Principles of Diagnosis and treatment in Microbial Diseases

Oladapo Olayemi

Introduction
Infectious diseases are common in O&G practice Some of these are due to the procedures we perform on our patients Obstetric patients are particularly prone to some infections especially in the puerperium This class will focus on bacterial infections mostly

Learning Objectives

At the end of this class participants will be able to

Enumerate the common gynecology and obstetric conditions that require antibiotic therapy Discuss the principles and practice of antibiotic therapy in these conditions

Regimen in antimicrobial Therapy

Therapeutic Peri-operative Prophylactic

General Principles
Community acquired infection Hospital Acquired Infections

General Principles
Take a microbiological Specimen Use a regimen based on the knowledge of the commonest organism causing that infection Never combine bacteriostatic and bacteriocidal drugs

Diagnosis

Clinical Presentation

Syndromic

Investigations

Treatment

Evidence Based

Treatment before obtaining Lab results Broad Spectrum Antibiotics

When lab results conflict with clinical observation

Target Sites

Gynecological Infections
Post abortal sepsis Pelvic Inflammatory Disease Vaginitis Vaginosis Post operative infections

Obstetric Infections
Vaginosis Urinary Tract Infections Chorioamnionitis Post partum sepsis

Post Abortal Sepsis

Infections are more common with induced when compared to spontaneous abortion Abortion is illegal and unsafe The spectrum of organisms

Gram positive Gram negative Anaerobes

From normal flora of genital tract and bowel Also from environment e.g tetanus

Post abortal sepsis

Antibiotic regimen usually Broad spectrum

Penicillin Cephalosporins Meteronidazoles Aminoglycosides

Regimen chosen will depend on suspected contaminants Microbiological evidence required for appropriate treatment

Post abortal sepsis

Parenteral therapy Oral therapy Antitetanus Prophylaxis

Pelvic Inflammatory Disease

Inflammation of the upper genital tract usually involving the uterus, fallopian tubes and ovaries Emperical treatment before microbiological evidence common No RCT to refute emperical treatment Admission and parenteral therapy usually indicated initially

Pelvic Inflammatory Disease

Vaginitis

The common causes of vaginitis are non bacterial

Candidiasis Trichomoniasis Chlamydia

Antifungal agents for candidiasis Meteronidazole active against Trichomoniasis Doxycycline for chlamydia

Post operative Infections

Preventive Measure

Perioperative antibiotics
Treatment similar to PID

Therapeutic measure

Obstetric Infections-Vaginosis
Probably sexually transmitted Caused by G.vaginalis No inflammation of Vaginal epithelium Associated with

Vaginal discharge High vaginal pH 5.0-5.5 Low birthweight preterm births

Obstetric Infections-Vaginosis

Diagnosis

Clue test Whiff test Pap smear

Bacteriophage infection of Lactobacilli

Current thinking

Special note

Cause of vaginal discharge is one of the most difficult Diagnosis to make

Obstetric Infections-Vaginosis

Treatment

Meteronidazole preferably vaginal gel Clindamycin

Concomitant treatment of partner

Urinary Tract Infection

Asymptomatic in 4-7% of pregnant women Risk factors

Multiparity Sickle cell disease Diabetes mellitus

UTI
Commonest is cystitis Can progress to pyelonephritis Treatment

Nitrofurantoin Nalixidic acid Cephalosporin Amoxicillin

Chorioamnionitis
Inflammation of the chorion and amniotic membranes Predisposes to puerperal sepsis PROM of greater than 6 hours increases risk of chorioamnionitis Repeated vaginal examination

Treatment

Usually microbiological specimen should guide treatment

Broad spectrum penicillins Cephalosporins

Postpartum infections

Managing Multi-drug resistant Strains

Principle of environmental pressure and genetic adaptation Adaptation obeys the principle of Opportunity Cost