Chow A W, Marshall J R, Guze L B
J Infect Dis. 1977 Mar;135 Suppl:S35-9. doi: 10.1093/infdis/135.supplement.s35.
The responses to therapy with either clindamycin alone or penicillin plus chloramphenicol in 77 patients with septic abortions were compared in a randomized, double-blind study. Although fever index and duration of hospitalization were similar for both groups of patients, significantly more patients in the group that received clindamycin developed major complications (P less than 0.05). This is believed to result from clindamycin's lack of activity against aerobic gram-negative bacilli. Aggressive management that included early uterine evacuation and broad-spectrum antibiotics effective against both aerobic and anaerobic bacteria was the key to reduced morbidity and mortality rates in treatment of septic abortion. For patients treated with clindamycin, early uterine evacuation appeared more important than antibiotic therapy (P less than 0.005). Bacteremia was documented in a total of 29 patients (38%). Bacteremia was polymicrobial in eight patients (28%) and involved anaerobes exclusively in 18 (62%), aerobes exclusively in nine (31%), and both aerobes and anaerobes in two (7%). The organisms most frequently isolated were Bacteroides (other than Bacteroides fragilis), Peptostreptococcus, and Escherichia coli.
在一项随机双盲研究中，对77例流产后败血症患者单独使用克林霉素或青霉素加氯霉素治疗的反应进行了比较。尽管两组患者的发热指数和住院时间相似，但接受克林霉素治疗的组中发生严重并发症的患者明显更多（P<0.05）。这被认为是由于克林霉素对需氧革兰氏阴性杆菌缺乏活性所致。积极的治疗措施，包括早期清宫和对需氧菌及厌氧菌均有效的广谱抗生素，是降低流产后败血症发病率和死亡率的关键。对于接受克林霉素治疗的患者，早期清宫似乎比抗生素治疗更为重要（P<0.005）。共有29例患者（38%）记录有菌血症。8例患者（28%）的菌血症为多种微生物感染，18例（62%）仅涉及厌氧菌，9例（31%）仅涉及需氧菌，2例（7%）同时涉及需氧菌和厌氧菌。最常分离出的病原体为拟杆菌属（脆弱拟杆菌除外）、消化链球菌属和大肠杆菌。
