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1.  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
2.  Performance of the Syva Direct Fluorescent Antibody Assay for Chlamydia in a Low-Prevalence Population 
Chlamydia trachomatis is the most common reportable sexually transmitted disease (STD) in the United States. In the 1980s, rapid diagnostic tests for chlamydia began to replace more cumbersome tissue culture methods. Current data on rapid antigen detection assays demonstrate acceptable sensitivity, specificity, and predictive values in populations with a high prevalence of chlamydia. Few studies report the performance of these assays in a low-prevalence obstetric and gynecologic (Ob/Gyn) population, This study compares the most commonly used direct fluorescent antibody (DFA) assay (Syva Microtrak) with tissue culture (TC) in a low-prevalence population. Endocervical specimens (775) were tested from women at risk for chlamydia infection, and the prevalence was found to be 7.7%. The DFA assay demonstrated a sensitivity of 80% and a specificity of 97% compared with TC. The positive and negative predictive values were 72% and 98%, respectively. The results of this study indicate that the Syva DFA assay lacks the sensitivity and positive predictive value for routine use in Ob/Gyn populations with a lowprevalence of C. trachomatis.
PMCID: PMC2364681  PMID: 18476197
3.  Abdominal Wound Problems After Hysterectomy With Electrocautery vs. Scalpel Subcutaneous Incision 
The purpose of this study was to evaluate the relationship between postoperative abdominal incision problems and opening subcutaneous tissues with electrocautery or scalpel. Women scheduled for elective abdominal hysterectomy who gave informed consent were randomly assigned to subcutaneous abdominal wall tissue incision by electrocautery or scalpel. Postoperative abdominal wound problem diagnoses included seroma, hematoma, infection, or dehiscence without identifiable etiology. Fifteen of 380 women (3.9%) developed a wound problem; six had scalpel and nine had electrosurgical subcutaneous incisions (P = 0.4). Thicker subcutaneous tissues (P = 0.04) and concurrent pelvic infection (P < 0.001) were significant risk factors for postoperative wound problems. Only two women (0.5%) developed an infection. We conclude that the method of subcutaneous tissue incision was unrelated to the development of postoperative abdominal incision problems in 380 women undergoing elective abdominal hysterectomy.
PMCID: PMC2364680  PMID: 18476202
4.  Clinical Significance of Credé's Prophylaxis in Germany at Present 
The introduction of silver nitrate for prophylaxis of gonococcal ophthalmia neonatorum is one of the milestones of preventive medicine. However, in our time an increasing necessity to review Credé's prophylaxis from both a human rights and a medical standpoint is required. The chairmen of the obstetrics and gynecology departments of the German university hospitals were questioned to learn about their policy and experience. Data were provided by 22 of 28 consulted institutions, representing 31,700 annual deliveries seen over a mean period of 5.5 years. Ocular prophylaxis was in use in 16 (73%) of the reporting hospitals (1% silver nitrate in 14 and gentamicin in 2). A nonspecific conjunctival reaction occurred in 5–10% of the newborns, but no major side effects were seen. Non-gonococcal ophthalmia neonatorum was observed in less than 0.1%; however, institutions without a preventive policy reported up to a 5% incidence of neonatal conjunctivitis, mostly due to Staphylococcus aureus, as well as Neisseria gonorrhoeae in two newborns. Application of silver nitrate is considered a necessary prophylactic measure and safe if it is properly administered. However, major efforts should be directed toward its replacement by alternative antiseptic substances as well as toward chlamydial screening and therapy in pregnancy.
PMCID: PMC2364679  PMID: 18476203
5.  Development of Pelvic Abscess Following Water-Skiing Injury 
Several descriptions of hydrostatic injuries while water-skilng have been described, including lacerations of the perineum, vagina, and cervix. Salpingitis or pelvic abscess resulting from water-skiing injuries are rare but important complications. A case of a pelvic abscess following a fall while water-skiing is described. The abscess was drained laparoscopically, resulting in a good clinical outcome. The mechanism of injury and recommendations for prevention are also presented. Upper genital tract infection may result from water-skiing injuries due to hydrostatic pressure forcing bacteria and water through the vagina and cervix into the endometrium, fallopian tube, and peritoneal cavity. While an uncommon complication, physicians and other practitioners caring for women should be aware of this potential complication from water-skiing.
PMCID: PMC2364678  PMID: 18476207
6.  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
7.  Maternal and Neonatal Infection With Salmonella heidelberg : A Case Report 
Maternal and neonatal infections with Salmonella typhi have been well documented. There are only two previous case reports of intrauterine infection with non-typhoidal species. This paper presents a third case of maternal septicemia followed by neonatal sepsis with Salmonella heidelberg.
PMCID: PMC2364676  PMID: 18476206
8.  Streptococcus agalactiae  
PMCID: PMC2364675  PMID: 18476209
9.  Pregnancy Outcome Following Pelvic Infection 
To determine whether a previous pelvic infection has an effect on the outcome of a subsequent pregnancy, we identified women with a diagnosis of pelvic inflammatory disease (PID), amnionitis, and postpartum or postabortal endometritis-salpingitis by a retrospective chart review of all patients admitted to the Department of Obstetrics and Gynecology at The New York Hospital-Cornell Medical Center between 1975 and 1977 and between 1985 and 1988. Antimicrobial regimens effective against Chlamydia trachomatis were initiated in 1985. Controls were randomly selected patients presenting during the same time period for routine examinations who had normal Pap smears and no infections. Both groups were comparable for age, race, gravity, and parity. Differences were evaluated by chi square analysis, using the Yates correction factor. We identified 183 women with a history of the above infections who subsequently conceived, and 82 controls. There were no differences in outcome between the two index groups. Term vaginal deliveries occurred in 14.2% of the women with a prior pelvic infection and in 56% of the controls (P < 0.001). Among the 97 women who had had PID, 21 (21.6%) had a spontaneous abortion in the subsequent pregnancy, as opposed to 6 (7.3%) of the controls (P = 0.013). In addition, eight of the women with PID (but no controls) went into preterm labor (P = 0.021). An increased incidence of preterm labor (P = 0.001) was also observed in women with a history of amnionitis. A history of endometritis was not associated with an increased prevalence of abnormal outcome in subsequent pregnancies. PID and amnionitis may adversely affect the outcome of subsequent pregnancies.
PMCID: PMC2364674  PMID: 18476199
10.  Why a New Journal? 
PMCID: PMC2364673  PMID: 18476196
11.  Necrotizing Fasciitis: A Review of Management Guidelines in a Large Obstetrics and Gynecology Teaching Hospital 
Necrotizing fasciitis is a severe, life-threatening soft tissue infection that results in rapid and progressive destruction of the superficial fascia and subcutaneous tissue. Because of its varied clinical presentation and bacteriological make-up, it has been labelled with many other names such as acute streptococcal gangrene, gangrenous erysipelas, necrotizing erysipelas, hospital gangrene, and acute dermal gangrene. Although described by Hippocrates and Galen, it has received increasing attention in obstetrical and gynecological literature only within the last 20 years. This review includes two recent cases successfully managed at Parkland Memorial Hospital, Dallas, Texas. The first patient was a 50 year old, morbidly obese, diabetic woman who presented with a small, painful lesion on the vulva. After failing triple antibiotic therapy with ampicillin, clindamycin, and gentamicin, the diagnosis of necrotizing fasciitis of the vulva was made, and she was taken to the operating room for extensive excision. She was discharged home on hospital day 29. The second patient was a 65 year old, obese, diabetic woman with risk factors for atherosclerosis who had a wound separation after an abdominal hysterectomy. Two days later a loss of resistance to probing was noted in the subcutaneous tissue. Necrotizing fasciitis was suspected, and she was taken to the operating room for resection. The patient was discharged home on hospital day 27. The mortality rate after diagnosis of necrotizing fasciitis has been reported to be 30% to 60%. We review the literature and outline the guidelines used in a large Ob/Gyn teaching hospital to minimize the adverse outcome. Lectures on soft-tissue infections are included on a regular basis. The high-risk factors of age over 50, diabetes, and atherosclerosis are emphasized. The need for early diagnosis and surgical treatment within 48 hours is stressed, and any suspicious lesions or wound complications are reported to experienced senior house officers and staff. We use two recent cases to highlight the diagnostic clues and management strategies for this often fatal polymicrobial infection.
PMCID: PMC2364672  PMID: 18476200
12.  Development of a High Performance Liquid Chromatographic Assay Measuring Mezlocillin in Serum or Tissue 
Objective: This study evaluated the blood and uterine tissue concentration of mezlocillin, a broadspectrum penicillin.
Methods: We adapted a liquid chromatographic method to measure mezlocillin in serum and tissue. Mezlocillin reference standard was diluted in water, chromatographed on a reversed phase C18 column eluted at 1.5 ml/min with acetonitrile and phosphate buffer (1:3 v:v), and detected spectrophotometrically at 210 nm. Mezlocillin was administered to 14 premenopausal women scheduled to undergo vaginal hysterectomy. Each patient received a 4 g IV infusion of the drug 30 to 60 min prior to surgery. During surgery, tissue was removed from the uterine cervix and blood was obtained for assay of mezlocillin content.
Results: Chromatography of the mezlocillin standard furnished a discrete peak with a retention time of 2.4 min. The sensitivity of the assay was 0.1 µg/ml with a linear response up to 100 µg/ml. The correlation coefficient for the standard curve was 0.9997. When reference standard was diluted in pooled human serum, the assay was complicated by interfering compounds. These were removed by ether extraction. The sensitivity of the assay performed in serum was 3 µg/ml. Serum samples contained from 81.2 to 358 µg of mezlocillin/ml with an average serum concentration of 207.5 µg/ml. When serum containing a known amount of mezlocillin was homogenized for a period of time similar to that required to homogenize tissue samples, a deteatable loss of drug was observed and was applied as a correction factor to the measured tisulevels. After correction, the average tissue level was 117.2 µg/ml and ranged from 27% to 98% of the serum levels.
Conclusions: The serum concentration of mezlocillin after IV infusion of 4 g was greater than that required to inhibit the majority of the most significant organisms responsible for post-hysterectomy sepsis. Although tissue levels appeared to be consistently lower than serum levels, they could be expected to provide an inhibitory effect against many of the bacterial strains that contaminate the surgical site.
PMCID: PMC2364671  PMID: 18476212
13.  Does Method of Placental Removal or Site of Uterine Incision Repair Alter Endometritis After Cesarean Delivery? 
Objective: his investigation was undertaken to evaluate the relationship between postcesarean endometritis and (1) method of placental removal and (2) site for uterine repair.
Methods: This prospective, randomized study included 120 patients who underwent primary or repeat abdominal delivery for arrest of progress in labor, fetal distress, or breech presentation. Parturients were divided into four groups: I—spontaneous placental detachment, in situ uterine repair; II—spontaneous placental detachment, exteriorized uterine repair; III—manual placental removal, in situ uterine repair; and IV—manual placental removal, exteriorized uterine repair. Prophylactic antibiotics were not used.
Results: Endometritis was significantly increased in the manual removal/exteriorized uterine repair group versus all the other groups including the spontaneous removal in situ (group I, P = 0.012), the spontaneous removal/exteriorized repair group (group II, P = 0.034), and the manual removal/in situ repair group (group III, P = 0.043). Comparison of group IV (manual removal/ exteriorized repair) with the combined groups I, II, and III (spontaneous removal/in situ repair, spontaneous removal/exteriorized repair, and manual removal/in situ repair) was significantly different (P = 0.005). Prior to delivery, use of an internal monitoring system, skill of the operating surgeon, and type of anesthesia were similar among groups.
Conclusions: The findings of this investigation suggest that; when other known causes of infectious morbidity are constant, manual placental remvol in association with exteriorization for uterine repair significantly increases postcesarean endometritis.
PMCID: PMC2364670  PMID: 18476211
14.  Intravenous Penicillin for Antenatal Syphilotherapy 
A 21 year old woman (G2 P0101) of 24 weeks gestation presented with syphilis of unknown duration. Sonography revealed fetal hydrops and placental thickening. Weekly intramuscular injections of 2.4 million U Bicillin for 3 weeks was initiated as recommended by the Centers for Disease Control. Repeat sonogram 1 week after starting treatment revealed increased ascites and a new pericardial effusion. Due to the worsening fetal condition, therapy was altered and the patient was admitted for IV penicillin. She received a continuous infusion of 18 million U penicillin G daily for 10 days. Serial sonograms showed improvement offetal ascites and pericardial effusion with 10 days of IV therapy, and complete resolution of hydrops was noted within 3 weeks. The fetus was born at term with no stigmata of congenital syphilis on newborn exam, and laboratory tests suggested adequate treatment in utero.
PMCID: PMC2364669  PMID: 18476198
15.  Infection and Infertility 
Asymptomatic infection appears to be a common cause of fallopian tube damage resulting in ectopic pregnancy or infertility.
PMCID: PMC2364668  PMID: 18476208
16.  Sheathing of the Endovaginal Ultrasound Probe: Is It Adequate? 
The purpose of this prospective investigation was to compare two methods for sheathing of the endovaginal ultrasound-probe. The study was conducted over a 7-month period in 1991–1992. In the first half of the investigation, latex examination gloves were used to sheath the endovaginal probe; during the second half of the investigation, latex condoms were used. Following the ultrasound examination, the probes were inspected for gross contamination by the ultrasonographer. The sheaths were then tested for perforations by filling them with water to twice their usual volume and observing for leaks. Fifty unused gloves and condoms were similarly tested to determine the prevalence of preexisting defects. One hundred twenty-eight gloves and 102 condoms from patients were tested. Four gloves (3.1%, 95% C.I. 1.6–4.6%) and seven condoms (6.9%, 95% C.I. 4.4–9.4%) had perforations (NS). When the probe was covered by a glove, one instance of visible contamination occurred (0.78%, 95% C.I. 0–1.6%) compared with eight instances when the probe was covered with a condom (7.8%, 95% C.I. 5.2–10.4%, P < .007). The prevalance of preexisting defects in the 50 unused gloves was 2%, which is not significantly different from the prevalence in used gloves. There were no defects in the 50 unused condoms compared with 7 in the used condoms (P = .057). Visible contamination of the endovaginal probe with blood or genital tract secretions is more likely when condoms are used as sheaths. However, even gloves provide imperfect coverage of the probe, illustrating the need for thorough decontamination of the endovaginal instrument after each use.
PMCID: PMC2364667  PMID: 18476204
17.  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
18.  Practical Guidelines for Preventing Congenital Syphilis 
PMCID: PMC2364311  PMID: 18475329
19.  Review of Vaginitis 
Adisruption of the dynamic equilibrium of the healthy vagina may have significant sequelae, leading to chronic or serious conditions. Therefore, all cases of vaginitis should be accurately diagnosed and appropriately treated.
PMCID: PMC2364310  PMID: 18475337
20.  Coccidioidal Placentitis With Normal Umbilical Artery Velocimetry 
Background: Disseminated coccidiomycosis during pregnancy can lead to both maternal and neonatal mortality. Placentitis is an uncommon sequelae and its effect on placental function remains speculative. The present report describes our management of such a case and describes serial umbilical artery velocimetry of an affected placenta.
Case: A pregnant woman with coccidioidal placentitis confirmed histologically was treated with systemic and intrathecal amphotericin B starting at 28 weeks gestation. Serial umbilical artery velocimetry revealed that all systolic/diastolic ratios remained normal, and a normal infant was delivered at term.
Conclusion: Coccidioidal placentitis was successfully treated with amphotericin B; serial umbilical artery velocimetry monitoring exhibited no abnormalities and, along with other reassuring fetal parameters, allowed continuation of the pregnancy to term.
PMCID: PMC2364309  PMID: 18475335
21.  Evaluating the Concentration of a Candida albicans Suspension 
Objective: The objective of this study was to develop a reproducible method of establishing the concentration of yeast cells per milliliter of solution.
Methods: Three methods of determining the number of yeast cells in solution were compared: Neubauer's counting chamber, spectrophotometry, and nephelometry.
Results: All three methods were comparable and reproducible. The following formulas were highly effective in determining the number of yeast cells in solution: chamber (× 103/ ml) 64.3 + 8,206 × spectrophotometry (absorbance); and chamber (× 103 /ml) –0.2 + 64 × nephelometry (volt).
Conclusions: Utilization of spectrophotometry or nephelometry and the appropriate formula allow for the precise determination, which is easily reproducible, of the concentration of yeast cells in solution. This will facilitate experimentation involving precise inocula or requirement for specific concentrations of yeast cells for various experiments.
PMCID: PMC2364308  PMID: 18475333
22.  Management of Intrauterine Device-Associated Actinomycosis 
Objective: To assess various methods of management of actinomyces-like organisms associated with intrauterine devices.
Methods: A retrospective chart review of 173 patients with intrauterine device-associated actinomyces- like organisms detected on Pap smear was performed. The patients were managed by IUD removal with or without antibiotic therapy, antibiotic therapy alone, or no treatment at all.
Results: The success rate as reflected in negative follow-up smear was 100% for IUD removal combined with antibiotics, 97.4% for IUD removal alone, and 36.8% for antibiotics therapy alone.
Conclusions: The best way to manage intrauterine device-associated actinomyces-like organisms is removal of the device with or without antibiotics.
PMCID: PMC2364307  PMID: 18475332
23.  Evaluation of Infectious Disease Knowledge in Obstetrics and Gynecology and the Effects of Varying Durations of Training 
Objective: The amount, origin, and resources of infectious disease knowledge in the field ofobstetrics and gynecology were investigated. If this knowledge is lacking, the exact length of the specific infectious disease training during residency should be defined to meet the ever-increasing knowledge required in training.
Methods: A 50-question test was developed by one faculty member utilizing questions that incorporated the basic sciences of microbiology and pharmacology and clinical knowledge of infectious diseases in the area of obstetrics and gynecology. Multiple choice and matching questions were structured so as to ascertain the source of the knowledge, including medical school curriculum, recent journal articles, and clinical experience.
Results: The test was given yearly to all students and residents on the Obstetric and Gynecology Service over a period of 2 year's. The questions were the same for each group, but were reshuffled each exam period. Three hundred and seven tests were properly administered and recorded. There was no statistical improvement in any successive year’s scores unless specific infectious disease training occurred. Increasing improvement in scores was noted, with an increasing duration of infectious disease training specific for obstetrics and gynecology, beginning at 2 weeks (22% improvement), 4 weeks (30% improvement), and 6 weeks (31% improvement) (P = .05–.001). Basic science questions were most frequently answered correctly by medical students and early residents, while correctly answered clinical questions correlated with increasing clinical experience except in the area of ambulatory care.
Conclusions: The infectious disease knowledge of residents in obstetrics and gynecology can be improved with 4 weeks of intensive training. Re-exposure to basic science knowledge and improved training in ambulatory care in this resident group appear to be necessary. This test or similar tests can be helpful in defining areas of deficiencies and their possible remedies.
PMCID: PMC2364306  PMID: 18475330
24.  Inpatient Treatment for Uncomplicated and Complicated Acute Pelvic Inflammatory Disease: Ampicillin/Sulbactam Vs. Cefoxitin 
Objective: Ampicillin plus sulbactam, an irreversible β-lactamase inhibitor, was compared to cefoxitin in the treatment of women with acute pelvic inflammatory disease (PID) with and without inflammatory mass(es).
Methods: Participation in an open, prospective, randomized clinical trial was offered to all women given the clinical diagnosis of acute PID who required inpatient therapy. Neisseria gonorrhoeae and Chlamydia trachomatis were sought in cervical and endometrial samples and aerobic and anaerobic species were sought in endometrial samples prior to treatment initiation. Treatment was given on at least 4 days and until women were afebrile for at least 48 h. Daily examinations were performed to assess response to therapy and safety. Only women in whom C. trachomatis was identified were discharged from the hospital on oral doxycycline to be taken for 10–14 days.
Results: One hundred twenty-four women were evaluated for safety; 117 (94%) were evaluated for efficacy. Demographic characteristics were similar for women in each treatment group. N. gonorrhoeae was recovered from 59% and C. trachomatis was recovered from 42% of study subjects. Inflammatory masses were identified in 35/76 (46%) women given ampicillin/sulbactam and 17/41 (41%) women given cefoxitin. Ampicillin/sulbactam cured 75 ,of 76 women (98.7%) [95% confidence interval (CI) 92.9–100.0%] and cefoxitin cured 37 of,41,omen (90.2%) (95% CI 76.9–97.3%) in that treatment regimen.
Conclusions: Overall ampicillin/sulbactam was more effective (P = 0.05) than cefoxitin, due to superior efficacy in infection complicated by inflammatory mass(es).35/35 vs. 12/17 cured; P = 0.007).
PMCID: PMC2364305  PMID: 18475331
25.  Candida Esophagitis in an Immunocompetent Pregnant Woman 
Background: Nausea and vomiting are common during the first half of pregnancy and usually require only supportive measures. When symptoms are progressive and weight loss occurs, treatable causes should be sought by means of upper gastrointestinal endoscopy. We report a case of an immunocompetent gravida with invasive Candida albicans esophagitis.
Case: The immunocompetent primigravida developed progressive nausea, vomiting, epigastric pain, and a 4.1 kg weight loss during the second trimester of pregnancy. Treatment with metoclopramide and cimetidine for presumed gastroesophageal reflux was not effective. The patient had normal T-cell CD4 and CD8 subsets and was human immunodeficiency virus (HIV) antibody negative. Upper gastrointestinal endoscopy revealed C. albicans esophagitis which was treated with oral nystatin. The esophagitis had resolved completely when reassessed postpartum. The use of histamine2 blockers is associated with an increased risk for fungal esophagitis and may have been a contributing cause in this case.
Conclusion: Pregnant patients with persistent nausea, vomiting, and weight loss should be evaluated by endoscopy for fungal esophagitis.
PMCID: PMC2364304  PMID: 18475336

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