Management of gynecological infections Flashcards
What are three main categories for infection of the female pelvis
Pregnancy, post-surgical infections, pelvic inflammatory disease (PID)
What are the three classifications of infections related to pregnancy
Intrapartum, postpartum, or postabortal infections
What is an intrapartum infection, when does it usually occur
amniotic fluid/fetal membranes become infected due to normal flora ascending into the intrauterine cavity after membrane rupture, less than 37 weeks
What are the organisms that usually cause intrapartum infections
Beta-Streptococci, E. coli, Mycoplasma spp. and Prevotella Spp
T/F: Intrapartum infections should be treated before delivery to make sure the pathogen does not become systemic
True
What antibiotics are given to treat a intrapartum infection
Ampicillin and gentamicin
What part of the uterus in infected after birth causing a postpartum infection
The endometrium is infected by normal flora
What are the risk factors for endomyometritis
Duration of labor or rupture of membranes, bacterial vaginosis, number of vaginal exams, internal fetal monitoring
What organisms cause endomyometritis
E. coli, Beta-stretococcous, C. vagininalis, prevotella
What are the first line antibiotics used to treat endomyometritis, alternatives
Clindamycin and gentamicin, amp/sulb, pip/tazo, cefoxitin. carbapenenms
What causes surgical site infections in women
Surgical site is contaminated with vaginal flora
What organisms usually cause a surgical site infection in women
beta-strep, E. coli, prevotella, G. vaginalis
What are classifications for surgical site infections in women
cuff cellulitis, pelvic cellulitis and pelvic abscess
What are key diffenences in the 3 types of surgical site infections
Cuff cellultis: minimal discahe with lower abdominal pain
Pelvic cellultiis: Fever tenderness with patients appearing sick
Pelvic Abscess: spread of infection deep into abdominal tissue that may require antibiotics and surgical drainage
What is a key way to prevent a surgical site infection
use chlorhexidine or providone iodine around the skin and vagina area
What are other risk factors for getting a surgical site infection
Not using systemic antimicrobial prophylaxis, blood loss, prolonged surgery (greater than 2 hours), blood transfusion, using staples instead of sutures
What are the antibiotics that are suggested if a patient has cuff cellulitis
Augmentin 875 mg BID OR Cirprofloxacin 500 mg BID plus Flagyl 500 mg BID
T/F: For pelvic cellulitis and pelvic abscess the length of treatment should only be 7 days with a start of IV antibiotics
False: For pelvic cellulitis and pelvic abscess the length of treatment should be 14 days with IV antibiotics starting off
If a patient has pelvic abscess what will determine whether or not there is drainage of a mass
Abscess is greater than 8 cm or abscess is less than 8 cm but there is not improvement after using antibiotic therapy
What is the most common cause of vaginal discharge, what causes this
Bacterial vaginosis. due to alteration of normal vaginal flora
What organism works to keep normal flora in check, what can cause their decline
Lactobacillus, G. vaginalis predomniates, vaginal anaerobes (prevotella, bacterocides, peptosteptococcus)
What are symptoms of bacterial vaginosis
Homogenous gray- white discharge, pH greater than 4.5, coccobacillary cells adhered to vaginal epithelium
What are risk factors of bacterial vaginosis
Douching, smoking, early age sexual intercours, multiple sex partners, woman/woman sex
T/F: Bacterial vaginosis is NOT and STD/STI
True
