29 - Gynecological Infections / PID Flashcards by Karlo Sison

What type of Gynecological Infection?

Fever + tenderness
more diffuse across abdominal region

Sicker / often require IV ABx

Often associated w/ surgical procedures such as:
Hysteroctomy

PELVIC CELLULITIS
Surgical Site Infection

Surgical site is contamintated w/ vaginal flora:
B-Strep / E-Coli / Anaerobes (Prevotella / G. Vaginalis)

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Pelvic Inflammatory Disease
PID

CRITERIA FOR INPATIENT TREATMENT

Surgical Emergency can NOT be ruled out

PREGNANCY

Lack of Clinical response to ABX
>72 hours

Unable to tolerate outpatient management

VERY SICK = high fever + NVD

Presence of ABSCESS

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What type of Gynecological Infection?

Spread of Infection –> DEEP into ABDOMINAL TISSUE

Late Complication

Antibiotics +/- Surgical Drainage

Often associated w/ surgical procedures such as:
Hysteroctomy

PELVIC CELLULITIS
Surgical Site Infection

Surgical site is contamintated w/ vaginal flora:
B-Strep / E-Coli / Anaerobes (Prevotella / G. Vaginalis)

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Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Doxycycline

Doxycycline

CHLAMYDIA

NOT FOR PREGNANCY

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Bacteria Found in
IAIS
Intra-Amniotic Infectious Syndrome = Chorioamniotis

*IASA**
*IntraPartum** -> involve contamination of amniotic fluid w/ vaginal flora

B-Strep** + **E.COLI

Anaerobes:
Mycoplasma + Prevotella

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*PELVIC INFLAMMATORY DISEASE**
*PID**

RISK FACTORS

Similar Risk factors to STD’s

Younger Females 20s

Multiple Sex Partners

Substance Abuse

Lower Socioeconomic Status

Douching

Bacterial Vaginosis

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What type of Gynecological Infection?

Infxn @ surgical Margins

Discharge w/ lower abdominal pain

Often associated w/ surgical procedures such as:
Hysteroctomy

VAGINAL CUFF CELLULITIS
Surgical Site Infection

Surgical site is contamintated w/ vaginal flora:
B-Strep / E-Coli / Anaerobes (Prevotella / G. Vaginalis)

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*Vaginal Flora Bacteria**
potentially infectious*

B-Streptococci

E. Coli

Anaerobes - PPBM
Peptostreptococcus spp.
Prevotella
Bacteroids
Mycoplasma

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Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Cephalosporins
Cefoxitin / Ceftriaxone / Cefotetan

Cephalosporins
Cefoxitin / Ceftriaxone / Cefotetan

GONORRHEA (GC)

no chlamydia

avoid QUINOLONES & CEFIXIME*
due to RESISTANCE*

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Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Clindamycin

Clindamycin

+Gram POS+
Streptococcus

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

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Bacterial Vaginosis

DIAGNOSIS

CLUE CELLS** + **Gray-White Discharge

Clue Cells:
Coccobacillary Cells (G. VAGINALIS) adhered to Vaginal Epithelum

pH > 4.5

“whiff test” was used before + KOH

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Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

*B-Lactams + Inhibitor**
*Augmentin / Amp-Sub / Pip-Tazo**

*B-Lactams + Inhibitor**
*Augmentin / Zosyn / Pip-Tazo**

-GRAM NEG-
E. Coli

+Gram POS+
Streptococcus

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

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Bacteria Found in:
PELVIC INFLAMMATORY DISEASE = PID

PID

C. TRACHOMATIS** + **N. GONORRHEAE
plus normal
E. Coli + Strep

Severe Cases ADD ANAEROBES

avoid Quinolones in those suspected of N. gonorrheae
due to resistance

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Intrapartum IAIS
Intra-Amniotic Infectious Syndrome
AKA: Chorioamnionitis

Diagnosis / Signs

IMPRECISE DIAGNOSIS:
FEVER (>100.4*) + >2 of below
Maternal/Fetal TACHYcardia
↑WBC >15k
FOUL-smelling amniotic fluid
Uterine Tenderness

Amniotic Fluid + Fetal Membranes
infected due to vaginal organisms ASCENDING –> intrauterine cavity
after membrane rupture - Preterm Labor <37 weeks

Causes dysfunctional labor = Oxytocin or C-section

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Pelvic Inflammatory Disease
PID

INPATIENT TREATMENT
Criteria:
PREGNANCY - Surgery
SEVERE ILLNESS
ABSCESS
No Abx Response > 72 hours

14 DAYS

Cefotetan IV** + **Doxycycline IV -> followed by Doxy PO
OR
CeFOXitin IV** + **Doxy IV –> Doxy PO
OR
Clindamycin IV** + **Gentamicin IV** –> **Doxy** or **Clinda PO
OR
Ampicillin/Sulbactam IV** + **Doxy** –> **Doxy Po

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Bacteria Found in
ENDOMYOMETRITIS

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*Endomyometritis**
*IntraPartum** -> involve contamination of amniotic fluid w/ vaginal flora

Same as IASA:
B - Strep** + **E. Coli
PLUS
ANAEROBES
Peptostreptococcus / Prevotella / Bacteroids / Mycoplasma

Pelvic Inflammatory Disease
PID

Outpatient Treatment

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14 DAYS

*CeFOXitin** 2mg IM x1 + Probenecid 1g PO x1
*Doxycycline** 100mg PO BID

CeftTRIaxone 250mg IM x1 + Doxycycline 100mg PO BID

*PELVIC INFLAMMATORY DISEASE**
*PID**

Diagnostic Criteria

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often VAGUE presentation** –> **no SINGLE symptom specific

Suggested to Treat:
Sexually Active + Pelvic/ab pain + Discharge

Minimum criteria > 1:
Cervical Motion** / **Uterine** / **Adnexal
TENDERNESS

Additional Criteria:
Oral Temp > 101 / Discharge / WBC >10k
ESR > 15 / ↑CRP

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Flagyl

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Flagyl

ANAEROBES
Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma
+ G. Vaginalis

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Azithromycin

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Azithromycin

CHLAMYDIA

could be used for prgnancy > Doxycycline

avoid QUINOLONES & CEFIXIME
due to RESISTANCE

TREATMENT
PCN ALLERGY

Surgical Site Infection:
Vaginal Cuff Cellulitis
Infxn @ surgical margins / Discharge+lower abdominal Pain

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Vaginal Cuff Cellulitis

ORAL ABx

CIPRO 500mg BID** + **FLAGYL 500mg BID

instead of Augmentin 875 BID ONLY

Gynecological / Fetal Friendly Antibiotics

What does this ABx Cover?

Gentamicin

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Gentamicin

-GRAM NEG-
E. Coli

Surgical Site Infections:
Cuff Celulitis / Pelvic Cellulitis / Pelvic Abscess

RISK FACTORS

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NOT using PREOPERATIVE PREP*
*Chlorhexidine or Providone Iodine**

NOT using SYSTEMIC ABx
around time surgery is started

Blood Loss > 500mL** or **Blood Transfusion

Prolonged Surgery >140min

STAPLES > Sutures
sutures are @ lower risk for infxn

TREATMENT

Surgical Site Infection:
Pelvic Cellulitis
patient is more sick vs cuff cellulitis
deeper tissue infxn

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Pelvic Cellulitis

Hospitilization + IV TREATMENT until patient FEBRILE (24-48hrs)
complete regimen OUTPATIENT

14 DAY TREATMENT

Augmentin 875 BID

PCN ALLERGY:*
*CIPRO 500mg BID_ + _FLAGYL 500mg BID**

* *_ENDOMYOMETRITTIS_** * *Postpartum infxn of the uterus** ## Footnote **Diagnosis / Risk Factors**

_Risk Factors:_ * *DURATION of LABOR** or **RUPTURE** of membranes * *Bacterial Vaginosis** * *# of Vaginal Exams** * *Internal Fetal Monitoring** POSTpartum Endometritis: * *C-Section** or **Rupture of membranes** after labor = **strong predictor** * *Inoculation**

**Bacteria found in: _Bacterial Vaginosis_**

**_Bacterial Vaginosis_** Caused by: ↓**_Lactobacillus_** - keeps flora in check, stops anaerobe growth Then: **_Vaginal Anaerobes PREDOMINATE_** **G. VAGINALLIS** / **prevotella / Bacterdes / Peptostrep** Treat with: * *Flagyl** or **Clindamycin** * exception to 14 day treatment --\> could be 3/5/7 days*

**_Bacterial Vaginosis_** ## Footnote **RISK FACTORS**

* not considered an STD* * *alteration of normal vaginal flora --\> preterm birth** _Risk Factors_ **SMOKING / DOUCHING AA Race** **Early Age Sex / Multiple Sex Partners WSW**

**_Intrapartum IAIS_** **Intra-Amniotic Infectious Syndrome** AKA: Chorioamnionitis ## Footnote **TREATMENT**

**_SOURCE CONTROL_**: is **DELIVERY** **Start Intrapartum ABx (during) to prevent systemic infections** Target **B-Strep** + **E. Coli**: **_AMPICILLIN**_ + _**GENTAMICIN_** If **C-Section**: * *Add _ANAEROBIC COVERAGE_** * *Clindamycin / Flagyl** or B-Lactam ONLY (covers all 3)

**TREATMENT** Surgical Site Infection: **_Pelvic ABSCESS_**

* *PELVIC ABSCESS** * *Same as Cellulitis but...** * *_DRAIN MASS if_**: * *\>8 cm** OR **\<8 cm** **& not improving on therapy** **Hospitilization + _IV TREATMENT_** until patient **FEBRILE (24-48hrs)** complete regimen OUTPATIENT **_14 DAY TREATMENT_** **_Augmentin 875 BID_** * PCN ALLERGY:* * *_CIPRO 500mg BID**_ + _**FLAGYL 500mg BID_**

**_Endomyometritis_** Postpartum infxn of the uterus ## Footnote **TREATMENT**

**_Endomyoetritis_** Treatment is **similar to IAIS** w/ **EMPHASIS on _ANAEROBES_** **_GENTAMICIN**_ + _**CLINDAMYCIN_** Drug of choice Alternates: **Amp/Sulb** - **Pip/Tazo** - **Cefoxitin** - **Carbapenems** Need to cover: **Penicillin Resistant Prevotella**

**TREATMENT** Surgical Site Infection: **_Vaginal Cuff Cellulitis_** Infxn @ surgical margins / Discharge+lower abdominal Pain

**Vaginal Cuff Cellulitis** **ORAL ABx** **_AUGMENTIN 875mg BID_**

**Gynecological / Fetal Friendly Antibiotics** **What does this ABx Cover?** * *_B-Lactams_** * *Cefoxitin** / **Cefotetan**

* *_B- Lactams_** * *Cefoxitn / Cefotetan** **-GRAM NEG-** E. Coli **+Gram POS+** Streptococcus **ANAEROBES** Peptostreptococcus / Prevotella / Bacteroides / Mycoplasma + G. Vaginalis

**Bacteria found in: _Surgical Site Infections_** Cuff / Pelvic Cellulitis + Pelvic Abscess

**_Surgical Site Infections_** Cuff / Pelvic Cellulitis + Pelvic Abscess Normal Vaginal Flora: **_B - Strep**_ + _**E. Coli**_ + _**Anaerobes (PPMP)_** PLUS **_GARDNERELLA VAGINALIS_**

**_Bacterial Vaginosis_** **_TREATMENT_**

Goal is to **↓****Anaerobes Present**, since its an **alteration of normal flora** Empiric treatment: **_Metronidazole 500mg BID x 7 days_** or **_Metronidazole 0.75% gel QD x 5 days_** or **_Clindamycin 300mg BID x7 days_** *not routinely recommended to treat partner*

29 - Gynecological Infections / PID Flashcards

(34 cards)