Faro S
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Obstet Gynecol Clin North Am. 1988 Dec;15(4):685-95.
Patients delivered by cesarean section are at risk for postoperative infectious morbidity, especially those patients who have labored with ruptured membranes for a long period of time. The bacteria involved in these infections are predominantly those of the patient's lower genital tract, both aerobes and anaerobes. Antibiotic prophylaxis has reduced the risk of postpartum infection but has also resulted in selection of resistant bacteria. Treatment of postpartum endometritis has classically been with clindamycin plus an aminoglycoside. However, the newer beta-lactam antibiotics have proved to be just as efficacious. A significant advance in the treatment of postpartum endometritis is the use of beta-lactamase inhibitors combined with beta-lactams, such as clavulanic acid plus ticarcillin or ampicillin plus sulbactam. Regardless of which antibiotic is chosen for treatment, it is important to know the weakness of each antibiotic. For example, cephalosporins such as cefoxitin or cefotetan do not have activity against Strep. faecalis, Ent. cloacae, or Pseudomonas aerugenosa; mezlocillin, ticarcillin, or piperacillin tend to be weakest against the gram-negative facultative anaerobes; and combinations such as clindamycin plus gentamicin do not provide coverage against Strep. faecalis. This knowledge of the weakness of the different antibiotics permits appropriate additions to the antibiotic regimen and avoids irrational changes in antibiotic therapy.
剖宫产分娩的患者术后有发生感染性并发症的风险，尤其是那些胎膜破裂后长时间临产的患者。这些感染中涉及的细菌主要是患者下生殖道的细菌，包括需氧菌和厌氧菌。抗生素预防降低了产后感染的风险，但也导致了耐药菌的产生。产后子宫内膜炎的经典治疗方法是克林霉素加氨基糖苷类抗生素。然而，新型β-内酰胺类抗生素已被证明同样有效。产后子宫内膜炎治疗的一项重大进展是使用β-内酰胺酶抑制剂与β-内酰胺类药物联合使用，如克拉维酸加替卡西林或氨苄西林加舒巴坦。无论选择哪种抗生素进行治疗，了解每种抗生素的弱点都很重要。例如，头孢西丁或头孢替坦等头孢菌素对粪肠球菌、阴沟肠杆菌或铜绿假单胞菌没有活性；美洛西林、替卡西林或哌拉西林对革兰氏阴性兼性厌氧菌的抗菌活性往往最弱；而克林霉素加庆大霉素等联合用药方案对粪肠球菌没有覆盖作用。了解不同抗生素的弱点有助于在抗生素治疗方案中合理添加药物，并避免不合理地更换抗生素治疗。
