Term
34 y/o female develops fever, 2nd day postpartal, pelvic exam => uterine tenderness, ↑WBC with left shift and hx of prolonged labor with PROM
What is your clinical impression and how do you treat it? |
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Definition
Clinical impression: postpartal endometritis
Rx: IV abx till she is afebrile, covering the polymicrobial flora
IV clindamycin and gentamicin works 95% of the time, if fever persists => add IV ampicillin as enterococcus is implicated |
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Term
49 y/o female, enlarging fibroids, underwent hysterectomy
now has tenderness on palpation of lower mid abdomen,
tenderness with bimanual exam
Dx? Rx? |
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Definition
Dx: likely dx…pelvic cellulitis (2 days post op)
Rx: IV abx for a few days, ampicillin |
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Term
17 y/o c/o lower abd pain for 48hrs, low grade temp, sexually active with multiple partners, ↑ vaginal discharge, percussion tenderness of lower abdomen (L>R), marked tenderness with cervical motion, WBC 12,000, ESR 79↑
Dx? Rx? |
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Definition
PID
marked tenderness with cervical motion (nearly pathognomonic for PID) |
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Term
| What do you call Infection of the uterus and its contents during pregnancy? |
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Definition
| Chorioamnionitis or intra-amniotic infection syndrome |
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Term
>25% of women with premature labor or
prolonged labor and PROM get this? |
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Definition
|
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Term
| clinical features of this infection related to pregnancy are: ↑temp not otherwise explained, uterine tenderness, ↑fetal HR, purulent amniotic fluid (uncommon finding) |
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Definition
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Term
these are both true for this infectin related to pregnancy: Delivery is required for cure
Treat before birth to prevent neonatal pneumonia |
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Definition
| Chorioamnionitis or intra-amniotic infection syndrome |
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Term
| What is the ABX regimen to cover for the typical pelvic bugs (E.coli and GBS) |
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Definition
| Ampicillin and gentamicin |
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Term
| What addition to he ABX do you make if treating choriamnionitis and the pt has a c-section |
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Definition
Add clindamycin for anaerobes with C-section or after cord clamping
If you don’t add clindamycin, 20-30% of ampi or gent treatment may fail |
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Term
| Postpartal infection of the uterus is called? |
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Definition
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Term
↑temp 1 or 2 days postpartum
low abd pain, uterine tenderness, ↑WBC
are S/S of this infection relatd to pregnancy |
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Definition
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Term
| A recurrent theme of these bugs is seen with pelvic infections |
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Definition
Gram (-) E. coli
Gram (+) GBS
Anaerobes: Bacteroides spp. |
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Term
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Definition
Gram + cocci
Infections: UTI, pelvic and intra-abd
Tx: Ampicillin |
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Term
| Tx for postpartal endometritis after vaginal delivery? |
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Definition
| IV clindamycin and gentamicin works 95% of the time, if fever persists => add IV ampicillin as enterococcus is implicated |
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Term
| Tx for postpartal endometritis after c-section? |
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Definition
|
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Term
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Definition
| Broad spectrum PCN, covers both G+ and G-, equivalent to amoxicillin |
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Term
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Definition
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Term
| Aminoglycoside ABX are identified by what suffix? |
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Definition
|
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Term
| after c-section fever lasting >72 hours should prompt a search for? |
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Definition
| incisional or pelvic abscess, infected hematoma or septic pelvis thrombophlebitis |
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Term
| Should pts receive prophylactic ABX while undergoing C-section or after prolonged rupture of membranes? |
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Definition
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Term
Puerperal ovarian vein thrombophlebitis (POVT) and Septic Pelvic Thrombophlebitis (SPT) (these are both very rare) Consider if pt is without response to abx for presumed PPE or post op pelvic infection
IV abx aimed at polymicrobial flora and this additional medication? |
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Definition
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Term
| a postabortal infection from an uncomplicated elective abortion is the same as? |
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Definition
| simple endometritis (low grade temp and uterine tenderness) Rx: oral doxycycline |
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Term
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Definition
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Term
following an improperly performed abortion there may be S/S of fever, abd pain, vaginal bleeding, pus from cervical os
What bugs are you concerned about? |
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Definition
| Gram (-) e. coli, Gram (+) GBS, anaerobes and GC |
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Term
| What is the Rx for a mild infection post improperly performed abortion? |
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Definition
| Mild: monotherapy with broad spectrum: cefoxitin, cefotetan, ampicillin-sulbactam |
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Term
| Rx for a severe infection post improperly performed abortion |
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Definition
Severe: ampi, clinda + aminoglycoside
Or ampi-sulbactam + aminoglycoside
Or 3rd G cephalosporin plus metronidazole |
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Term
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Definition
| Sulbactam is a molecule which is given in combination with beta-lactam antibiotics to inhibit beta-lactamase, an enzyme produced by bacteria that destroys the antibiotics. |
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Term
| True or False? All GYN surgical infections are polymicrobial |
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Definition
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Term
| most common infection after a hysterectomy? |
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Definition
| Pelvic cellulitis: inflammation of the soft tissue, |
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Term
| How do you diagnose and treat pelvic cellulitis? |
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Definition
No overt abscess on CT or ultrasound
Monotherapy cefoxitin or amp-sulbac |
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Term
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Definition
second−generation cephalosporins
broad range of gram-negative and gram-positive bacteria including anaerobes |
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Term
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Definition
inflammatory response at the margins of the vaginal cuff incision after hysterectomy, part of the normal healing, usually resolves spontaneously a few days post op
Tx with oral abx |
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Term
| this condition is rare but often occurs in the weeks following gyn surgery, diverticular or appendical disease or PID and needs to be confirmed with ultrasound |
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Definition
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Term
| Pelvic abscess Tx: surgical unless small, then ABX alone might work |
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Definition
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Term
| A spectrum of inflammatory disorders of female genital tract: Endometritis, Salpingitis, Pelvic peritonitis, Early tubo-ovarian abscess are all referred to together as? |
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Definition
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Term
| Tx of PID needs to cover for typical pelvic polymicrobia plus these 2 bugs? |
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Definition
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Term
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Definition
Cefotetan (Gram -, anaerobes, GC)
Or
Cefoxitin
Plus
Doxycycline (Chlamydia) |
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Term
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Definition
| second-generation cephalosporin, similar antibacterial spectrum to other 2G ceph, but with additional anti-anaerobe converage. |
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Term
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Definition
Chlamydia trachomatis, an obligate intracellular human pathogen
C. trachomatis is Gram-indeterminate |
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Term
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Definition
| Neisseria gonorrhoeae, also known as Gonococci (plural), or Gonococcus (singular), a species of Gram-negative coffee bean-shaped diplococci |
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Term
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Definition
Levfloxacin Or Ofloxacin
With or without Metronidazole |
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Term
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Definition
| second-generation fluoroquinolone. |
|
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Term
| do prophylactic ABX treat early known infections? |
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Definition
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Term
| Which surgeries benefit from proph abx? |
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Definition
High inoculum: colonic, vaginal, infected biliary
Prosthetic devices: heart valves, prosthetic joints |
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Term
| Decisive period in which to give abx regarding Sx? |
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Definition
Just before, during and up to 3 hours after Sx
Need to be at good tissue levels for the 1st 3-4 hours following incision
C-sections: typically delayed until cord is clamped
Typically given at induction of anesthesia |
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Term
| duration of surgical prophylaxis |
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Definition
Typically single dose
Some favor 2 doses <24hr certainly
Prosthetic device proph abx duration unclear => go with 24hr |
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Term
| abx choice for surgical prophylaxis for an extended length Sx |
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Definition
Cefotetan: long acting prep only once every 6 hours, long T½
For extended surgeries |
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Term
| Bug common in clean surgery (most surgical porcedures) |
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Definition
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Term
| Bugs common in colonic surgery |
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Definition
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Term
| Bugs common in GU or Pelvic Sx? |
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Definition
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Term
| Prophylactic Rx for normal (clean) Sx: |
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Definition
cephalosporins, 1G, cefazolin, active against S. aureus
Vanc if ceph allergy |
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Term
| Prophylactic Rx Colon Sx: |
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Definition
2G cephs with anaerobe activity, cefoxitin or cefotetan
If ceph allergy: metronidazole and gentamicin |
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Term
| Potential problems with prohylaxis: |
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Definition
Select out for resistant infections => prevent by using short courses
Allergic reactions => use cephs because low incidence of SE and low iincidence or toxicity
Cost: abx typically less expensive than cost of infection |
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