A randomized trial of conjugated group B streptococcal type Ia vaccine in a rabbit model of ascending infection.

OBJECTIVE: Maternal vaccination may become a central strategy in the prevention of early-onset group B Streptococcal sepsis. Unlike earlier group B streptococcal polysaccharide vaccines that were poorly immunogenic, newer vaccines conjugated to tetanus toxoid have been developed and have improved immunogenicity. We sought to evaluate a conjugated vaccine using our rabbit model of ascending infection. STUDY DESIGN: Rabbit does were randomized to receive either conjugated group B streptococcal type Ia (Ia-tetanus toxoid) or conjugated group B streptococcal type III (III-tetanus toxoid) vaccine. Does were vaccinated 7 days before conception and 7 and 21 days after conception. On days 28 to 30 of a 30-day gestation, does were inoculated intracervically with 10(6) colony-forming units of type Ia group B Streptococcus. Labor was induced if does were undelivered after 72 hours. Does were observed up to 7 days after inoculation. Offspring were observed up to 4 days. We obtained maternal cultures from the uterus, peritoneum, and blood and offspring cultures from the mouth, anus, and blood. Antibody levels were also determined. RESULTS: Offspring survival was significantly improved in the group receiving Ia-tetanus toxoid (P =.047). Outcomes such as maternal sepsis and severe illness, although not reaching statistical significance, showed a trend toward improved outcomes in the Ia-tetanus toxoid group. CONCLUSIONS: This is the first study to evaluate the conjugated group B streptococcal vaccine by using any model of ascending infection. The Ia-tetanus toxoid vaccine led to improved survival and was immunogenic but fell short of its expected efficacy in preventing ascending group B streptococcal disease under these experimental conditions.

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.

Moxalactam for treatment of pelvic infections after cesarean delivery.

Moxalactam was given to 136 women for treatment of uterine infections after cesarean delivery. After an intravenous loading dose of 2 g, 36 women received 3 g daily and 100 were given 6 g daily. The clinical success rates of these two regimens were 86% and 89%, respectively; however, in four of five women for whom treatment with the 3-g daily dose failed, extensive surgery was necessary for cure. A total of 395 pathogens was isolated from these women with polymicrobial infections, and almost 90% were susceptible to moxalactam at less than or equal to 32 micrograms/ml. Adverse effects of therapy were minimal. Thus, moxalactam given initially as a dosage of 6 g daily is effective for treatment of women with pelvic infections after cesarean delivery.

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.

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.

Bacteriologic effects of prophylactic antibiotics in cesarean section.

An eight-hour course of prophylactic clindamycin and gentamicin was given to 54 service patients undergoing cesarean section. Aerobic and anaerobic endometrial cultures obtained from eight patients who developed endometritis after prophylaxis revealed major changes in flora. Compared to infected patients who had received no prophylaxis, the clindamycin-gentamicin group had marked decreases in aerobic and anaerobic cocci and Bacteroides but increases in E. coli and enterococci. However, this regimen was found to be no more effective than the previously reported regimen of ampicillin and kanamycin.