Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital

Abstract

IntroductionPuerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking.MethodsWe performed a prospective cohort study of 4,231 Ugandan women presenting to a regional referral hospital for delivery or postpartum care, measured vital signs after delivery, performed structured physical exam, symptom questionnaire, and microbiologic evaluation of febrile and hypothermic women. Malaria rapid diagnostic testing, blood and urine cultures were performed aseptically and processed at Epicentre Mbarara Research Centre. Antimicrobial susceptibility and breakpoints were determined using disk diffusion per EUCAST standards. Hospital diagnoses, treatments and outcomes were abstracted from patient charts.ResultsMean age was 25 years, 12% were HIV-infected, and 50% had cesarean deliveries. Approximately 5% (205/4176) with ≥1 temperature measurement recorded developed postpartum fever or hypothermia; blood and urine samples were collected from 174 (85%), and 17 others were evaluated clinically. Eighty-four (48%) had at least one confirmed source of infection: 39% (76/193) clinical postpartum endometritis, 14% (25/174) urinary tract infection (UTI), 3% (5/174) bloodstream infection. Another 3% (5/174) had malaria. Overall, 30/174 (17%) had positive blood or urine cultures, and Acinetobacter species were the most common bacteria isolated. Of 25 Gram-negatives isolated, 20 (80%) were multidrug-resistant and cefepime non-susceptible.ConclusionsFor women in rural Uganda with postpartum fever, we found a high rate of antibiotic resistance among cultured urinary and bloodstream infections, including cephalosporin-resistant Acinetobacter species. Increasing availability of microbiology testing to inform appropriate antibiotic use, development of antimicrobial stewardship programs, and strengthening infection control practices should be high priorities.

Extended‐spectrum beta‐lactamase (ESBL)‐producingEnterobacteriaceaeand urinary tract infections in pregnant/postpartum women: A systematic review and meta‐analysis

“… Acquisition: All studies reported pregnant women with community‐acquired infections, except one study where three‐fourth of UTIs among postpartum patients were described as catheter‐associated UTIs. …”

“…Four studies did not report the frequency of specific ESBL-P organisms. 24,29,41,45 The remaining studies reported a total of 1448 Enterobacteriaceae strains cultured and identified as ESBL producers. The most commonly reported organisms were E coli with a pooled prevalence of 61% (47, 74%) and K pneumoniae with a prevalence of 40% (22, 57%).…”

“…Of the 23 studies mentioned above, 6 studies were conducted in Africa, [24][25][26][27][28][29] 2 studies in North America, 30,31 1 study in South…”

“…For studies that lasted for more than 12 months, the midyear of the study period that actual sampling and laboratory evaluation was done was determined as the date of the study. Nine studies reported data on patients with symptomatic UTI, 24,27,29,[31][32][33]43,44,46 nine reported AB, 25,26,[34][35][36][37][40][41][42] and infection type in five studies 28,30,38,39,45 were indeterminate. Two studies included postpartum women.…”

The Prevalence, Risk Factors, and Bacterial Profile of Cesarean Surgical Site Infections at a University Teaching Hospital in South Western Uganda

“…In addition, after Cesarean section women are treated with combination intravenous ceftriaxone and metronidazole for three days, followed by five days of oral cefixime. Microbiological evaluation of potential infections is not routine, but when requested, samples are processed at MUST's teaching lab adjacent to MRRH [15]. For this study, wound sepsis was defined by a positive culture of fluid or tissue from the superficial incision for microorganisms.…”