Microbial profile in women with puerperal sepsis in Gadarif State, Eastern Sudan

Abstract

Background: Increasingly, women in rural areas in Sudan reported to hospital with puerperal sepsis. Aims: This study was design to identify the common pathogens causing puerperal sepsis and their susceptibility to current antibiotics. Materials and Methods: We prospectively studied 170 women from January 2011 through December 2012 who attended Hussein Mustafa Hospital for Obstetrics and Gynecology at Gadarif State, Sudan. We included patients if they met the criteria proposed by the World Health Organization (WHO) for de inition of puerperal sepsis. Results: Out of the 170 patients, 124 (72.9%) were pathogen-positive samples. Out of 124 positive isolates, aerobes were the predominant isolates 77 (62.1%) which included Staphylococcus aureus 49 (39.5%), Staphylococcus epidermidis 7(5.6%), and Listeria monocytogenes 21 (16.9%). The anaerobe isolates were Clostridium perfringens 34 (27.4%) and Enterobactor cloacae 13 (10.5%). Standard biochemical test were for bacterial isolation. Higher rate of infections followed vaginal delivery compared to Cesarean section, 121 (97.6%) and 3 (2.5%), respectively. All strains of Staph were sensitive to vancomycin, gentamicin, and ceftriaxone. C. perfringens were sensitive to ceftriaxone, penicillin, vancomycin, and metronidazole, while E. cloacae was sensitive to gentamicin and ceftriaxone. Conclusion: In this study, the main bacteriological isolates were S. aureus, S. epidermidis, L. monocytogenes, C. perfringens, and E. cloacae. Despite the limited resources in the developing countries, treatment based on cultures remains the only solution to reduce maternal morbidity and mortality rates following puerperal sepsis.

Factors and Causes of Puerperal Sepsis in Kilimanjaro, Tanzania: A Descriptive Study among Postnatal Women who Attended Kilimanjaro Christian Medical Centre

“… 16 The high prevalence of Staphylococcus spp as the cause of puerperal sepsis might be exogenous where pathogens from nearby skin flora or contact with contaminated non-sterilised instruments or frequent vaginal examination with unwashed hands. 30 Additionally, the current study did not go further to characterise the Staphylococcus at specie level, although Staphylococcus aureus is more expected than other species. However, in other settings, Staphylococcus epidermidis were isolated among women with puerperal sepsis in other settings.…”

“…However, in other settings, Staphylococcus epidermidis were isolated among women with puerperal sepsis in other settings. 30 Although, S. epidermidis is rarely reported but it is a significant nosocomial pathogen, patients may acquire infection when they have compromised immunity. 30 The present study reports that E.coli (28.6%) as the second common cause of puerperal sepsis.…”

“…30 Although, S. epidermidis is rarely reported but it is a significant nosocomial pathogen, patients may acquire infection when they have compromised immunity. 30 The present study reports that E.coli (28.6%) as the second common cause of puerperal sepsis. This is similar to a study conducted in Harare, which reported E.coli as the commonest cause of puerperal sepsis.…”

“… 30 Although, S. epidermidis is rarely reported but it is a significant nosocomial pathogen, patients may acquire infection when they have compromised immunity. 30 …”

Burden of Antimicrobial Resistance Among Women with Post-Partum Infections in Low-Middle Income Countries: A Systematic Review

“…Of the total 22 articles included, 21 were in English [ 24 – 44 ], and one was in French [ 23 ]. The papers reported data from 12 different countries: 8 countries of the WHO African region (Burkina Faso, Ethiopia, Ghana, Liberia, Nigeria, Rwanda, Uganda, and Tanzania) [ 23 , 24 , 26 , 27 , 30 , 31 , 34 , 36 , 40 , 41 , 43 , 44 ], 2 of the Eastern Mediterranean region (Sudan, Kuwait) [ 32 , 39 ], 2 of the South East Asian region (Bangladesh, India, Indonesia) [ 30 , 33 , 35 , 38 , 42 ], and one of the European region (Ukraine) [ 25 , 28 , 29 , 37 ].…”