scholarly journals Prognosis and effectiveness of antibacterial treatment of endometritis after cesarian section with isolating drug-resistent ESKAPE pathohens

2020 ◽  
Vol 12 (3) ◽  
pp. 35-40
Author(s):  
Nikolay A. Korobkov ◽  
N. V. Bakulina ◽  
Ekaterina I. Kakhiani
Keyword(s):  
Cesarean Section ◽  
Antimicrobial Therapy ◽  
Antibacterial Treatment ◽  
Drug Resistant ◽  
Multiresistant Pathogens ◽  
Infectious Process ◽  
Empirical Antimicrobial Therapy ◽  
Cesarian Section ◽  
Eskape Pathogens ◽  
Abdominal Delivery

Purpose. The purpose of this study was to determine the frequency of isolation of drug-resistant ESKAPE pathogens isolation in endometritis after cesarean section; to assess the prognosis of the disease and the effectiveness of initial empirical antimicrobial therapy for isolating multiresistant pathogens. Methods. A retrospective analysis of all the cases of endometritis after cesarean section in St. Petersburg was performed. The study period: September 2008 September 2019. Results. 68 (26.7%) out of 255 cases of endometritis after cesarean section were caused by pathogens of the rESKAPE group. In puerperas with endometritis caused by rESKAPE pathogens, the following are more often observed: clinical failures in prescribing initial empirical antimicrobial therapy compared with endometritis of another etiology (p = 0.0012); severe course of infectious process with the risk of its generalization and hysterectomy (p 0.05). Conclusions. Endometritis after abdominal delivery caused by rESKAPE pathogens is associated with an unfavorable prognosis of the disease and a high risk of ineffective antimicrobial therapy.

scholarly journals The experience of vaginal birth after cesarean delivery in the Maternity home No 13 of Saint Petersburg

2017 ◽  
Vol 66 (3) ◽  
pp. 82-88 ◽  
Author(s):  
Margarita D. Leonova ◽  
Elena V. Frederiks ◽  
Yulia R. Dymarskaya
Keyword(s):  
Cesarean Section ◽  
Cesarean Delivery ◽  
Vaginal Delivery ◽  
Contractile Activity ◽  
Vaginal Birth ◽  
Fetal Hypoxia ◽  
Uterine Contractile ◽  
Cesarian Section ◽  
Abdominal Delivery ◽  
Previous Cesarean

Introduction. In developed countries the attempts of vaginal delivery after cesarian section are not an unjustified risk, but considered the most favorable outcome. In Russia, unfortunately, obstetricians do not risk offering a vaginal birth to pregnant women after cesarian section, and outpatient doctors often adjust the abdominal delivery from early stages of pregnancy. The aim of the study: to identify specifics of labor and outcome of delivery for vaginal birth after previous cesarean and determine possible ways to reduce the frequency of abdominal delivery in these patients. Materials and methods. We conducted a retrospective analysis of 337 histories of delivery of patients after previous cesarean in 2016 in “Maternity hospital No 13”. The main group consisted of 189 patients to whom vaginal birth was planned, of which 82 patients completed the birth in accordance with the previous plan (subgroup 1) and 107 women completed cesarean section (group 2). The control group consisted of 148 women who had cesarean delivery without trial vaginal delivery. Results. Among the indications for the first cesarean section in the subgroup 1 were: breech malpresentation – 19.7%, fetal hypoxia – 22.4% and abnormalities of the uterine contractile activity – 13.2%. The most common indications for a second operation in the 2nd subgroup were: premature rupture of amniotic fluid and absence of spontaneous labor (28%), lack of cervical muturity (21.5%), abnormalities of the uterine contractile activity (18.7%), fetal hypoxia (14%), abnormal preliminary period (13.1%), placental abruption (1.9%), absence of the effect of induction (amniotomy) (1.9%), cepalopelvic disproportion (0.9%). Thus, the percentage of success of vaginal delivery was 43.3%. At the same time, the fact of the presence of uterine contractions during the previous delivery did not affect the mode of delivery in this pregnancy. The volume of blood loss in cases of vaginal delivery was significantly less than in the subgroups of patients delivered by cesarean section. Conclusions. The analysis may lead to reviewing indications and terma for the birth after cesarean. Reserve groups have been defined for high chances of vaginal delivery: prolongation of pregnancy up to 41 weeks, induction and augmentation of labor, conservative management of labor with presumed macrosomia, that may help reduce the frequency of repeated abdominal delivery, development of intra- and postoperative complications.

Community acquired pneumonia-current scenario among immunocompromised patients in a tertiary care hospital

2016 ◽  
Vol 5 (01) ◽  
pp. 4715
Author(s):  
A. V. Sowmya* ◽  
G. Jayalakshmi ◽  
David Agatha
Keyword(s):  
Diabetes Mellitus ◽  
Antimicrobial Therapy ◽  
Tertiary Care ◽  
Community Acquired Pneumonia ◽  
Polymicrobial Infection ◽  
Resistance Pattern ◽  
Care Hospital ◽  
Immunocompromised Patients ◽  
Drug Resistant ◽  
Etiologic Agents

Pneumonia is a common illness accounting for majority of hospitalizations worldwide with significant mortality and morbidity. Antimicrobial therapy, being the main stay of treatment, the choices of antibiotics depends on the nature of the etiologic agents and the host factors. The current study was aimed to identify the bacterial & fungal etiologic agents of Community Acquired Pneumonia (CAP) in Immunocompromised (IC) patients, with their antimicrobial resistant pattern and to analyze the associated immunocompromised states. Various respiratory samples from study group of 75 immunocompromised patients with features of pneumonia were collected, processed and the isolates were identified with their antimicrobial susceptibility& resistance pattern according to CLSI guidelines. The results were analyzed statistically. Diabetes mellitus is the most common immunocompromised state (48%) associated with CAP. Monomicrobial and polymicrobial infection rates were 80.36% and 19.64% respectively. Gram negative pathogens and fungal pathogens were identified in 60% and 25.37% of culture positive cases respectively. Diabetes mellitus is commonly found in association with polymicrobial infection (19.44%) and fungal infection (16.66%). Drug resistant strains comprise about 75% of MRSA strains, 72.72 % of ESBL producers and 3.44% of Amp C producers. As the number of elderly people with associated IC state is on rise, with change in the pattern of microbial etiologic agents causing CAP, a prior knowledge of the host and microbial factors will help in formulating empirical antimicrobial therapy and proper treatment thereby curbing the spread of infections by drug resistant pathogens and the associated morbidity and mortality.

Comparison of Unit-Specific and Hospital-Wide Antibiograms Potential Implications for Selection of Empirical Antimicrobial Therapy

2006 ◽  
Vol 27 (7) ◽  
pp. 682-687 ◽  
Author(s):  
Shawn Binkley ◽  
Neil O. Fishman ◽  
Lori A. LaRosa ◽  
Ann Marie Marr ◽  
Irving Nachamkin ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Medical Center ◽  
Tertiary Care ◽  
General Medicine ◽  
Bacterial Isolates ◽  
Anatomic Site ◽  
Empirical Antimicrobial Therapy ◽  
Tertiary Care Medical Center ◽  
Surgical Icu ◽  
Selection Of

Objective.To identify differences between unit-specific and hospital-wide antibiograms and to determine the potential impact of these differences on selection of empirical antimicrobial therapy.Setting.A 625-bed tertiary care medical center.Methods.Antimicrobial susceptibility results were collected for all inpatient clinical bacterial isolates recovered over a 3-year period; isolates were categorized by the hospital location of the patient at the time of sampling and by the anatomic site from which the isolate was recovered. Antibiograms from each unit were compiled for the most commonly isolated organisms and were compared to the hospital-wide antibiogram.Results.A total of 9,970 bacterial isolates were evaluated in this study, including 2,646 enterococcal isolates, 2,806 S. aureus isolates, 2,795 E. coli isolates, and 1,723 Pseudomonas aeruginosa isolates. The percentages of bacterial isolates resistant to antimicrobials were significantly higher in the medical ICU and surgical ICU than the hospital-wide antibiogram would have predicted, whereas the percentages of isolates susceptible to antimicrobials were significantly higher in the non-ICU units, compared with the hospital overall. However, on general medicine units, the prevalence of susceptibility to levofloxacin was significantly lower than that for the hospital overall.Conclusions.Unit-specific antibiograms are important for making informed decisions about empirical antimicrobial therapy, because the hospital-wide antibiogram may mask important differences in susceptibility rates across different units. These differences may have important implications for selecting the optimal empirical antimicrobial therapy.

scholarly journals Empirical antimicrobial therapy for late-onset sepsis in a neonatal unit with high prevalence of coagulase-negative Staphylococcus

2016 ◽  
Vol 92 (5) ◽  
pp. 472-478 ◽  
Author(s):  
Roberta Maia de Castro Romanelli ◽  
Lêni Márcia Anchieta ◽  
Ana Carolina Bueno e Silva ◽  
Lenize Adriana de Jesus ◽  
Viviane Rosado ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Late Onset ◽  
Neonatal Unit ◽  
Coagulase Negative Staphylococcus ◽  
Empirical Antimicrobial Therapy ◽  
Late Onset Sepsis ◽  
High Prevalence

The analysis of cases of abdominal delivery acute fetal hypoxia

2017 ◽  
pp. 28-31
Author(s):  
Yu.P. Vdovichenko ◽  
◽  
N.P. Goncharuk ◽  
Ye.Yu. Gurzhenko ◽  
◽  
...  
Keyword(s):  
Cesarean Section ◽  
Acute Hypoxia ◽  
Fetal Distress ◽  
Positive Trend ◽  
Cesarean Sections ◽  
Fetal Hypoxia ◽  
Vitro Fertilization ◽  
Surgical Interventions ◽  
Abdominal Delivery

The objective: was to study the level of abdominal delivery, its structure according to indications from the fetus, the effect of cesarean sections on perinatal losses in acute fetal hypoxia. Patients and methods. The study was conducted on the basis of the Kyiv City Maternity Hospital №1 for the period from 2001 to 2011. The frequency of cesarean sections was studied and analyzed, the percentage of urgent and planned operations was established, the structure of cesarean sections according to the indications from the fetus was determined, the frequency of cesarean sections in acute hypoxia Fetus, perinatal losses were studied, an analysis of the dependence of perinatal losses on the frequency of cesarean sections during fetal distress was carried out. The analysis used the history of delivery of women giving birth, which culminated in cesarean section. Results. In analyzing the structure of cesarean sections, the fetal indications are as follows: fetal hypoxia, confirmed by objective methods, in the absence of conditions for urgent delivery per vias naturales; Pelvic presentation of the fetus at a mass of more than 3700 g; in vitro fertilization; incorrect position of the fetus after the outflow of amniotic fluid. The conclusion. An increase in the frequency of cesarean sections was noted. Attention is drawn to the positive trend of decreasing the frequency of urgent surgical interventions. The expected decrease in the number of perinatal losses with an increase in the level of caesarean sections due to fetal distress has not been confirmed. Key words: cesarean section, acute fetal hypoxia, cardiotocographic monitoring.

STUDY OF THE STATE OF STRESS-IMPLEMENTING SYSTEMS IN ABDOMINAL DELIVERY DEPENDING ON ANESTHETIC TECHNIQUES

2020 ◽  
Vol 73 (11) ◽  
pp. 2378-2385
Author(s):  
Marine A. Georgiyants ◽  
Olena V. Vуsotska ◽  
Nataliia P. Seredenko ◽  
Tatiana V. Chernii ◽  
Hanna N. Strashnenko ◽  
...  
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
Pregnant Women ◽  
Pain Intensity ◽  
Stress Hormones ◽  
Anesthetic Techniques ◽  
Protective Effects ◽  
Sodium Thiopental ◽  
State Of Stress ◽  
Abdominal Delivery

The aim: Evaluation of stress-protective effects of various anesthetic techniques on Cesarean section (CS). Materials and methods: 127 pregnant women who delivered by cesarean section, were divided into 4 subgroups: 1a (n = 31) – general anesthesia (GA) with ketamine, 1b (n = 31) – GA with sodium thiopental, 2a (n = 31) – spinal anesthesia (SA), 2b (n = 34) – SA with intravenous administration of ondansetron at a dose of 8 mg. The assessment was performed at 5 stages: 1 – initial; 2 – infant extraction; 3 – 6 hours after surgery; 4 – 12 hours after surgery. Results: At stage 2, insulin levels in 1a and 1b subgroups decreased by 23.9% and 34.1%, while in 2a and 2b subgroups there were no significant changes. There was an increase in the levels of cortisol, prolactin and cortisol/insulin ratio at the 2 and 3 stages in the 1a and 1b subgroups. Pain intensity increased by the 3 stage in patients of all groups. It was the highest in the 1a and 1b subgroups. At the 4 stage, pain intensity was reduced in all groups, remaining significantly higher in patients of 1a and 1b subgroups. Conclusions: The dynamics of the content of stress hormones, the pain intensity in patients undergoing CS under SA give reason to consider this method as an optimal and adequate one for protection from surgery stress.

Secondary infertility associated with a uterine niche after cesarean section

2020 ◽  
Vol 19 (5) ◽  
pp. 95-101
Author(s):  
M.A. Kurtser ◽  
◽  
N.M. Egikyan ◽  
N.A. Savelyeva ◽  
M.A. Vatagina ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Cesarean Section ◽  
Key Words ◽  
Assisted Reproductive Technologies ◽  
Embryo Implantation ◽  
Reproductive Technologies ◽  
Psychological Factor ◽  
Secondary Infertility ◽  
Embryo Survival ◽  
Abdominal Delivery

The frequency of abdominal delivery remains high and does not tend to decrease. This may lead to an increase in the number of complications associated with cesarean section, such as uterine niche. Considering the fact that literature data on uterine form of secondary infertility in patients with niches is lacking, and taking into account our own experience and observations made during laparoscopic and hysteroscopic metroplasty, we believe that it is necessary to discuss hypothetical mechanisms underlying the effects of uterine niches on: (1) natural embryo implantation or during an IVF program; (2) embryo survival (embryotoxicity); (3) quality and survival of spermatozoa (spermatoxicity). It is also important to analyze the psychological factor that decreases fertility in these patients. Key words: infertility; assisted reproductive technologies; isthmocele; caesarean section; niche; fertility

Recent advances: peptides and self-assembled peptide-nanosystems for antimicrobial therapy and diagnosis

2020 ◽  
Vol 8 (18) ◽  
pp. 4975-4996
Author(s):  
Pengfei Zou ◽  
Wen-Ting Chen ◽  
Tongyi Sun ◽  
Yuanyuan Gao ◽  
Li-Li Li ◽  
...  
Keyword(s):  
Human Health ◽  
Antimicrobial Therapy ◽  
Bacterial Infections ◽  
The Body ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Self Assembling ◽  
Recent Advances ◽  
Drug Resistant Bacteria ◽  
Therapy And Diagnosis

Bacterial infections, especially the refractory treatment of drug-resistant bacteria, are one of the greatest threats to human health. Self-assembling peptide-based strategies can specifically detect the bacteria at the site of infection in the body and kill it.

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