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Biomedical subjects

M Maccato

Publications and source records attributed to M Maccato.

At least 19 recordsLinked to original sources
PubMed1998

Penetration of trovafloxacin into gynecologic tissues.

BACKGROUND: This randomized open-label study assessed the penetration into gynecologic tissues of trovafloxacin, a new broad-spectrum, fourth-generation fluoroquinolone with in vitro activity against anaerobes, gram-positive, gram-negative, and atypical pathogens. METHODS: Women undergoing hysterectomy or hysterectomy and adnexectomy received 200 mg trovafloxacin orally before surgery as a single dose or as multiple doses. Samples of genital tract tissue and serum were obtained simultaneously during surgery. RESULTS: In the single-dose group, trovafloxacin concentrations in genital tract tissues were measurable for up to 30 hours. Tissue concentrations of trovafloxacin after multiple doses were comparable to those after single doses. Mean tissue: serum concentration ratios after a single dose were greatest in the ovary (1.6 microg/g) and comparable in uterus, myometrium, cervix, and fallopian tubes (0.5 to 0.7 microg/g). Adverse events after a single dose were minor. CONCLUSIONS: A daily dose of 200 mg trovafloxacin produces gynecologic tissue concentrations that persist for up to 30 hours at levels necessary to prevent or treat pelvic infections. This dosing regimen is well tolerated.

Administration, Oral↗
PubMed1995

Development of wound infection or separation after cesarean delivery. Prospective evaluation of 2,431 cases.

Wound infections are a common surgical complication, often requiring a prolonged hospital stay and leading to increased costs. Over a one-year period, 2,431 patients were followed after cesarean delivery with prompt evaluation and culture of all suspicious wounds. Seventy subjects (2.8%) developed confirmed wound infection, and 42 (1.7%) developed noninfected open surgical wounds. Seven (0.3%) fascial dehiscences were diagnosed, requiring surgical repair. Forty of 63 (64%) infected wounds had positive bacterial cultures, with Staphylococcus epidermidis (29%), Enterococcus faecalis (17%), Staphylococcus aureus (17%), Escherichia coli (11%) and Proteus mirabilis (10%) the most frequent isolates. Only 7 of 42 (17%) noninfected wounds had positive cultures, with only S aureus, S epidermidis and Corynebacterium species isolated. Ninety-five percent of the noninfected wounds had blood or serous collections present. Rupture of membranes lasting longer than six hours, emergency cesarean delivery and morbid obesity were associated with a statistically increased likelihood of the development of infected wounds. Emergency cesarean delivery and morbid obesity, but not prolonged rupture of membranes, were associated with an increased likelihood of the development of noninfected wounds. Therefore, it appears that at least two mechanisms are responsible for the development of postcesarean open wounds: (1) increased amniotic fluid and wound colonization due to prolonged rupture of membranes, resulting in a wound infection containing one or more bacterial species derived from the cervicovaginal flora, and (2) increased exogenous bacterial contamination and flora consistent with skin species or breaks in sterile technique, often accompanying difficult or emergency surgery.

Bacterial Infections↗
PubMed1993

Vaginal flora and pelvic inflammatory disease.

Forty-one patients with acute pelvic inflammatory disease were evaluated for the coexistence of bacterial vaginosis. Because all patients had a copious purulent vaginal discharge, microscopic criteria could not be used and microbiologic criteria were employed. The vaginal bacterial flora were not consistent with that of bacterial vaginosis, because Lactobacillus and other gram-positive bacteria dominated with colony counts of 10(3) to 10(5) cfu/ml (colony-forming units per milliliter). Endocervical specimens yielded Neisseria gonorrhoeae from 20 patients and Chlamydia trachomatis from 11 patients. Anaerobes were not dominant in any site sampled. A total of 147 bacteria were isolated from the endometrium, 16 (11%) of which were anaerobes. Thus the endogenous bacterial flora were not consistent with that of the microbiologic definition of bacterial vaginosis. N. gonorrhoeae was the most common isolate from the endocervix and endometrium; it was isolated three times more frequently from the endocervix and two times more frequently from the endometrium than was C. trachomatis.

Adolescent↗
PubMed1993

Prevalence of beta-lactamase enzyme production in bacteria isolated from women with postpartum endometritis.

One hundred eighty-four postpartum patients with the diagnosis of endomyometritis underwent intrauterine culturing. Beta-Lactamase production was tested using nitrocephin-impregnated discs in 278 bacterial isolates from patients with postpartum endometritis. beta-Lactamase production was found to be present in 149 of 278 (54%) isolates tested: 0 of 39 Streptococcus faecalis (0%), 22 of 41 Escherichia coli (54%), 66 of 68 Bacteroides bivius (97%), 0 of 13 Proteus mirabilis (0%) and 15 of 42 Staphylococcus epidermidis (36%). Anaerobes, as a group, had the highest rate of beta-lactamase production, 94 of 102 (93%), followed by gram negatives, 34 of 84 (40%), then gram positives, 21 of 91 (23%). However, it was the beta-lactamase produced by the gram-negative bacteria that was most responsive to the addition of a beta-lactamase inhibitor. The frequent isolation of beta-lactamase-producing bacteria from patients with postpartum endometritis raises concern about the use of antibiotics not resistant to these enzymes. Therefore, antibiotics combined with a beta-lactamase inhibitor may have potential as single-agent therapy in obstetric and gynecologic infections.

Ampicillin↗
PubMed1993

The microbiology of post-cesarean wound morbidity.

OBJECTIVE: To determine the microbiology of wound morbidity following cesarean deliveries. METHODS: Nine hundred thirty-nine wounds in post-cesarean patients were followed prospectively. Aspirates from the abdominal incision were collected if the wounds developed erythema, induration, or pain and had demonstrable fluid collection noted on ultrasound. Cultures were also obtained of wound exudates when there was spontaneous separation of the skin. Gram stains were performed concomitantly with culture. RESULTS: The cumulative incidence of post-cesarean wound morbidity between September 1990 and June 1991 was 6.9% (65 of 939), and the rate of culture-positive wounds was 72% (47 of 65). Ureaplasma urealyticum was the most frequent isolate at a rate of 62% (29 of 47), followed by coagulase-negative staphylococci at 32% (15 of 47) and Enterococcus faecalis at 28% (13 of 47). Gram stains of the exudates obtained were used to predict microbiologic results. Organisms present on Gram stain yielded a sensitivity of 0.55, specificity of 1.0, positive predictive value of 1.0, and negative predictive value of 0.71 when used to predict positive culture results for bacterial wound infection other than with genital mycoplasmas. White blood cell counts greater than ten per 400x high-power fields yielded a sensitivity of 0.83, specificity of 0.72, positive predictive value of 0.89, and negative predictive value of 0.62 when used to predict wound infection including genital mycoplasmas. CONCLUSIONS: Genital mycoplasmas are the most prevalent bacterium in post-cesarean wound infections in this population. If genital mycoplasmas are pathogenic in this setting, then the Gram stain may be useful in predicting wound microbiology. More research is needed on the pathogenic role of genital mycoplasmas in wound infections.

Adult↗
PubMed1992

Prevalence of active Chlamydia trachomatis infection at the time of exploratory laparotomy for ectopic pregnancy.

Cultures of the fallopian tube, cul-de-sac, and cervix were obtained from 50 patients undergoing exploratory laparotomy for ectopic pregnancy. Chlamydia trachomatis was cultured from the cervix in four patients (8%). All the cultures from the fallopian tube or cul-de-sac were negative. Immunofluorescent stain of deparaffinized cross-sections of fallopian tube at the site of tubal involvement with the ectopic pregnancy failed to reveal any C trachomatis inclusions.

Adolescent↗
PubMed1991

Effectiveness of ofloxacin in the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae cervical infection.

Forty patients with cervical infection caused by Chlamydia trachomatis were treated with ofloxacin (20) or doxycycline (20). Ofloxacin was successful in eradicating C. trachomatis from all 20 (100%) patients. Doxycycline was effective in 18 of 20 (90%) patients. Three patients had a concomitant cervical gonococcal infection. All three were successfully treated: one with ofloxacin and two with doxycycline. Ofloxacin, 300 mg, taken twice daily for 7 days, is effective in eradicating endocervical C. trachomatis infection.

Adolescent↗
PubMed1991

Susceptibility of female pelvic pathogens to oral antibiotic agents in patients who develop postpartum endometritis.

Fifteen hundred patients were enrolled in a prospective, randomized study on the effect of antibiotic prophylaxis during cesarean section. Two hundred thirty-one patients developed postpartum endometritis, and the isolates obtained from the endometrium were tested for sensitivity to ampicillin, cefuroxime, ofloxacin, ciprofloxacin, and clindamycin. Minimum inhibitory concentrations of 50% and 90% of ampicillin, cefuroxime, and clindamycin were similar to previously reported values; however, slight differences were noted in the activity of the two quinolones to common pelvic isolates. The minimum inhibitory concentrations of 90% of ofloxacin and ciprofloxacin to 119 isolates of Enterococcus faecalis were 4.0 and 2.0, to 17 isolates of Staphylococcus aureus 1.0 and 0.5, to 39 isolates of Escherichia coli 0.5 and 1.0, to 46 isolates of Bacteroides bivius 4.0 and 8.0, to 57 isolates of Gardnerella vaginalis 1.0 and 2.0, to 71 isolates of Staphylococcus epidermidis 0.5 and 0.5, to 16 isolates of Proteus mirabilis 0.25 and 0.12, and to 50 isolates of Lactobacillus species 32.0 and 8.0 micrograms/ml, respectively. In summary, the quinolones have activity comparable with a variety of other oral agents versus female pelvic pathogens, with the quinolones ofloxacin and ciprofloxacin having better activity against most of the gram-negative isolates. Anaerobic activities were comparable with the beta-lactams, but inferior to clindamycin and metronidazole as expected.

Administration, Oral↗
PubMed1991

Respiratory insufficiency due to pneumonia in pregnancy.

Respiratory insufficiency is a common complication of pneumonia in pregnancy. Respiratory insufficiency may progress to respiratory failure, requiring mechanical ventilation. Prompt diagnosis of the pneumonia and rapid institution of supportive care and effective antimicrobial therapy results in the best possible outcome for both mother and fetus. If the patient requires mechanical ventilation, resolution of the pneumonia usually allows for uneventful weaning from the respirator.

Female↗
PubMed1990

Treatment of postpartum endometritis.

In this study, cefoxitin alone (2 gm, every 8 hours) was generally sufficient to cure postpartum endometritis, even when the patient had received prophylaxis with a beta-lactam antibiotic. When single-agent therapy fails, addition of ampicillin usually results in a prompt clinical response.

Cefoxitin↗
PubMed1990

Comparison of cefotaxime, cefoxitin and clindamycin plus gentamicin in the treatment of uncomplicated and complicated pelvic inflammatory disease.

Patients with uncomplicated pelvic inflammatory disease (PID) (acute salpingitis and no pelvic masses) were randomly assigned for treatment with either cefotaxime or cefoxitin. A clinical cure was achieved in 17 of 20 cases (82%) and 19 of 22 cases (84%), respectively. Within the complicated PID group, patients were assigned to two subgroups: those with a tubo-ovarian complex (26 patients), and those with a tubo-ovarian abscess (32 patients), as confirmed by ultrasonography or surgery. Patients within each of these two subgroups were then randomly assigned for treatment with either cefotaxime or clindamycin plus gentamicin. Within the tubo-ovarian complex subgroup, a clinical cure was achieved in 11 of 13 cases (85%) treated with cefotaxime and 10 of 13 cases (77%) treated with clindamycin plus gentamicin. Within the tubo-ovarian abscess subgroup, a clinical cure was achieved in 12 of 16 cases (75%) treated with cefotaxime and 11 of 16 cases (69%) treated with clindamycin plus gentamicin. No differences in any category were statistically significant. Specimens for culture were obtained from the endocervix, endometrium, and when possible, the cul-de-sac, fallopian tubes, and abscess. Neisseria gonorrhoeae (33%) was isolated more frequently than Chlamydia trachomatis (12%) in patients with PID, and neither of these organisms was isolated with any increased frequency in patients with complicated PID. The majority of the patients were considered to have polymicrobial infection. Cefotaxime was as efficacious as cefoxitin and clindamycin plus gentamicin for the treatment of acute salpingitis, tubo-ovarian complex and tubo-ovarian abscess.

Adolescent↗
PubMed1990

Ampicillin/sulbactam versus clindamycin in the treatment of postpartum endomyometritis.

Sixty-eight patients with postpartum endomyometritis were enrolled in this open randomized comparative study. Forty-two patients received ampicillin/sulbactam and 26 received clindamycin. The cure rates were similar in the two groups: 83% in the ampicillin/sulbactam group and 88% in the clindamycin group. The most frequent endometrial bacterial isolates were Bacteroides bivius, Streptococcus faecalis, Escherichia coli, and Ureaplasma urealyticum. Bacteremia was present in 15 of 68 (22%), the most frequent isolates being Mycoplasma (four cases) and B bivius (three cases). Clindamycin-resistant species were S faecalis, E coli, and Proteus mirabilis. There were seven treatment failures in the ampicillin/sulbactam group; only one isolate (an E coli) was resistant to ampicillin/sulbactam. In a significant number of these failures, Mycoplasma was isolated. Ampicillin/sulbactam and clindamycin were found to be equally efficacious in the treatment of postpartum endometritis.

Adult↗
PubMed1990

Pelvic pain and infections.

Infectious etiologies of both acute and chronic pelvic pain are common and may involve multiple organ systems. In the evaluation of the acute pain, it is important to remember that rapidity of diagnosis is important because of the possibility of significant morbidity and even death if a condition is not attended to rapidly. In recent years, laparoscopic evaluation of the pelvis has provided a better understanding of the pathophysiology of some of these infections, as well as possible therapeutic maneuvers. The evaluation of chronic pelvic pain requires a thorough attempt at careful diagnosis with minds open to the possibility that other organ systems besides the genital tract may be involved. Laparoscopy also may be an important diagnostic and therapeutic tool in the evaluation of the sequelae of pelvic inflammation leading to chronic pelvic pain. All therapeutic modalities that are instituted on the basis of the diagnostic evaluation must take into consideration that a strong emotional component is generally associated with chronic pelvic pain. Such components must be addressed in order to achieve the best possible results for the patient.

Abdominal Pain↗
PubMedDate not supplied

Sulbactam/ampicillin versus metronidazole/gentamicin in the treatment of post-cesarean section endometritis.

Sixty-seven patients diagnosed with post-cesarean-section endometritis were studied in a prospective comparative randomized trial of sulbactam/ampicillin, a new beta-lactamase inhibitor drug combination, versus treatment with metronidazole/gentamicin. The success rate was 91% for each antibiotic regimen. Mycoplasma spp. or Ureaplasma spp. were isolated from all treatment failures. Endometrial cultures revealed 2.3 aerobes as well as anaerobes per patient, with Enterococcus faecalis, Bacteroides bivius, and Escherichia coli the most frequently reported bacterial isolates in 64, 40, and 28% of all patients, respectively. Positive blood cultures were noted in 11 (15%) patients with Mycoplasma sp. the most commonly found isolate (45.5%). Sulbactam/ampicillin appears to be safe and equally effective as a metronidazole/aminoglycoside drug regimen in the treatment of postpartum endometritis.

Adult↗
PubMedDate not supplied

Wound infections after cesarean section with Mycoplasma hominis and Ureaplasma urealyticum. A report of three cases.

Mycoplasma hominis and Ureaplasma urealyticum were isolated from the surgical wounds of three patients who developed endometritis and a wound infection after cesarean section. In all patients, aspiration of the incision yielded a cloudy serosanguinous exudate. Gram stain of the fluid revealed numerous white blood cells but no bacteria. All patients responded to antibiotic therapy and local wound care.

Adolescent↗