title: Puerperal infection after cesarean delivery: evaluation of a standardized protocol.
abstract: OBJECTIVE
  Our goal was to evaluate an antibiotic protocol for treatment of postcesarean endometritis.
  
  
  METHODS
  Endometritis was diagnosed as a persistent fever > or =100.4 degrees F beyond 24 hours after cesarean delivery and one or more of the following: uterine tenderness, tachycardia, foul lochia, or leukocytosis. Antibiotic therapy included gentamicin plus clindamycin and ampicillin (or vancomycin) as a triple antimicrobial in 148 women. Antibiotic failure was defined as persistent fever after 5 days of antibiotics and 72 hours of triple antibiotics.
  
  
  RESULTS
  Between 1993 and 1996, 322 of 1643 (20%) women were diagnosed with postcesarean endometritis. One hundred seventy-four patients (54%) were cured with clindamycin-gentamicin, and 129 who additionally received ampicillin or vancomycin (40%) were cured. Nineteen of the 322 (6%) women had persistent fever despite triple antibiotics. Of these, 6 had a wound complication, 12 were suspected to have antimicrobial resistance, and 1 had an infected hematoma.
  
  
  CONCLUSIONS
  A prospective protocol consisting of clindamycin-gentamicin plus the selective addition of ampicillin or vancomycin cured 303 of 322 (94%) women with postcesarean endometritis.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Center for Research in Women's Health, The University of Alabama at Birmingham, 35249-7333, USA.
authors.forename: C G
authors.initials: CG
authors.lastname: Brumfield
authors.forename: J C
authors.initials: JC
authors.lastname: Hauth
authors.forename: W W
authors.initials: WW
authors.lastname: Andrews
mesh_terms: D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002585:Cesarean Section / Q000009:adverse effects*; D002981:Clindamycin / Q000627:therapeutic use; D004352:Drug Resistance, Microbial; D004359:Drug Therapy, Combination; D004716:Endometritis / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005334:Fever; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007964:Leukocytosis; D011183:Postoperative Complications / Q000188:drug therapy*; D011247:Pregnancy; D011644:Puerperal Disorders; D013610:Tachycardia; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002981:Clindamycin; D014640:Vancomycin; D000667:Ampicillin