No abstract

The charts of all patients who were seen at a vaginitis clinic between January 1989 and December 1994 were retrospectively reviewed; 80 patients whose vaginal cultures yielded Torulopsis glabrata were identified. Sixty of these patients experienced 75 symptomatic episodes of vaginitis attributed to T. glabrata, and these patients are the subject of this review. Of the 60 symptomatic patients, 40 had uncomplicated T. glabrata infection, and 20 had mixed infection, most commonly in association with bacterial vaginosis. Evaluation of treatment of T. glabrata vaginitis with vaginal boric acid (600 mg/d for 14 days) revealed clinical improvement or cure in 21 (81%) of 26 episodes and mycological eradication in 20 (77%) of 26 episodes. One-third of the patients received maintenance therapy with boric acid. The clinical response and mycological eradication rates associated with therapy with topical and systemic azoles were <50%. The rate of therapeutic response to boric acid administered to patients with mixed T. glabrata infection remained high. In conclusion, in this series of patients with T. glabrata vaginitis, for whom repeated courses of antimycotic therapy with azoles had previously failed, boric acid emerged as a promising modality of therapy.

OBJECTIVE: To correlate clinical variables (gestational age, severe pregnancy-induced hypertension, gestational diabetes mellitus, history of previous cesarean sections, fetal distress, perinatal mortality, postpartum anemia, Apgar score < or = 3 at 1 minute and < or = 7 at 5 minutes, and instrumental delivery) with postpartum endometritis (PPE) and wound infection. METHODS: Descriptive cross-sectional study of the outcome of 75,947 term and preterm singleton deliveries; vaginally and by cesarean section from 1989-1997. RESULTS: The prevalence of PPE after vaginal deliveries was 0.17% (120/68,273). Gestational age of less than 37 weeks, severe pregnancy-induced hypertension, fetal distress, instrumental deliveries, neonatal mortality, postpartum anemia, and Apgar scores of < 7 after 5 minutes were significantly associated with PPE. Gestational diabetes and an Apgar score of < 3 after 1 minute showed similar frequency with and without PPE. The prevalence of PPE after cesarean section was 2.63% (202/7,677). Preterm cesarean sections, history of previous cesarean sections, anemia, and low Apgar scores were seen more frequently with PPE than without. The incidence of cesarean delivery with gestational diabetes mellitus, fetal distress, and perinatal mortality was similar in presence and absence of PPE. The rate of wound infection after cesarean section was 3.97% (318/7,995). Gestational diabetes mellitus, history of previous cesarean deliveries, and low Apgar scores were significantly more frequent with than without wound infection. Gestational age, severe pregnancy-induced hypertension, fetal distress, perinatal mortality, and postpartum anemia were not associated with wound infection. CONCLUSIONS: Awareness of the aforementioned associations may prevent and shorten hospital stay by early diagnosis and appropriate treatment.