title: The role of cervical cultures to guide perioperative antibiotics in cervical cerclage - a retrospective analysis of 65 consecutive cases.
abstract: OBJECTIVE
  The objective of this study is to examine results of bacterial cultures of the cervix prior to cerclage placement and how these may be used to guide prophylactic antibiotics.
  
  
  METHODS
  All patients undergoing cerclage between 2000 and 2003 in a single, large community hospital were evaluated for indication for cerclage, signs and symptoms on presentation, transvaginal ultrasound cervical length findings, type of cerclage placed, type of anesthesia used, cervical culture taken, tocolytics given, gestational age at delivery, and complications surrounding delivery.
  
  
  RESULTS
  Sixty-five cerclages were performed between 2000 and 2003, 13 (20%) prophylactic, 47 (72%) therapeutic, and five (8%) emergent. Cervical cultures were obtained in 85% of patients, of which 40% were negative resulting in no antibiotics given. In the remaining 45%, one or more pathogens were isolated and antibiotics were given according to sensitivities reported. Fifty-five of 65 patients (84%) delivered after 32 weeks gestation and a latency > 60 d was seen in 84%. The incidence of chorioamnionitis and PPROM was low.
  
  
  CONCLUSIONS
  Bacterial cultures of the cervix prior to cerclage show variable colonization and antibiotic sensitivities and, there is no single antibiotic, chosen empirically, that will cover all pathogens.
authors.affiliation: a Department of Obstetrics and Gynecology , Städtisches Klinikum Frankfurt Höchst , Frankfurt , Germany .|b Gynecologic Group Practice , Wiesbaden , Germany .
authors.forename: Christina M
authors.initials: CM
authors.lastname: Moisidis-Tesch
authors.affiliation: a Department of Obstetrics and Gynecology , Städtisches Klinikum Frankfurt Höchst , Frankfurt , Germany .|c Association for Women's Healthcare and Northwestern University Hospital , Chicago , IL , USA , and.
authors.forename: Norman A
authors.initials: NA
authors.lastname: Ginsberg
authors.affiliation: a Department of Obstetrics and Gynecology , Städtisches Klinikum Frankfurt Höchst , Frankfurt , Germany .|d Gynecologic Group Practice , Hildesheim , Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Uleer
authors.affiliation: a Department of Obstetrics and Gynecology , Städtisches Klinikum Frankfurt Höchst , Frankfurt , Germany .
authors.forename: Volker J
authors.initials: VJ
authors.lastname: Möbus
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000382:microbiology* / Q000601:surgery; D002821:Chorioamnionitis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008826:Microbial Sensitivity Tests; D019990:Perioperative Care / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Adjunctive therapy; McDonald; Shirodkar; choriamnionitis; incompetent cervix; latency; premature rupture of membranes; preterm birth