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PDAT6 ID > 29 - Gynecological Infections / PID > Flashcards

29 - Gynecological Infections / PID Flashcards

1
Q

What type of Gynecological Infection?

Fever + tenderness
more diffuse across abdominal region

Sicker / often require IV ABx

Often associated w/ surgical procedures such as:
Hysteroctomy

A

PELVIC CELLULITIS
Surgical Site Infection

Surgical site is contamintated w/ vaginal flora:
B-Strep / E-Coli / Anaerobes (Prevotella / G. Vaginalis)

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2
Q

Pelvic Inflammatory Disease
PID

CRITERIA FOR INPATIENT TREATMENT

A

Surgical Emergency can NOT be ruled out

PREGNANCY

Lack of Clinical response to ABX
>72 hours

Unable to tolerate outpatient management

VERY SICK = high fever + NVD

Presence of ABSCESS

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3
Q

What type of Gynecological Infection?

Spread of Infection –> DEEP into ABDOMINAL TISSUE

Late Complication

Antibiotics +/- Surgical Drainage

Often associated w/ surgical procedures such as:
Hysteroctomy

A

PELVIC CELLULITIS
Surgical Site Infection

Surgical site is contamintated w/ vaginal flora:
B-Strep / E-Coli / Anaerobes (Prevotella / G. Vaginalis)

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4
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Doxycycline

A

Doxycycline

CHLAMYDIA

NOT FOR PREGNANCY

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5
Q

Bacteria Found in
IAIS
Intra-Amniotic Infectious Syndrome = Chorioamniotis

A
  • *IASA**
  • *IntraPartum** -> involve contamination of amniotic fluid w/ vaginal flora

B-Strep** + **E.COLI

Anaerobes:
Mycoplasma + Prevotella

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6
Q
  • *PELVIC INFLAMMATORY DISEASE**
  • *PID**

RISK FACTORS

A

Similar Risk factors to STD’s

Younger Females 20s

Multiple Sex Partners

Substance Abuse

Lower Socioeconomic Status

Douching

Bacterial Vaginosis

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7
Q

What type of Gynecological Infection?

Infxn @ surgical Margins

Discharge w/ lower abdominal pain

Often associated w/ surgical procedures such as:
Hysteroctomy

A

VAGINAL CUFF CELLULITIS
Surgical Site Infection

Surgical site is contamintated w/ vaginal flora:
B-Strep / E-Coli / Anaerobes (Prevotella / G. Vaginalis)

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8
Q
  • *Vaginal Flora Bacteria**
  • potentially infectious*
A

B-Streptococci

E. Coli

Anaerobes - PPBM
Peptostreptococcus spp.
Prevotella
Bacteroids
Mycoplasma

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9
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Cephalosporins
Cefoxitin / Ceftriaxone / Cefotetan

A

Cephalosporins
Cefoxitin / Ceftriaxone / Cefotetan

GONORRHEA (GC)

no chlamydia

  • avoid QUINOLONES & CEFIXIME*
  • due to RESISTANCE*
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10
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Clindamycin

A

Clindamycin

+Gram POS+
Streptococcus

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

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11
Q

Bacterial Vaginosis

DIAGNOSIS

A

CLUE CELLS** + **Gray-White Discharge

Clue Cells:
Coccobacillary Cells (G. VAGINALIS) adhered to Vaginal Epithelum

pH > 4.5

“whiff test” was used before + KOH

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12
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

  • *B-Lactams + Inhibitor**
  • *Augmentin / Amp-Sub / Pip-Tazo**
A
  • *B-Lactams + Inhibitor**
  • *Augmentin / Zosyn / Pip-Tazo**

-GRAM NEG-
E. Coli

+Gram POS+
Streptococcus

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

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13
Q

Bacteria Found in:
PELVIC INFLAMMATORY DISEASE = PID

A

PID

C. TRACHOMATIS** + **N. GONORRHEAE
plus normal
E. Coli + Strep

Severe Cases ADD ANAEROBES

avoid Quinolones in those suspected of N. gonorrheae
due to resistance

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14
Q

Intrapartum IAIS
Intra-Amniotic Infectious Syndrome
AKA: Chorioamnionitis

Diagnosis / Signs

A

IMPRECISE DIAGNOSIS:
FEVER (>100.4*) + >2 of below
Maternal/Fetal TACHYcardia
↑WBC >15k
FOUL-smelling amniotic fluid
Uterine Tenderness

Amniotic Fluid + Fetal Membranes
infected due to vaginal organisms ASCENDING –> intrauterine cavity
after membrane rupture - Preterm Labor <37 weeks

Causes dysfunctional labor = Oxytocin or C-section

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15
Q

Pelvic Inflammatory Disease
PID

INPATIENT TREATMENT
Criteria:
PREGNANCY - Surgery
SEVERE ILLNESS
ABSCESS
No Abx Response > 72 hours

A

14 DAYS

Cefotetan IV** + **Doxycycline IV -> followed by Doxy PO
OR
CeFOXitin IV** + **Doxy IV –> Doxy PO
OR
Clindamycin IV** + **Gentamicin IV** –> **Doxy** or **Clinda PO
OR
Ampicillin/Sulbactam IV** + **Doxy** –> **Doxy Po

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16
Q

Bacteria Found in
ENDOMYOMETRITIS

A
  • *Endomyometritis**
  • *IntraPartum** -> involve contamination of amniotic fluid w/ vaginal flora

Same as IASA:
B - Strep** + **E. Coli
PLUS
ANAEROBES
Peptostreptococcus / Prevotella / Bacteroids / Mycoplasma

17
Q

Pelvic Inflammatory Disease
PID

Outpatient Treatment

A

14 DAYS

  • *CeFOXitin** 2mg IM x1 + Probenecid 1g PO x1
  • *Doxycycline** 100mg PO BID

OR

CeftTRIaxone 250mg IM x1 + Doxycycline 100mg PO BID

18
Q
  • *PELVIC INFLAMMATORY DISEASE**
  • *PID**

Diagnostic Criteria

A

often VAGUE presentation** –> **no SINGLE symptom specific

Suggested to Treat:
Sexually Active + Pelvic/ab pain + Discharge

Minimum criteria > 1:
Cervical Motion** / **Uterine** / **Adnexal
TENDERNESS

Additional Criteria:
Oral Temp > 101 / Discharge / WBC >10k
ESR > 15 / ↑CRP

19
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Flagyl

A

Flagyl

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

20
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Azithromycin

A

Azithromycin

CHLAMYDIA

could be used for prgnancy > Doxycycline

avoid QUINOLONES & CEFIXIME
​due to RESISTANCE

21
Q

TREATMENT
PCN ALLERGY

Surgical Site Infection:
Vaginal Cuff Cellulitis
Infxn @ surgical margins / Discharge+lower abdominal Pain

A

Vaginal Cuff Cellulitis

ORAL ABx

CIPRO 500mg BID** + **FLAGYL 500mg BID

instead of Augmentin 875 BID ONLY

22
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Gentamicin

A

Gentamicin

-GRAM NEG-
E. Coli

23
Q

Surgical Site Infections:
Cuff Celulitis / Pelvic Cellulitis / Pelvic Abscess

RISK FACTORS

A
  • NOT using PREOPERATIVE PREP*
  • *Chlorhexidine or Providone Iodine**

NOT using SYSTEMIC ABx
around time surgery is started

Blood Loss > 500mL** or **Blood Transfusion

Prolonged Surgery >140min

STAPLES > Sutures
sutures are @ lower risk for infxn

24
Q

TREATMENT

Surgical Site Infection:
Pelvic Cellulitis
patient is more sick vs cuff cellulitis
deeper tissue infxn

A

Pelvic Cellulitis

Hospitilization + IV TREATMENT until patient FEBRILE (24-48hrs)
complete regimen OUTPATIENT

14 DAY TREATMENT

Augmentin 875 BID

  • PCN ALLERGY:*
  • *CIPRO 500mg BID_ + _FLAGYL 500mg BID**
25
Q
  • *ENDOMYOMETRITTIS**
  • *Postpartum infxn of the uterus**

Diagnosis / Risk Factors

A

Risk Factors:

  • *DURATION of LABOR** or RUPTURE of membranes
  • *Bacterial Vaginosis**
  • *# of Vaginal Exams**
  • *Internal Fetal Monitoring**

POSTpartum Endometritis:

  • *C-Section** or Rupture of membranes after labor = strong predictor
  • *Inoculation**
26
Q

Bacteria found in:
Bacterial Vaginosis

A

Bacterial Vaginosis

Caused by:
↓Lactobacillus - keeps flora in check, stops anaerobe growth
Then:
Vaginal Anaerobes PREDOMINATE
G. VAGINALLIS / prevotella / Bacterdes / Peptostrep

Treat with:

  • *Flagyl** or Clindamycin
  • exception to 14 day treatment –> could be 3/5/7 days*
27
Q

Bacterial Vaginosis

RISK FACTORS

A
  • not considered an STD*
  • *alteration of normal vaginal flora –> preterm birth**

Risk Factors
SMOKING / DOUCHING
AA Race
Early Age Sex / Multiple Sex Partners
WSW

28
Q

Intrapartum IAIS
Intra-Amniotic Infectious Syndrome
AKA: Chorioamnionitis

TREATMENT

A

SOURCE CONTROL:
is DELIVERY

Start Intrapartum ABx (during) to prevent systemic infections

Target B-Strep + E. Coli:
AMPICILLIN** + **GENTAMICIN

If C-Section:

  • *Add ANAEROBIC COVERAGE**
  • *Clindamycin / Flagyl** or B-Lactam ONLY (covers all 3)
29
Q

TREATMENT

Surgical Site Infection:
Pelvic ABSCESS

A
  • *PELVIC ABSCESS**
  • *Same as Cellulitis but…**
  • *DRAIN MASS if**:
  • *>8 cm** OR <8 cm & not improving on therapy

Hospitilization + IV TREATMENT until patient FEBRILE (24-48hrs)
complete regimen OUTPATIENT

14 DAY TREATMENT

Augmentin 875 BID

  • PCN ALLERGY:*
  • *CIPRO 500mg BID_ + _FLAGYL 500mg BID**
30
Q

Endomyometritis
Postpartum infxn of the uterus

TREATMENT

A

Endomyoetritis
Treatment is similar to IAIS w/ EMPHASIS on ANAEROBES

GENTAMICIN** + **CLINDAMYCIN
Drug of choice

Alternates:
Amp/Sulb - Pip/Tazo - Cefoxitin - Carbapenems
Need to cover:
Penicillin Resistant Prevotella

31
Q

TREATMENT

Surgical Site Infection:
Vaginal Cuff Cellulitis
Infxn @ surgical margins / Discharge+lower abdominal Pain

A

Vaginal Cuff Cellulitis

ORAL ABx

AUGMENTIN 875mg BID

32
Q

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

  • *B-Lactams**
  • *Cefoxitin** / Cefotetan
A
  • *B- Lactams**
  • *Cefoxitn / Cefotetan**

-GRAM NEG-
E. Coli

+Gram POS+
Streptococcus

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

33
Q

Bacteria found in:
Surgical Site Infections
Cuff / Pelvic Cellulitis + Pelvic Abscess

A

Surgical Site Infections
Cuff / Pelvic Cellulitis + Pelvic Abscess

Normal Vaginal Flora:
B - Strep** + **E. Coli** + **Anaerobes (PPMP)
PLUS
GARDNERELLA VAGINALIS

34
Q

Bacterial Vaginosis

TREATMENT

A

Goal is to ↓Anaerobes Present,
since its an alteration of normal flora

Empiric treatment:
Metronidazole 500mg BID x 7 days
or
Metronidazole 0.75% gel QD x 5 days
or
Clindamycin 300mg BID x7 days

not routinely recommended to treat partner

PDAT6 ID (31 decks)

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