PubMed Health⌕ Search

Biomedical subjects

R S Gibbs

Publications and source records attributed to R S Gibbs.

At least 91 records · Page 5Linked to original sources
PubMed1988

Enterococci in post-cesarean endometritis.

Three hundred eleven patients with post-cesarean endometritis were treated with clindamycin and gentamicin. Isolation of enterococci in the endometrium was associated with use of cephalosporin prophylaxis (P less than .001). Other risk factors for enterococcus-associated endometritis included increased numbers of vaginal examinations (P = .018) and increased length of internal monitoring (P = .006). Patients with enterococcus-associated endometritis were less likely to respond to therapy with clindamycin and gentamicin than were patients without enterococci (82.4 versus 92.7%, respectively; P = .015). Patients with enterococcus-associated endometritis also were significantly more likely to have wound infection (15.7 versus 3.2%, respectively; P = .001). In a retrospective survey of 14 patients with postpartum enterococcal bacteremias, four (29%) had a poor response to initial therapy.

Cesarean Section↗
PubMed1987

Predictors of vaginal delivery in patients with a previous cesarean section, who require oxytocin.

Prospective analysis of 98 consecutive patients at term pregnancy with one previous cesarean section, who received oxytocin during a trial of labor (34 inductions, 64 augmentations), was undertaken to identify specific factors associated with successful vaginal delivery. The overall vaginal delivery rate was 59.2%. Comparing route of delivery in the induction and augmentation groups separately revealed no significant differences in maternal height, weight, or parity, duration of membrane rupture, length of oxytocin treatment or maximum dose, cervical examination on admission or before oxytocin treatment, or use of conduction anesthesia. A previous vaginal delivery favored repeat vaginal delivery in patients with augmentation while a nonrecurrent indication was significantly associated with vaginal delivery in all patients. After the beginning of oxytocin augmentation, the cervical dilatation rate was 1.82 cm/hr in patients delivered vaginally, compared with 0.18 cm/hr in those requiring cesarean section (p less than 0.001). Any cervical dilatation during the first 2 hours of augmentation was associated with more frequent vaginal delivery: 24 of 40 vaginal deliveries (60%) versus six of 24 cesarean sections (25%, p less than 0.01). Discriminant analysis correctly identified route of delivery in 85.3% of those with induction and 87.5% of patients with augmentation. During a trial of labor, oxytocin induction or augmentation is effective in a majority of patients. Furthermore, an early response during augmentation is of predictive value when such patients are being managed.

Cervix Uteri↗
PubMed1987

Microbiology of the female genital tract.

Patients who contract genital tract infections are predominantly young, are otherwise healthy, and generally respond well to treatment for bacterial infections. These infections are most commonly polymicrobial in etiology, with several noteworthy exceptions. Often there is an inciting event such as childbirth, surgical intervention, pregnancy termination or intrauterine contraceptive device insertion. With treatment, prognosis for cure is excellent; however, sequelae such as recurrent infections, infertility, or ectopic pregnancy can be serious. Bacteria encountered in the female genital tract can be divided into aerobic and anaerobic organisms. Among the aerobic gram-positive organisms, several varieties of streptococci such as Group B streptococci and enterococci occur frequently. Staphylococcus aureus is an infrequent but important pathogen. Among the aerobic gram-negative organisms, the most common is Escherichia coli. Klebsiella sp. and Proteus sp. occur in about 5% of genital tract infections. Species that are more resistant to antibiotics, such as Pseudomonas aeruginosa and Enterobacter sp., occur in approximately 1% or 2% of these cases and are more likely to appear in patients who have previously received antibiotic therapy or who have been hospitalized for some time. Among the anaerobic organisms, the most common gram-positive isolates are Peptostreptococci and Peptococci. Clostridia sp. occurs less frequently. Among the anaerobic gram-negative organisms, the Bacteroides sp. most frequently encountered are Bacteroides bivius and Bacteroides disiens. Bacteroides fragilis is still a common problem but appears to be less predominant. Other organisms encountered are Chlamydia trachomatis, the genital mycoplasmas, yeasts, protozoa, and viruses.

Bacteria↗
PubMed1987

Microbiologic and serologic studies of Gardnerella vaginalis in intra-amniotic infection.

Our objective was to investigate the role of Gardnerella vaginalis in intra-amniotic infection by use of comparative, quantitative cultures on selective media and by detection of maternal antibody response. Amniotic fluid was collected from patients with intra-amniotic infection and from matched control women. In addition to media for aerobes, anaerobes, and mycoplasmas, we used V agar-selective (Remel, Lenexa, KS) to isolate G vaginalis. Acute and convalescent maternal sera were collected and assayed for antibodies by a microenzyme-linked immunosorbent assay (ELISA) prepared against whole cells of G vaginalis. Gardnerella vaginalis was isolated in the amniotic fluid of 24 (28%) of the 86 patients with intra-amniotic infection, but this was not significantly different from the isolation rate in amniotic fluid of 86 matched controls (21%). No patient exhibited G vaginalis bacteremia. The ELISA performed on paired sera of selected patients showed that 25 had intra-amniotic infection (eight G vaginalis-positive, 17 negative), and 18 were asymptomatic (seven G vaginalis-positive, 11 negative). The amount of G vaginalis antibodies detected by ELISA in acute sera was similar in all four groups. Mean changes during convalescence were small (.053-.084 optical density units) and not significantly different. Although G vaginalis is found commonly in amniotic fluid of patients with intra-amniotic infection, the data do not support a pathogenic role for this organism; however, a facilitating role in polymicrobial infection cannot be excluded.

Amnion↗
PubMed1987

A microbiologic and clinical study of placental inflammation at term.

This study describes the relationships between histologically evident inflammation of the placenta, membranes, and umbilical cords, and correlates these lesions with clinical outcome and with amniotic fluid and amniotic membrane cultures in pregnancies at risk for clinical infection. The overall frequency of inflammation in 123 placentas was 85.45%. There were good interrelationships between inflammatory lesions at various sites. Membrane infiltrates of 3+ were seen in 90.9% of intra-amniotic infection cases, but in only 18.4% of asymptomatic patients (P less than .001). Conversely, 76.9% of patients with 3+ inflammation had intra-amniotic infection, whereas only 7% with lesser degrees of inflammation had intra-amniotic infection. Inflammation of any degree (1-3+) had a low specificity (28%) for febrile maternal outcome. Bacteria were recovered in 117 (95.1%) of the amniotic fluids. The grade of histologic lesions was associated with total colony count of bacteria in amniotic fluid (P less than .05) and with high-virulence bacteria in amniotic fluid (P less than .05), and Mycoplasma hominis in amniotic fluid (P less than .05). Bacteria were found in 67.6% and mycoplasmas in 18.6% of amniotic membrane cultures. Chlamydia trachomatis was not recovered in any of 35 amniotic membrane cultures. No significant correlation was seen between organisms in the amniotic membrane and histologic inflammation. Thus, positive amniotic fluid culture results are associated with histologic inflammation, and may cause the inflammatory response. A logistic regression model revealed that predictors of histologic inflammation include maternal diagnosis, amniotic fluid colony count, and M hominis in amniotic fluid.

Adult↗
PubMed1987

A comparison of intrapartum versus immediate postpartum treatment of intra-amniotic infection.

There are no reported randomized trials to determine the ideal timing of antibiotic treatment for intra-amniotic infection. We evaluated the effect of intrapartum versus immediate postpartum treatment of intra-amniotic infection on maternal and neonatal morbidity and mortality. Two hundred fifty-seven women with clinically diagnosed intra-amniotic infection who had amniotic fluid cultures were evaluated. Patients received treatment with penicillin and gentamicin, but the timing of the treatment was determined at the physician's discretion. Most patients (82%) received intrapartum treatment; the remaining women (18%), mainly those with an anticipated short interval before delivery, received the same antibiotics immediately postpartum. As expected, the postpartum treatment group had a significantly shorter diagnosis-to-delivery interval (1.9 +/- 2.1 versus 4.7 +/- 4.3 hours; P less than .001) and a lower maximum temperature during labor (100.8 +/- 0.7 versus 101.0 +/- 0.8F; P = .038). The two treatment groups did not differ in distribution of low birth weight infants, frequency of maternal bacteremia, mode of delivery, or organisms isolated from the amniotic fluid. There were no differences in maternal outcome, but the incidence of neonatal sepsis was significantly lower in the intrapartum treatment group (2.8 versus 19.6%; P less than .001). Neonatal mortality from sepsis was also lower in the intrapartum treatment group (0.9 versus 4.3%), but this difference was not statistically significant. The reduced frequency of neonatal septicemia observed in the intrapartum-treated group might reflect early intrauterine therapy for the infected fetus.

Adult↗
PubMed1987

Detection of serum antibody response to Bacteroides bivius by enzyme-linked immunosorbent assay in women with intraamniotic infection.

Amniotic fluid from patients with intraamniotic infection usually reveals multiple organisms, including aerobes, anaerobes, and mycoplasmas. Bacteroides bivius, one of the most common isolates in these fluids, is found in approximately 20% of cases. To provide further information of the role of B bivius in intraamniotic infection, we measured serum immunoglobulin G (IgG) against B bivius by a micro-enzyme linked immunosorbent assay. Antigen was prepared from whole cells of a clinical isolate. Amniotic fluid was collected by aspiration of a transcervical pressure catheter, and was cultured for aerobes, anaerobes, and mycoplasmas. Acute and convalescent sera from 47 infected women and 31 controls were assayed to detect serologic response. Patients with intraamniotic infection and B bivius in amniotic fluid culture had significantly greater serologic responses than did infected women without B bivius in amniotic fluid and asymptomatic controls. These data suggest a pathogenic role of B bivius in intraamniotic infection, and imply that it probably plays a frequent role in other obstetric infections.

Adult↗
PubMed1986

Further studies on genital mycoplasmas in intra-amniotic infection: blood cultures and serologic response.

Mycoplasma hominis is recovered significantly more often in amniotic fluid of women with intra-amniotic infection than in matched control women, but Ureaplasma urealyticum is found in 50% of amniotic fluid samples of both groups. To gain further understanding, we performed blood cultures for genital mycoplasmas and measured serologic responses by a micro enzyme-linked immunosorbent assay method in women with intra-amniotic infection and in control subjects. In blood cultures of 81 women with intra-amniotic infection, M. hominis was isolated in two (2.5%) and U. urealyticum in 11 (13.6%). In 44 control blood cultures, M. hominis was not isolated, and U. urealyticum was recovered in eight (18.2%). These differences were not significant. Serologic response was determined in 86 patients. Rise in antibody to M. hominis was significantly more common in women with intra-amniotic infection and M. hominis in the amniotic fluid than in either women with intra-amniotic infection or control patients without M. hominis. For U. urealyticum antibody response was significantly more common in the intra-amniotic infection group than in control subjects, but there was no association between antibody response and isolation of this organism in amniotic fluid. When M. hominis was found in amniotic fluid or maternal blood, patients were nearly always symptomatic. The high likelihood of serologic response in these cases supports a pathogenic role of M. hominis in intra-amniotic infection. The role of U. urealyticum remains unclear.

Adult↗
PubMed1986

The in vivo effect of amniotic fluid on endocervical microflora.

To test the in vivo effect of amniotic fluid on endocervical microflora, we performed endocervical cultures before and after rupture of the membranes in 20 patients in term labor. There were no significant qualitative or quantitative differences in aerobic or anaerobic isolates for up to 4 hours after membrane rupture. Group B streptococci, isolated in two patients (10%), persisted after rupture of the membranes. These data suggest that endocervical cultures are minimally influenced by rupture of the chorioamnion for at least 4 hours.

Amniotic Fluid↗
PubMed1986

Genital aerobic bacterial flora of women receiving radiotherapy for gynecologic malignancy.

In the present study, genital aerobic bacterial flora was prospectively studied in 12 women receiving radiotherapy for gynecologic malignancy. Gram-positive cocci accounted for 59% and gram-negative bacilli for 27% of the 26 cervical or vaginal isolates preradiation. A similar pattern of recovery was found during external beam, 60CO whole pelvis radiotherapy. The gram-positive cocci and gram-negative bacilli accounted for 42 and 46% of the preradiotherapy rectal isolates, respectively. There was no significant change in the pattern of rectal flora during external beam radiotherapy. Thus, results from this preliminary study would indicate that external beam radiotherapy has little or no influence on the major aerobic pathogens in either the cervix, vagina, or rectum.

Adenocarcinoma↗
PubMed1986

Sperm washing and swim-up technique using antibiotics removes microbes from human semen.

Pelvic infections may follow intrauterine or intratubal insemination with washed semen. In this study, we determined whether sperm washing removes microorganisms from human semen. Before and after semen wash, we cultured 15 ejaculates for aerobic and anaerobic bacteria, genital mycoplasma, and chlamydia. All semen samples had from one to five organisms isolated (total, 40 isolates) before the semen wash preparation. The mean number (+/- standard deviation) of isolates per sample was 2.67 +/- 1.35. After the semen were prepared, none of the samples showed a positive culture. The decrease in the number of samples with positive cultures and the decrease in the number of isolates is significant (P less than 0.0001). After sperm washing, electronmicroscopic studies did not show any microbes attached to any portion of the spermatozoa. We conclude that the method of sperm wash preparation used is effective in removing microbes present in human semen.

Anti-Bacterial Agents↗
PubMed1986

Infection control of herpes simplex virus infections in obstetrics and gynecology.

The rising incidence of herpes simplex virus (HSV) infections and concern about nosocomial transmission require the establishment of effective, reasonable infection control measures. Guidelines are based on the knowledge that herpes is usually transmitted by direct contact but may also be spread by droplets. Obstetric inpatients with evidence of HSV infection, including lesions or a positive culture, should be given a private room and bathroom. Gown and glove precautions should be taken by hospital personnel in contact with contaminated areas or articles. Perineal pads and bed linens should be handled as infected discharges and double bagged. The mother can handle and feed her infant under supervision. Infants with suspected herpes infections should be kept in a special care, observation or isolation nursery unit. Hospital personnel with herpetic lesions on exposed body surfaces should not work with newborns, if possible. They may work with obstetric patients if the lesions are covered and strict hand washing is employed. To avoid herpetic whitlow, gloves should be worn on both hands when handling suspicious lesions. An employee with active herpetic whitlow must wear a glove on the involved hand while working in patient care areas. Anecdotal reports suggest that acyclovir is of value in suppressing whitlow.

Cross Infection↗
PubMed1986

Effect of amniotic fluid bacteria on the course of labor in nulliparous women at term.

Patients with intraamniotic infection have an increased rate of cesarean delivery. To determine whether bacterial colonization of amniotic fluid affects uterine activity or delivery outcome, serial amniotic fluid samples were collected from 41 nulliparous patients in active labor with ruptured membranes for longer than 12 hours. To define positive changes, these samples were divided arbitrarily by colony count change using an increase of less than 10(2) colony-forming units per milliliter; greater than or equal to 10(2) but less than 10(4) colony forming units per milliliter; or greater than or equal to 10(4) colony forming units per milliliter. Nineteen, seven, and 15 sample sets fulfilled these criteria, respectively. Comparing serial samples with these changes in colony count revealed no significant difference in ten labor and delivery variables. Based on virulence of the isolates identified, samples were then divided into high (N = 19) or low (N = 16) virulence in both samples. Compared with sample sets with persistently low-virulence organisms, sample sets with persistently high-virulence isolates had a lower cervical dilatation rate (0.49 +/- 0.39 versus 0.98 +/- 0.58 cm/hour, P = .04), despite an increased maximum oxytocin dose (10.0 +/- 8.0 versus 5.4 +/- 5.2 mU/minute, P = .03). Controlling for birth weight, labor length, and epidural, magnesium sulfate, and oxytocin use, it was found that patients with high-virulence bacteria also had a higher cesarean section rate (57.9 versus 25.0%, P = .05). These results support a causal relationship between high-virulence bacteria in the amniotic fluid and poor cervical dilatation response to oxytocin in patients at risk for the development of intrapartum infection.

Amniotic Fluid↗
PubMed1985

Asymptomatic parturient women with high-virulence bacteria in the amniotic fluid.

This study describes the postpartum course of asymptomatic parturient women who had greater than or equal to 10(2) cfu of high-virulence (HV) bacteria per milliliter of amniotic fluid. Of 60 asymptomatic parturient women with greater than or equal to 10(2) cfu of HV bacteria per milliliter of amniotic fluid, 27 (48%) remained asymptomatic in the puerperium, 16 (27%) developed fever only, and 17 (28%) developed endometritis. In asymptomatic versus symptomatic women, there were no statistically significant differences in number or type of isolates or in length of membrane rupture or labor-to-collection interval. However, there were significant differences in the intervals from collection to delivery and in the rate of cesarean section delivery. For comparison, 40 of these patients were matched with women in whom only low-virulence organisms were detected in the amniotic fluid. In the HV group, 16 women (40%) remained asymptomatic, 15 (37.5%) developed fever only, and nine (22.5%) had endometritis. In the low-virulence group, 27 women (67.5%) remained asymptomatic, 10 (25%) developed fever only, one (2.5%) developed endometritis 10 days post partum, and two (5%) had other infections (p less than 0.01). Clinically evident uterine infection depends upon type and numbers of bacteria in utero, duration of bacteria in utero, and route of delivery.

Adult↗
PubMed1985

Aminoglycoside dosing in obese puerperal women.

We compared serum aminoglycoside levels in two groups of obese puerperal women being treated for endometritis. In these obese puerperal women (weights as much as 100 kg), the aminoglycoside dose did not have to be adjusted for excess weight initially, but it seems that determination of antibiotic levels should be performed in view of the large doses.

Adult↗