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Nosocomial post-cesarean endometritis: a rationalized strategy of antibacterial therapy

https://doi.org/10.17749/2313-7347.2018.12.2.012-020

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Abstract

The number of patients with nosocomial post-cesarean endometritis is steadily growing. Aim: to study the etiology of nosocomial post-cesarean endometritis and to propose a rationalized antimicrobial therapy. Material and methods. Sixty six puerperas with post-cesarean endometritis were examined. The spectrum of microflora and its resistance to antimicrobial agents were determined using an automatic microbiological analyzer based on mass spectrometry. Results. Enterococci, E. coli, staphylococci and streptococci were the most clinically significant pathogens found in the examined patients with post-cesarean endometritis. The microflora spectrum in the endometrium reflected the previous «antibacterial history»; this association must be taken into account when developing antibacterial therapy. Conclusion. If the new mother was previously treated with antibacterial agents, it is recommended to use a combination of the reserve antibiotics in order to block the entire spectrum of possible multidrug-resistant pathogens. In cases of the resistant Gram-positive microflora (MRSE, MRSA, E. faecium), it is advisable to prescribe vancomycin. For the resistant Gram-negative microflora (Enterobacter spp., Citrobacter spp., E. coli-ESBL+ and Klebsiella spp.-ESBL+), vancomycin should be combined with carbapenems.

About the Authors

N. A. Korobkov
North-Western State Medical University named after I.I. Mechnikov, Health Ministry of Russian Federation
Russian Federation

Korobkov Nikolay Aleksandrovich – PhD, Associate Professor, Department of Reproductive Health of Women

41, ul. Kirochnaya, Saint Petersburg, 191015



N. N. Volkov
North-Western State Medical University named after I.I. Mechnikov, Health Ministry of Russian Federation; City Mariinsky Hospital
Russian Federation

Volkov Nikolai Nikolayevich – PhD, Assistant, Department of Reproductive Health of Women, NWSMU n.a. I.I. Mechnikov HM of RF

41, ul. Kirochnaya, Saint Petersburg, 191015, 56, Liteiny prospect, Saint Petersburg, 191014



E. R. Tsoy
City Mariinsky Hospital
Russian Federation

Tsoi Ekaterina Rodionovna – Еpidemiologist

56, Liteiny prospect, Saint Petersburg, 191014



S. М. Mikaelyan
City Mariinsky Hospital
Russian Federation

Mikaelyan Siranush Mikaelovna – Еpidemiologist

56, Liteiny prospect, Saint Petersburg, 191014



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For citation:


Korobkov N.A., Volkov N.N., Tsoy E.R., Mikaelyan S.М. Nosocomial post-cesarean endometritis: a rationalized strategy of antibacterial therapy. Obstetrics, Gynecology and Reproduction. 2018;12(2):12-20. (In Russ.) https://doi.org/10.17749/2313-7347.2018.12.2.012-020

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ISSN 2313-7347 (Print)
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