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Principles of Diagnosis and
treatment in MicrobialDiseases
Oladapo Olayemi
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Introduction
Infectious diseases are common in O&Gpractice
Some of these are due to the procedures
we perform on our patients Obstetric patients are particularly prone to
some infections especially in thepuerperium
This class will focus on bacterial infectionsmostly
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Learning Objectives
At the end of this class participants will beable to
Enumerate the common gynecology and
obstetric conditions that require antibiotictherapy
Discuss the principles and practice of antibiotictherapy in these conditions
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Regimen in antimicrobial Therapy
Therapeutic
Peri-operative
Prophylactic
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General Principles
Community acquired infection
Hospital Acquired Infections
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General Principles
Take a microbiological Specimen
Use a regimen based on the knowledge ofthe commonest organism causing that
infection Never combine bacteriostatic and
bacteriocidal drugs
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Diagnosis
Clinical Presentation
Syndromic
Investigations
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Treatment
Evidence Based
Treatment before obtaining Lab results
Broad Spectrum Antibiotics
When lab results conflict with clinicalobservation
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Target Sites
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Gynecological Infections
Post abortal sepsis
Pelvic Inflammatory Disease
Vaginitis
Vaginosis
Post operative infections
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Obstetric Infections
Vaginosis
Urinary Tract Infections
Chorioamnionitis
Post partum sepsis
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Post Abortal Sepsis
Infections are more common with inducedwhen compared to spontaneous abortion
Abortion is illegal and unsafe
The spectrum of organisms Gram positive
Gram negative
Anaerobes
From normal flora of genital tract andbowel
Also from environment e.g tetanus
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Post abortal sepsis
Antibiotic regimen usually Broad spectrum
Penicillin
Cephalosporins
Meteronidazoles Aminoglycosides
Regimen chosen will depend on suspectedcontaminants
Microbiological evidence required forappropriate treatment
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Post abortal sepsis
Parenteral therapy
Oral therapy
Antitetanus Prophylaxis
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Pelvic Inflammatory Disease
Inflammation of the upper genital tractusually involving the uterus, fallopiantubes and ovaries
Emperical treatment beforemicrobiological evidence common
No RCT to refute emperical treatment
Admission and parenteral therapy usuallyindicated initially
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Pelvic Inflammatory Disease
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Vaginitis
The common causes of vaginitis are nonbacterial
Candidiasis
Trichomoniasis Chlamydia
Antifungal agents for candidiasis
Meteronidazole active againstTrichomoniasis
Doxycycline for chlamydia
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Post operative Infections
Preventive Measure
Perioperative antibiotics
Therapeutic measure
Treatment similar to PID
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Obstetric Infections-Vaginosis
Probably sexually transmitted
Caused by G.vaginalis
No inflammation of Vaginal epithelium
Associated with
Vaginal discharge
High vaginal pH 5.0-5.5
Low birthweight preterm births
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Obstetric Infections-Vaginosis
Diagnosis
Clue test
Whiff test
Pap smear Current thinking
Bacteriophage infection of Lactobacilli
Special note
Cause of vaginal discharge is one of the mostdifficult Diagnosis to make
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Obstetric Infections-Vaginosis
Treatment
Meteronidazole preferably vaginal gel
Clindamycin
Concomitant treatment of partner
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Urinary Tract Infection
Asymptomatic in 4-7% of pregnantwomen
Risk factors
Multiparity Sickle cell disease
Diabetes mellitus
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UTI
Commonest is cystitis
Can progress to pyelonephritis
Treatment
Nitrofurantoin
Nalixidic acid
Cephalosporin
Amoxicillin
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Chorioamnionitis
Inflammation of the chorion and amnioticmembranes
Predisposes to puerperal sepsis
PROM of greater than 6 hours increasesrisk of chorioamnionitis
Repeated vaginal examination
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Treatment
Usually microbiological specimen shouldguide treatment
Broad spectrum penicillins
Cephalosporins
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Postpartum infections
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Managing Multi-drug resistant Strains
Principle of environmental pressure andgenetic adaptation
Adaptation obeys the principle of
Opportunity Cost
