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1.  Pneumonia in Pregnancy 
Pneumonia complicating pregnancy requires a prompt diagnosis and the institution of adequate supportive and antimicrobial therapy. In a patient with a classic presentation of pneumonia, the most likely pathogens are Streptococcus pneumoniae and Haemophilus influenzae. In a patient with an atypical presentation of pneumonia, Mycoplasma pneumoniae and Chlamydia pneumoniae are frequently encountered. In a patient suffering from acquired immunodeficiency syndrome (AIDS), Pneumocystis carinii is the most frequent pathogen. The antimicrobial therapy, therefore, has to be tailored to the sensitivity patterns of these pathogens in the community. Hospitalization is recommended for the pregnant patient diagnosed with pneumonia to ensure effective supportive care and minimize the risk of preterm labor and delivery.
PMCID: PMC2364401  PMID: 18475411
2.  Intrauterine Pressure Catheter in Labor: Associated Microbiology 
Objective: The purpose of this study was to determine if bacterial growth occurred in the amniotic fluid of laboring women. Twenty patients who required an intrauterine pressure catheter (IUPC) during labor were studied. Amniotic fluid samples were aspirated during labor and at the time of delivery.
Methods: IUPCs were placed in laboring patients for a variety of reasons. Cervical cultures were taken prior to insertion of an IUPC. After the IUPC was placed, amniotic fluid cultures were taken both at the time of placement and 30 minutes prior to delivery. These cultures were sent for aerobic, anaerobic, Mycoplasma, and Ureaplasma cultures.
Results: The increase in bacterial concentration from the initial sample to the final sample was statistically significant (P < 0.01) for both aerobes and anaerobes. Amniotic fluid samples demonstrated a median of 0 bacterial species per patient on initial collection and 2 bacterial species per patient in final collection. The mean count of cfu for erobes in the initial amniotic samples was 3.5 × 104, compared to that of the second samples, which was 1.4 × 105. The mean count of cfu for anaerobes in the initial amniotic fluid samples,.was 4.1 × 102, compared to that of the second samples, which was 8.0 × 103. Only 3 of 20 patients developed chorioamnionitis, with only 1 patient having an increased number ofbacterial species significantly higher than the median. Although 80% of patients had a colony count ≥ 102 cfu/cc, only 19% of this group developed chorioamnionitis.
Conclusions: The number of bacterial species and colony counts increased significantly during labor, but this factor alone was not enough to cause chorioamnionitis in a significant number of patients.
PMCID: PMC2364682  PMID: 18476210
3.  In Vitro Susceptibility Testing of Clinical Isolates of Chlamydia trachomatis  
Penicillin class antibiotics have demonstrated varying degrees of in vivo and in vitro success when tested against Chlamydia trachomatis. The activity of ampicillin-sulbactam, an agent commonly utilized in the treatment of pelvic infections, was tested to ascertain if any antichlamydial activity is present. Up to six endocervical isolates of C. trachomatis were tested against each of five antibiotics including doxycycline, erythromycin, clindamycin, ampicillin/sulbactam, and sulbactam alone. McCoy cell monolayers were inoculated with high inclusion counts of 10,000–30,000 inclusion-forming units (IFU) per coverslip, and exposed to each antibiotic. Up to nine subsequent antibiotic free culture passes were performed to assess the viability of abnormal inclusions. Doxycycline, erythromycin, and clindamycin achieved 100% eradication of inclusions at concentrations of 4.0, 2.0, and 1.0 µg/mL. Exposure to ampicillin/sulbactam resulted in a greater than 99% reduction in the inclusion count at 32.0 µg/mL, while sulbactam by itself demonstrated considerably less activity. Abnormal inclusions were noted only in the ampicillin/sulbactam exposed cells, and these, plus all inclusions remaining following sublethal exposure to the other antibiotics, resulted in regrowth to control levels in subsequent passes. Doxycycline and erythromycin demonstrated excellent activity. Clindamycin and ampicillin/sulbactam also significantly reduced inclusion formation, and therefore may provide adequate C. trachomatis coverage in patients receiving these antibiotics for pelvic infections.
PMCID: PMC2364677  PMID: 18476205
4.  Cefotetan Susceptibility Testing Against Anaerobic Bacteria From Obstetrical and Gynecologic Sources: Comparison of Five Different Methods 
Five different antibiotic susceptibility methods were utilized to test the effectiveness of cefotetan against 200 anaerobic bacteria recovered from patients with obstetrical or gynecological infections. The object of this study was to determine if a more economical and rapid method for anaerobic susceptibility testing was as acceptable as the reference agar dilution method. The five methods were: 1) broth disk elution, 2) microbroth technique, 3) a commercially available microbroth technique, 4) a commercially available spiral gradient technique, and 5) reference agar dilution. The minimal inhibitory concentrations (MICs) calculated from the spiral gradient technique were equal to or within one doubling dilution of the reference system in 99.5% of cases, while the percentage for the commercially available microbroth system was 96.8%, very similar to the microbroth technique used in our laboratory that yielded a percentage of 96.3. The disk elution method correlated to the reference agar dilution method in 95.3% cases. While the overall agreement between these techniques is good, especially for the spiral gradient system, clustering of certain organisms near the breakpoint of the antibiotic tested results in variability in the labeling of these organisms as susceptible or resistant. This problem appears to be particularly significant for the disk elution method. Therefore, further refinements in these methods of suscleptibility testing are needed in order to provide a more clinically useful assessment of the susceptibility or resistance of certain bacterial isolates.
PMCID: PMC2364666  PMID: 18476201

Results 1-4 (4)