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Why Patients Fail Antibiotic Prophylaxis at Cesarean Delivery: Histologic Evidence for Incipient Infection

From the Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Medical School at Houston; the Department of Pathology, St. Luke's Episcopal Hospital, Houston; and the Department of Pathology, Baylor College of Medicine, Houston, Texas

Abstract

A prospective, blinded study was conducted to test the hypothesis that antimicrobial prophylaxis failure after cesarean delivery is associated with incipient infection of the uterus, as determined by histologic evaluation of bacterial invasion and acute inflammatory cell response. One hundred nineteen patients undergoing cesarean delivery and receiving antibiotic prophylaxis were included in this study. At the time of the operation, a hysterotomy biopsy was obtained for hematoxylin and eosin staining. Marked histologic differences were noted in decidual inflammation, myometrial inflammation, and myometrial polymorphonuclear cell invasion in those patients who subsequently developed endometritis (N=7) compared with subjects without postpartum endometritis. Using two techniques for in situ identification of bacteria within myometrial tissue (acridine orange and fluorescein DNA probe to bacterial ribosomal RNA), all clinically infected parturients demonstrated large numbers of organisms in the myometrial layer of the biopsy specimen, compared with few organisms seen in a matched subset of noninfected controls. These data support the concept that incipient infection at the time of cesarean delivery may limit the effectiveness of antimicrobial prophylaxis. Use of rapid-diagnosis methodologies may allow timely identification of these at-risk patients so that therapeutic antibiotics can be initiated.

This article has been cited by other articles:

				R. V. Starr, J. Zurawski, and M. Ismail Preoperative Vaginal Preparation With Povidone-Iodine and the Risk of Postcesarean Endometritis Obstet. Gynecol., May 1, 2005; 105(5): 1024 - 1029. [Abstract] [Full Text] [PDF]