experimental monkey models have been used for the study of mycoplasmal infections of the urogenital tract. Direct inoculation of Mycoplasma hominis and Ureaplasma urealyticum into the urethra of male monkeys resulted in successful reisolation of the organisms from the urethra without giving rise to signs of urethritis during the observation period. The organisms were inoculated into the posterior fornix of the vagina of female grivet monkeys. During the ten-week observation period, there was no clinical, histologic, or serologic evidence of lower genital tract infection. Inoculation of M. hominis and M. fermentans into the upper genital tract of grivet monkeys produced parametritis and salpingitis. It was concluded that grivet monkeys are apparently suitable for study of the pathogenicity of genital mycoplasms.

A comparative study of two antibiotic regimens for the treatment of operative site infections.

This prospective study was designed to compare the relative efficacy of two antibiotic regimens for the treatment of operative site infections subsequent to pelvic operations. Patients with endomyoparametritis after delivery or pelvic cellulitis subsequent to hysterectomy were randomized to treatment with the combination of penicillin-gentamicin or the single agent cefoxitin. Seventeen of the 26 patients (65%) with endomyoparametritis who were treated with penicillin-gentamicin were cured by antibiotic therapy alone, in comparison to 15 of 23 (65%) patients treated with cefoxitin. Fifty-eight percent of the patients with pelvic cellulitis who were treated with penicillin-gentamicin responded favorably, in comparison to 50% of the patients treated with cefoxitin. None of these differences was statistically significant. In this study, neither antibiotic regimen provided satisfactory initial treatment for surgically induced soft tissue pelvic infection. Moreover, 11 of the 28 patients with treatment failures (40%) developed serious sequelae of their primary infection.