The Department of Obstetrics and Gynecology, The Faculty of Medicine, The Chaim Sheba Medical Center, Tel-Aviv University, Ramat-GanTel-Aviv, Israel.
The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel.
Arch Gynecol Obstet. 2024 Oct;310(4):2081-2089. doi: 10.1007/s00404-024-07696-8. Epub 2024 Aug 23.
To evaluate the utility of cervical cultures in the diagnosis and management of postpartum endometritis.
A retrospective study was conducted on 1069 cervical cultures collected from postpartum women with suspected endometritis between 2011 and 2021. Patient demographics, obstetric history, clinical parameters, and culture results were analyzed. Microorganisms were categorized into five groups based on species and virulence. Statistical analysis was performed to identify associations between risk factors, pathogens, and disease severity.
The positivity rate for distinct microorganisms in cervical cultures was 33.1%. Escherichia coli (10.8%) and Group B Streptococcus (7.5%) were the most common isolates. Prolonged labor duration and prolonged rupture of membranes were associated with Enterobacterales infections. Elevated white blood cell count was linked to Enterobacterales and beta-hemolytic Streptococci, while the former were also associated with higher rate of postpartum clinic visit. No significant differences in disease severity were found between other microorganism groups.
The study suggests that while cervical cultures can identify potential pathogens in postpartum endometritis, their clinical utility is questionable due to the polymicrobial nature of the disease and the isolation of commensal microorganisms. The lack of significant differences in disease severity across various microorganism groups raises questions regarding the contribution of distinct bacterial identification in endometritis management.
评估宫颈培养在产后子宫内膜炎的诊断和管理中的应用价值。
对 2011 年至 2021 年间 1069 例疑似子宫内膜炎的产后妇女进行了回顾性研究。分析了患者的人口统计学、产科史、临床参数和培养结果。根据物种和毒力将微生物分为五类。采用统计学分析方法确定了风险因素、病原体和疾病严重程度之间的关联。
宫颈培养中不同微生物的阳性率为 33.1%。大肠埃希菌（10.8%）和 B 组链球菌（7.5%）是最常见的分离菌。产程延长和胎膜破裂时间延长与肠杆菌科感染有关。白细胞计数升高与肠杆菌科和β溶血性链球菌有关，而前者也与更高的产后就诊率有关。其他微生物组之间的疾病严重程度无显著差异。
本研究表明，虽然宫颈培养可以鉴定产后子宫内膜炎中的潜在病原体，但由于疾病的多微生物性质和共生微生物的分离，其临床应用价值值得怀疑。不同微生物组之间疾病严重程度无显著差异，这引发了对特定细菌鉴定在子宫内膜炎管理中的作用的质疑。
