Pastorek J G, Sanders C V
Department of Obstetrics and Gynecology, Louisiana State University Medical Center, New Orleans.
Rev Infect Dis. 1991 Jul-Aug;13 Suppl 9:S752-7. doi: 10.1093/clinids/13.supplement_9.s752.
Puerperal uterine infection, or endomyometritis, occurs more commonly after cesarean section than after vaginal birth. With the rate of cesarean delivery almost 25% of all births in this country, such infection is relatively common. The classic therapy for postcesarean endomyometritis is the combination of clindamycin and an aminoglycoside, usually gentamicin or tobramycin. This regimen has requisite antimicrobial activity against the aerobes and anaerobes of the cervicovaginal flora that usually cause this illness. In the last decade, however, the availability of broad-spectrum beta-lactam antibiotics has enabled the clinician to combat postcesarean infection with single-agent antimicrobial chemotherapy, or monotherapy. "Higher-generation" cephalosporins such as cefoxitin, cefotetan, and moxalactam, as well as the semisynthetic penicillins ticarcillin, piperacillin, and mezlocillin, have all been used alone in the therapy for postpartum infection. The addition of a beta-lactamase inhibitor to this class of drugs now offers a further resource to the practitioner if beta-lactamase-mediated antibiotic resistance arises in the patient population being treated.
产褥期子宫感染，即子宫内膜炎，在剖宫产术后比经阴道分娩后更常见。在该国，剖宫产率几乎占所有分娩的25%，因此这种感染相对较为普遍。剖宫产术后子宫内膜炎的经典治疗方法是克林霉素与氨基糖苷类药物联合使用，通常是庆大霉素或妥布霉素。该方案对通常导致这种疾病的宫颈阴道菌群中的需氧菌和厌氧菌具有必要的抗菌活性。然而，在过去十年中，广谱β-内酰胺类抗生素的出现使临床医生能够使用单药抗菌化疗（即单一疗法）来对抗剖宫产术后感染。“更高代”的头孢菌素，如头孢西丁、头孢替坦和拉氧头孢，以及半合成青霉素替卡西林、哌拉西林和美洛西林，都曾单独用于产后感染的治疗。如果在接受治疗的患者群体中出现β-内酰胺酶介导的抗生素耐药性，在这类药物中添加β-内酰胺酶抑制剂现在为从业者提供了进一步的选择。
