Bebell Lisa M, Ngonzi Joseph, Bazira Joel, Fajardo Yarine, Boatin Adeline A, Siedner Mark J, Bassett Ingrid V, Nyehangane Dan, Nanjebe Deborah, Jacquemyn Yves, van Geertruyden Jean-Pierre, Mwanga-Amumpaire Juliet, Bangsberg David R, Riley Laura E, Boum Yap
Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, United States of America.
Massachusetts General Hospital Center for Global Health, Boston, MA, United States of America.
PLoS One. 2017 Apr 13;12(4):e0175456. doi: 10.1371/journal.pone.0175456. eCollection 2017.
Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking.
We 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.
Mean 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.
For 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.
产褥期败血症导致非洲10%的孕产妇死亡，但缺乏关于发病率、微生物学和抗菌药物耐药性的前瞻性研究。
我们对4231名到一家地区转诊医院进行分娩或产后护理的乌干达妇女进行了一项前瞻性队列研究，在分娩后测量生命体征，进行结构化体格检查、症状问卷调查，并对发热和体温过低的妇女进行微生物学评估。进行疟疾快速诊断检测、血液和尿液培养，均无菌操作，并在姆巴拉拉震中研究中心进行处理。根据欧盟CAST标准，使用纸片扩散法确定抗菌药物敏感性和断点。从患者病历中提取医院诊断、治疗和结果。
平均年龄为25岁，12%感染艾滋病毒，50%进行了剖宫产。在记录了≥1次体温测量的患者中，约5%（205/4176）出现产后发热或体温过低；从174例（85%）采集了血液和尿液样本，另外17例进行了临床评估。84例（48%）至少有一个确诊感染源：39%（76/193）为临床产后子宫内膜炎，14%（25/174）为尿路感染（UTI），3%（5/174）为血流感染。另有3%（5/174）患有疟疾。总体而言，174例中有30例（17%）血液或尿液培养呈阳性，不动杆菌属是最常见的分离细菌。在分离出的25株革兰氏阴性菌中，20株（80%）对多种药物耐药且对头孢吡肟不敏感。
对于乌干达农村地区产后发热的妇女，我们发现在培养的泌尿系统和血流感染中抗生素耐药率很高，包括对头孢菌素耐药的不动杆菌属。增加微生物学检测的可及性以指导适当使用抗生素、制定抗菌药物管理计划以及加强感染控制措施应成为高度优先事项。
