Pathogenic Spectrum and Resistance Pattern of Bloodstream Infections Isolated from Postpartum Women: A Multicenter Retrospective Study

Abstract

Purpose Bloodstream infections (BSIs) cause morbidity and mortality in postpartum patients, resulting in poor prognosis for both mother and neonate. Gram-negative bacteremia is a public health threat, with high mortality among vulnerable populations and significant global economic costs. Gram-negative bacteremia and antimicrobial resistance are increasing. This study retrospectively analyzed the pathogen distribution and drug sensitivity among postpartum patients with BSIs to identify appropriate antibacterial agents for perioperative therapy. Material and Methods All bacteremia cases between January 2015 and December 2020 from three Health Centers for Women and Children in Chongqing, China, were retrospectively reviewed. Clinical data were collected from medical records and charts. Blood samples were cultured by BD BACTEC FX200. Bacterial and fungal species and bacterial susceptibility were identified by a BD Phoenix TM M50 automatic detection machine. Results In total, 274 pathogenic strains were isolated from 272 blood samples. Excluding 25 suspected contamination strains, 248 blood samples yielded 249 microorganisms, including 214 gram-negative bacteria (85.9%), 34 gram-positive bacteria (13.6%), and 1 fungus (0.5%). Escherichia coli ( E. coli ) was the most frequently isolated pathogen, both overall and among gram-negative bacilli (73.5%). Streptococcus agalactiae represented 3.6% of gram-positive cocci (n = 9). Laboratory-confirmed anaerobic infections comprised 9.2% of cases (n = 23). Additionally, 47.4% of postpartum patients with BSIs suffered premature rupture of membranes (PROM), a suspected infection risk factor. Drug sensitivity levels remained unchanged for less commonly used drugs, but resistance increased against commonly used drugs. Specifically, E. coli resistance against fourth-generation cephalosporins increased during this study period. Conclusion E. coli is the most common gram-negative bacillus in postpartum patients with BSIs, and increased anaerobic bacterial detections suggest genital tract inflammation control before delivery is necessary. Effective drug resistance monitoring remains necessary to alleviate bacterial resistance, such as preventing inappropriate antibiotic applications.

Evaluation of microbiological epidemiology and clinical characteristics of maternal bloodstream infection: a 10 years retrospective study

“…In our study, there were only six cases of maternal bacteremia caused by anaerobic bacteria, five of which were identified as Bacteroides fragilis and the remaining one as Clostridium species. The proportion of anaerobic bacteria was lower than that reported in other studies ( Blanco et al, 1981 ; Surgers et al, 2013 ; Zou et al, 2021 ). The detailed reason for the lower rate of anaerobic bacteria is unclear, although different patient composition and hygiene levels and different antibacterial drug exposure levels may be part of the reason.…”

“…Bloodstream infection in pregnancy or during the perinatal period is still a significant clinical problem with high morbidity and mortality, even in developed countries ( Waterstone et al, 2001 ; Surgers et al, 2013 ; Zou et al, 2021 ). There are some studies focusing on maternal infectious diseases in mainland China ( Lin et al, 2021 ; Zou et al, 2021 ; Zhong et al, 2022 ) but only one published study focused on perinatal BSI could be found ( Zou et al, 2021 ). Very little is known about various aspects of maternal bacteremia in relation to changes of microbiological epidemiology and obstetric outcomes.…”

Features of the Physiology of the Postpartum Period After Caesarean Section

“…The duration of the late phase depends on the recovery of muscle tone and connective tissue in the postpartum period. Physiological changes that occur in the late phase are, as a rule, very gradual and barely noticeable: increased elasticity of ligaments, which can persist for 4-5 months after childbirth; risk of thromboembolism due to increased blood coagulation factors; length and separation of rectus abdominis muscles -diastasis; weakened pelvic floor muscles, including weakened perineal muscles, muscle abnormalities and weakness of the levator anus muscle; enuresis; prolapse of pelvic organs; pelvic floor neuropathy; fecal incontinence and flatulence; swelling of the extremities -hands, feet and ankles; excessive weight gain; lower back pain [16,17].…”

“…The postpartum period is characterized by a wide range of new states of women's life and increased sensitivity to external factors. The whole range of postnatal changes can be considered as an integrative combination of psychological, physiological and endocrine factors [14,16,17] that affect the physical and mental activity of women, as well as determine their relationship with the child.…”

Justification of Features Rehabilitation Interventions During Pregnancy and the Postpartum Period

“…Однак ця точка зору не враховує той факт, що КР є хірургічною процедурою з численними потенційними ускладненнями як для матері, так і для дитини. Крім інтраопераційних ризиків (наприклад, інфекція, пошкодження органів або потреба в переливанні крові [39,40]), багато побічних ефектів можуть виникнути після пологів: наприклад, тромбоемболічні ускладнення [41]. Зокрема, існують ускладнення, пов'язані з пізніми вагітностями: розрив матки, безпліддя або аномалії плаценти, такі як передлежання, врощення та пророщення плаценти [42,43,44].…”