Severe endometritis caused by genital mycoplasmas after Caesarean section

Abstract

Infrequently, post-Caesarean endometritis can progress to severe conditions. A case of postCaesarean endometritis caused by Mycoplasma hominis and Ureaplasma urealyticum is reported in a young patient. In therapy-resistant endometritis unusual causative organisms should be considered and special microbiological investigations are recommended. Case reportIn the case of a 14-year-old white Caucasian woman there was a medical history of miscarriages in 6th and 7th weeks of previous pregnancies. She was hospitalized during her third pregnancy because of imminent abortion in the 8th and 11th weeks and premature labour in the 29th week. As a result of treatment [magnesium was used in the first trimester and Saletanol D5 solution (4 . 5 g sodium chloride, 50 g glucose and 50 g alcohol in 1000 ml solution) was used together with magnesium for tocolysis in the 29th week] she became asymptomatic and was discharged. She was admitted again to the department on the 40th week of gestation in ongoing labour. A Caesarean section was performed because of acute foetal asphyxia (heart rate decelerations), and a healthy, 2800 g girl with Apgar score 10/10 was delivered.The mother developed 38 8C fever on the first postoperative day and gentamicin (160 mg), ampicillin (4 g) and metronidazole (1 . 5 g) therapy was started. Despite the combined antibiotic treatment, her temperature increased during the next 2 days and reached 38 . 8 8C. The uterus was soft by palpation with normal lochia at gross inspection and the Caesarean wound did not show signs of a pathological reaction. A lochia sample was sent for microbiological investigation, but failed to demonstrate any pathological aerobic or anaerobic bacteria in the cultures. At this time, the tests did not include a search for genital mycoplasmas.By the fourth postoperative day the fever increased further, reaching 39 . 5 8C. Curettage was performed and histology revealed endometritis. Ceftriaxone (2 g) was added to the antibiotic treatment and the dose of gentamicin was reduced to 80 mg. The condition of the patient improved and in the next 4 days her temperature did not rise above 38 8C. Afterwards, on postoperative day 8, gentamicin and ampicillin were discontinued, and amoxycillin/clavulanic acid (4 . 8 g) and nystatin (1 500 000 IU) were introduced. A day later the body temperature elevated again above 39 8C, and clindamycin (900 mg) was added to the antibiotic therapy. Repeated lochia and blood samples revealed mycoplasmas in the cultures (Mycoplasma hominis and Ureaplasma urealyticum colour-changing units .10 4 ; Mycoplasma Duo, Sanofi Pasteur). Subsequent doxycycline therapy (200 mg on the first day, 100 mg on the following days) rendered the patient afebrile in 4 days and her condition improved rapidly. The standard aerobic and anaerobic cultures of the second lochia and blood samples were negative for bacteria.Chlamydia trachomatis antigen tests (IDEIA Chlamydia, DAKO) of the patient's cervical sample and smears from the newborn's eye and vagina on the third day of doxycyclin...

Clinical chorioamnionitis at term I: microbiology of the amniotic cavity using cultivation and molecular techniques

“…Knowledge of the microbiology of the amniotic cavity is important for rational antimicrobial therapy. The observation that genital Mycoplasmas are frequently involved is relevant because these microorganisms are not successfully treated with the antibiotics generally used for the treatment of clinical chorioamnionitis [137], puerperal endometritis [138–145], or neonatal sepsis [146–152]. Ureaplasma has been treated with erythromycin [153], while Mycoplasma requires treatment with other antimicrobial agents [154–156].…”

Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in pregnant women

“…They have been associated with various pathological conditions and intrauterine infections, including pyelonephritis, pelvic inflammatory disease, chorioamnionitis, endometritis, and postpartum fever, leading to important complications such as preterm birth, low birth weight, spontaneous abortion, stillbirth, premature birth, infertility, and perinatal mortality. [1][2][3][4][5][6] The genital mycoplasmas that contribute most to these conditions are Mycoplasma hominis and Ureaplasma urealyticum. They are most commonly present in the genital tract of sexually active women.…”

Oral and Intramuscular Treatment Options for Early Postpartum Endometritis in Low-Resource Settings

“…64,79 Close monitoring is warranted with all oral or intramuscular antibiotic treatment and for women treated with this regimen, one should consider adding oral amoxicillin or amoxicillin-clavulanate if marked clinical improvement is not seen and intravenous antibiotics remain unavailable. 80 Of note, genital mycoplasmas have been identified in endometrial cultures of patients with postpartum endometritis 30,36,55,81 ; however, their pathogenicity is questionable. Combination antibiotic regimens that are do not include mycoplasma coverage eradicate the infection, suggesting these organisms are unlikely to play a major role in the infection.…”