Department of Obstetrics and Gynecology, Galilee Medical Center, Nahariya, Israel; Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Eur J Obstet Gynecol Reprod Biol. 2020 Jun;249:42-46. doi: 10.1016/j.ejogrb.2020.04.011. Epub 2020 Apr 27.
Cesarean sections, particularly non-elective cesareans, are an important risk factor for the development of postpartum endometritis, a leading cause of postpartum febrile morbidity. We evaluated the yield of obtaining routine intrauterine culture during elective and non-elective cesarean sections, in the prevention and management of postpartum endometritis.
A retrospective comparative study investigating the distribution of uterine cultures obtained immediately after fetus and placenta delivery during cesarean sections performed in a single tertiary hospital during 2017. True pathogenic bacteria were included in the study analysis and considered as positive results, while other contaminant bacteria were excluded.
Positive uterine cultures were identified in 10.7 % (88/821) of cesarean sections, with no significant difference in prevalence between elective and non-elective cesareans. Escherichia coli (E.coli), isolated in 40.9 % of the positive cultures of all women, was the most common organism in non-elective cesareans vs. Group B Streptococcus (GBS) in elective cesareans. Higher rate of positive cultures was found in term vs. preterm cesareans (17.5 % vs 10.5 %, respectively, p-value = 0.04). E.coli was the most frequent pathogen reported in both women with intact membranes or premature rupture of membranes (46.3 % and 47.3 % respectively). Eight women (9.1 %) with positive cultures presented with postpartum fever; all had undergone non-elective cesarean section. In one-third of these cases the empirical antibiotic treatment was adjusted according to the uterine culture results and susceptibility testing results.
Obtaining routine intrauterine cultures during non-elective cesarean sections might be useful for detecting significant pathogens and tailoring the antibiotic treatment in postpartum endometritis.
剖宫产术，尤其是非计划性剖宫产术，是产后子宫内膜炎发展的一个重要危险因素，而子宫内膜炎是导致产后发热发病率的主要原因。我们评估了在选择性和非选择性剖宫产术中常规宫腔内培养的效果，以预防和治疗产后子宫内膜炎。
这是一项回顾性比较研究，调查了 2017 年在一家三级医院进行的剖宫产术中胎儿和胎盘娩出后立即获得的宫腔培养物的分布。在研究分析中纳入了真正的病原菌，并将其视为阳性结果，而将其他污染菌排除在外。
在 821 例剖宫产术中，有 10.7%（88/821）的宫腔培养物呈阳性，选择性和非选择性剖宫产术之间的阳性率无显著差异。在所有女性的阳性培养物中，分离出的大肠杆菌（E.coli）占 40.9%，而非选择性剖宫产中最常见的病原体是乙型链球菌（GBS），而在选择性剖宫产中则是 GBS。足月剖宫产的阳性培养率高于早产剖宫产（分别为 17.5%和 10.5%，p 值=0.04）。在胎膜完整或胎膜早破的女性中，E.coli 是最常见的病原体，分别占 46.3%和 47.3%。8 名（9.1%）阳性培养物的女性出现产后发热，均行非选择性剖宫产术。在这些病例中，有三分之一的经验性抗生素治疗根据宫腔培养结果和药敏试验结果进行了调整。
在非选择性剖宫产术中获取常规宫腔内培养物可能有助于发现有意义的病原体，并根据产后子宫内膜炎调整抗生素治疗。
