Stovall T G, Thorpe E M, Ling F W
Department of Obstetrics and Gynecology, University of Tennessee, Memphis.
J Reprod Med. 1993 Nov;38(11):843-8.
Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. One or more organisms was recovered from the endometrium in 90% of the patients using a double-lumen sampling device. The most frequent endometrial isolates were Peptostreptococcus and Bacteroides species, followed by Gardnerella vaginalis and enterococci. Thirty (81%) of 37 patients receiving ampicillin/sulbactam and 33 (83%) of 40 receiving gentamicin and clindamycin responded to therapy. There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endometritis.
77名患者被前瞻性纳入一项随机临床试验，以比较两种抗菌方案治疗剖宫产术后子宫内膜炎的效果。两组在年龄、种族、孕次、产次、分娩时间、剖宫产指征、术前或术后血红蛋白/血细胞比容、治疗前白细胞计数或治疗前体温方面无显著差异。采集了治疗前的尿液、血液和子宫内膜培养物。使用双腔采样装置，90%的患者子宫内膜中培养出一种或多种微生物。最常见的子宫内膜分离菌是消化链球菌和拟杆菌属，其次是阴道加德纳菌和肠球菌。接受氨苄西林/舒巴坦治疗的37例患者中有30例（81%）、接受庆大霉素和克林霉素治疗的40例患者中有33例（83%）对治疗有反应。有14例（18%）治疗失败，每组各7例。14例临床失败中有5例（36%）是由于盆腔感染性血栓性静脉炎，14例失败中有2例（14%）是腹腔内脓肿并发症，其余7例患者在更换抗生素方案后有反应。我们得出结论，氨苄西林/舒巴坦和克林霉素/庆大霉素在治疗剖宫产术后子宫内膜炎方面同样有效。
