Nosocomial post-cesarean endometritis: a rationalized strategy of antibacterial therapy

The number of patients with nosocomial post-cesarean endometritis is steadily growing. Aim: to study the etiology of nosocomial post-cesarean endometritis and to propose a rationalized antimicrobial therapy. Material and methods. Sixty six puerperas with post-cesarean endometritis were examined. The spectrum of microflora and its resistance to antimicrobial agents were determined using an automatic microbiological analyzer based on mass spectrometry. Results. Enterococci, E. coli, staphylococci and streptococci were the most clinically significant pathogens found in the examined patients with post-cesarean endometritis. The microflora spectrum in the endometrium reflected the previous «antibacterial history»; this association must be taken into account when developing antibacterial therapy. Conclusion. If the new mother was previously treated with antibacterial agents, it is recommended to use a combination of the reserve antibiotics in order to block the entire spectrum of possible multidrug-resistant pathogens. In cases of the resistant Gram-positive microflora (MRSE, MRSA, E. faecium), it is advisable to prescribe vancomycin. For the resistant Gram-negative microflora (Enterobacter spp., Citrobacter spp., E. coli-ESBL+ and Klebsiella spp.-ESBL+), vancomycin should be combined with carbapenems.