Cefoperazone-sulbactam and ornidazole for Gardnerella vaginalis bloodstream infection after cesarean section: A case report

Table 1 Clinical information and anti-infective treatment

Date	Basic information about the patient	Antimicrobial treatment
November 19, 2021 (C-section day)
Postoperative D1	The patient had a sudden fever in the afternoon and reported the highest temperature of 39.7 ℃ at 10:00 pm. Blood examinations indicated WBC was 15.97 × 109/L, NEUT was 84.7% and CRP was 93.96 mg/L	Cefoperazone-sulbactam (2:1) 3 g iv q12h
Postoperative D2	The temperature was 38.6 ℃ at 2:00 am and 38 ℃ at 6:00 pm. The abdominal incision of the patient was clean and dry, and the patient’s intestinal function had been restored	No changes in the treatment regimen
Postoperative D3	The temperature was normal and routine blood examination indicated that WBC was 10.38 × 109/L, NEUT was 71.3%, and CRP was 93.96 mg/L. Blood culture (first time) results suggested the possibility of gram-negative bacterial growth	Cefoperazone-sulbactam (2:1) 3 g iv q8h
Postoperative D4	A temperature of 37.6 ℃ was reported at 2:00 pm and was normal for the rest of the day	No changes in the treatment regimen
Postoperative D6	The temperature was 37.6 ℃ at 2:00 pm. Blood culture (first time) results suggested the growth of Gardnerella vaginalis (gram-negative bacteria) in anaerobic bottles (left and right). Blood examination indicated that WBC was 8.11 × 109/L, NEUT was 63.9%, and CRP was 77.88 mg/L	Cefoperazone-sulbactam (2:1) 3g iv q8h combined with ornidazole 0.5 g q12h
Postoperative D9	Temperature occasionally reached 37.7 ℃ and was normal for the rest of the day	No changes in the treatment regimen
Postoperative D10	The results of the blood culture (second time) showed no further bacterial growth	No changes in the treatment regimen
Postoperative D12	The temperature was normal, no discomfort, the uterus was well restored, and the patient’s blood tests were normal	No changes in the treatment regimen
Postoperative D14 (discharge day)	The results of the blood culture (third time) showed that there was no bacterial growth, and the patient could be discharged	Antimicrobial treatment was stopped

WBC: White blood cell; NEUT: Neutrophil count; CRP: C-reactive protein; C-section: Cesarean section; D: Day.

Table 2 Obstetric characteristics of patients with Gardnerella vaginalis bloodstream infection

Patients	Ref.	Age	Gestational weeks	Obstetric diagnosis	Infection-related perinatal factors	Mode of delivery
1	Fan et al[8], 2020	28	19+	Missed abortion	Inflammation of uterine cavity	Spontaneous vaginal delivery
2	Fan et al[8], 2020	23	24+	Fetal malformation	Drugs and balloons promoting cervical maturation	Forceps delivery
3	Fan et al[8], 2020	33	40+	Obstetric diagnosis	Amniotomy	Intrapartum cesarean section
4	Lu et al[9], 2018	33	37+4	Marginal placenta previa	Prenatal bleeding	Elective C-section
5	Chen et al[10], 2018	35	Unknown	Fetal distress	Nothing	Elective C-section
6	Present case	31	38+2	Obstetric diagnosis	Pelvic adhesion	Elective C-section

C-section: Cesarean section.

Table 3 Detection of Gardnerella vaginalis in blood

Patients	Ref	Blood sampling method	Blood culture results	Blood gram staining	Bacterial morphology	Inoculate on a culture plate	Mass spectrometry	PCR and sequencing
1	Fan et al[8], 2020	Bilateral double bottles	Aerobic bottle (+); Anaerobic bottle (+)	(-)	Small bacilli	Yes	Yes	No
2	Fan et al[8], 2020	Bilateral double bottles	Aerobic bottle (-); Anaerobic bottle (+)	(-)	Small bacilli	Yes	Yes	No
3	Fan et al[8], 2020	Bilateral double bottles	Aerobic bottle (-); Anaerobic bottle (+)	(-)	Small bacilli	Yes	Yes	No
4	Lu et al[9], 2018	Bilateral double bottles	Aerobic bottle (-); Anaerobic bottle (+)	(-)	Small bacilli	Yes	Yes	No
5	Chen et al[10], 2018	Bilateral double bottles	Aerobic bottle (-); Anaerobic bottle (+)	(-)	Cocci	Yes	No	Yes
6	Present case	Bilateral double bottles	Aerobic bottle (-); Anaerobic bottle (+)	(-)	Small bacilli	Yes	No	No

PCR: Polymerase chain reaction.

Table 4 Initial symptoms and laboratory examination of bloodstream infections caused by Gardnerella vaginalis after parturition

Patients	Ref.	First symptoms	T (℃)	WBC (× 109/L)	NEUT (%)	CRP (mg/L)	PCT (μg/L)
1	Fan et al[8], 2020	Fever	39.7	15.23	88.94	154.60	1.26
2	Fan et al[8], 2020	Fever	39.5	24.51	91.14	170.30	0.46
3	Fan et al[8], 2020	Fever	39.1	21.37	91.20	162.50	0.57
4	Lu et al[9], 2018	Fever	39.2	11.90	87.30	114.00	-
5	Chen et al[10], 2018	Fever	38.8	18.06	91.20	-	0.30
6	Present case	Fever	39.7	15.97	84.70	93.96	-

T: Temperature; WBC: White blood cells; NEUT: Neutrophils; CRP: C-reactive protein; PCT: Procalcitonin.

Table 5 Anti-microbial strategies for postpartum Gardnerella vaginalis bloodstream infections

Patients	Ref.	Initial treatment regimen	Adjusted treatment plan	Outcome
1	Fan et al[8], 2020	Ceftriaxone + ornidazole + levofloxacin	Same as before	Recovery
2	Fan et al[8], 2020	Penicillin + metronidazole	Same as before	Recovery
3	Fan et al[8], 2020	Cefoperazone-sulbactam + metronidazole	Same as before	Recovery
4	Lu et al[9], 2018	Ornidazole + ceftriaxone + imipenem-cilastatin	Cefoperazone-sulbactam + ornidazole	Recovery
5	Chen et al[10], 2018	Cefuroxime	Same as before	Recovery
6	Present case	Cefoperazone-sulbactam	Cefoperazone-sulbactam + ornidazole	Recovery