infection international infection. international objectives definition predisposing factors...

Infection

International

Infection

Infection

International

Objectives

• definition

• predisposing factors

• pathophysiology

• clinical features

• sites of postpartum infection

• treatment

• prevention

Infection

International

• Definition:– any patient with fever of 38.5°C 48-72 hours

following a vaginal or forceps delivery with uterine tenderness

Infection

International

Incidence and scope:- major cause of maternal death in emerging countries

- less frequent with vaginal births

- complications include: shock, pelvic abscesses and pelvic thrombosis

Infection

International

Pathophysiology- normal flora of genital tract contains potential pathogens

- amniotic fluid and increase in white blood cells during labour

Infection

International

Clinical Features- usually 2-3 days post partum

- low grade temperature, lower abdominal pain and uterine tenderness

- also: malaise, anorexia, foul lochia

- if severe: high temperature and generalized peritonitis

Infection

International

Predisposing factors- trauma and tissue necrosis following deliver creates a culture medium for ascending

- cesarean section is most important predisposing

- prolonged labour and ruptured membranes

- poverty and poor hygiene/nutrition

Infection

International

Bacteria- polymicrobial

- most common:

Escherichia coli, Kelbsiella, Proteus and

Bacteroides fragilis

- less common:

Clostridium, Staphylococcus aurea and Pseudomona

- exogenous source:

Group A beta-hemolytic streptococci

Infection

International

Clinical Features

- Group A beta-hemolytic stretpococci may be fulminant with peritonitis and septicemia

- if cultured, hospital personnel must be screened to try and identify the source

Infection

International

Diagnosis- sites of infection to consider in post partum patient (culture if able):

endomyometritis

urinary tract

episiotomy site

abdominal incision

breast

thrombophlebitis: legs, pelvis

appendicitis

other: upper respiratory infection

Infection

International

Management - Prevention- correct aseptic technique

- antibiotic use in women with cesarean section or prolonged rupture of membranes (1g ampicillin IV given prophylactically in cesarean section reduces infection)

Infection

International

Management -- Treatmentmild case: single broad spectrum antibiotic (eg. ampicillin 1 g IV q6h Or orally)

if cesarean section:

flagyl 500 mg q8h + cefoxitin 2g q6h

OR

aminoglysocide (gentamycin or tobramycin) 60-100 mg q8h +clindamycin 900 mg q8h

Infection

International

Management - Treatment

• if intravenous antibiotics used, continue for 48 hours after fever has stopped.

• if fever continues and aminoglycoside-clindamycin combination was used, add penicillin (5M units q6h) to cover enterococci

• oral antibiotics should be used for 5 days

Infection

International

Other issues- the more antibiotics used, > the higher the chance of necrotizing colitis

- antibiotics do appear in breast milk but in most cases are not clinically significant (avoid tetracyclines)

Infection

International

Specific issues:episiotomy infection: treat with antibiotics, baths (clean water!), heat

- remove sutures if fluctuation or pus

- rarely needs debridement

necrotizing fascitis: rare, rapid progression of local inflammation followed by gangrene -patient is toxic: high dose antibiotics but MUST surgically DEBRIDE

Infection

International

Other issues- Septic pelvic thrombophlebitis--usually anaerobic sepsis

- usually patient is already on antibiotics but continues to have high spiking fevers

- diagnosis of exclusion

- treatment is intravenous heparin

- > condition should respond to heparin

Infection

International

Other issues- Mastitis--penicillin G or penicillinase-resistant (methicillin or cloxacillin)

for 7-10 days

• continue breast feeding!

• if breast abcess--drain

Infection

International

infection international infection. international objectives definition predisposing factors...

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