Cultures of Bartholin Gland Abscesses Commonly Yield Pathogens

September 20, 2013

By Will Boggs, MD

NEW YORK (Reuters Health) Sep 20 - Bartholin gland abscesses are commonly culture-positive, and these microbiological findings should drive empirical antimicrobial treatment, researchers from Israel report.

"We were surprised by the high rates of positive cultures that were found in our study with the most common pathogen being�E. coli," Dr. Roy Kessous from Soroka University Medical Center in Beer-Shiva told Reuters Health by email. "We were also surprised at the correlation between positive cultures and�clinical features."

Dr. Kessous and colleagues examined Bartholin gland abscesses in 219 women admitted to Soroka University Medical Center, including 132 with primary infections and 87 with recurrent events.

Bartholin gland abscess drainage yielded positive cultures in 61.8% cases, and Escherichia coli was the most frequent pathogen found (43.6%). Only 7.9% of cases were polymicrobial.

Infection with E. coli was significantly more common with recurrent infection (56.8%) than with primary infection (37%).

About a quarter of the tested isolates were penicillin-resistant, but only three (5.2%) were extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae infections. There were no cases of methicillin-resistant Staphylococcus aureus (MRSA).

Among the 12 pregnant or postpartum women with Bartholin gland abscess, cultures were positive in 58.3% and were mixed in 25% of the positive cultures, the researchers report in the October issue of Obstetrics & Gynecology.

Positive culture results were significantly associated with fever, leukocytosis higher than 12,000 cells/mL, and neutrophilia higher than 85%.

Growth of anaerobic bacteria was also significantly associated with fever and insignificantly with leukocytosis and neutrophilia.

Dr. Kessous said there is still controversy over the role of empirical antimicrobial treatment.

"The main primary treatment for Bartholin's gland abscess consists of surgical drainage, with use of antibiotics as an adjunctive measure," he explained.

"Antimicrobial treatment is considered first line therapy when the abscess is not ripe enough for surgical drainage and may be considered second line therapy when there is no clinical improvement after surgical drainage or when complications develop," added Dr. Kessous.�"Severe complications such as sepsis, cellulitis, and necrotizing fasciitis in patients with Bartholin's gland abscess have been reported. In these cases culture results may be helpful."

"It is good medical practice to culture every abscess drained," he noted.

The researchers say amoxicillin-clavulanate may be an appropriate empirical choice of therapy.

"Empirical regimens should be periodically reviewed as a result of the possible emergence of antimicrobial resistant strains such as those producing ESBLs," they add.

SOURCE: http://bit.ly/1dv3LU0

Obstet Gynecol 2013;122:794-799.

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