Puerperal infection after cesarean delivery: Evaluation of a standardized protocol

OBJECTIVE: Our goal was to evaluate an antibiotic protocol for treatment of postcesarean endometritis. STUDY DESIGN: Endometritis was diagnosed as a persistent fever greater than or equal to 100.4 degrees F beyond 24 hours after cesarean delivery and on e or more of the following: uterine tenderness, tachycardia, foul lochia, o r leukocytosis. Antibiotic therapy included gentamicin plus clindamycin and ampicillin (or vancomycin) as a triple antimicrobial in 148 women. Antibio tic failure was defined as persistent fever after 5 days of antibiotics and 72 hours of triple antibiotics. RESULTS: Between 1993 and 1996, 322 of 1643 (20%) women were diagnosed with postcesarean endometritis. One hundred seventy-four patients (54%) were cu red with clindamycin-gentamicin, and 129 who additionally received ampicill in or vancomycin (40%) were cured. Nineteen of the 322 (6%) women had persi stent fever despite triple antibiotics. Of these, 6 had a wound complicatio n, 12 were suspected to have antimicrobial resistance, and 1 had an infecte d hematoma. CONCLUSION: A prospective protocol consisting of clindamycin-gentamicin plu s the selective addition of ampicillin or vancomycin cured 303 of 322 (94%) women with postcesarean endometritis.