UBC Faculty of Medicine, Vancouver, British Columbia, Canada.
BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.
Int J Gynaecol Obstet. 2024 Feb;164(2):786-792. doi: 10.1002/ijgo.15048. Epub 2023 Sep 1.
To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes.
Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018.
The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first- and third-generation cephalosporins, respectively. Clinical sources of infection included intra-amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%).
Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first-line antibiotics.
通过描述发病率、微生物流行病学、临床感染源、药敏模式以及母婴结局，评估一家四级医疗机构围产期菌血症经验性抗生素方案的有效性。
对 2010 年至 2018 年间血培养阳性的围产期患者进行回顾性图表分析。
围产期菌血症的发病率为 0.3%。最常培养的病原体为大肠埃希菌（51 例，26.7%）、链球菌属（52 例，27.2%）和厌氧细菌属（35 例，18.3%）。在大肠杆菌病例中，分别有 54.9%（28 例）、19.6%（10 例）和 19.6%（10 例）对氨苄西林、第一代和第三代头孢菌素耐药。感染的临床来源包括羊水内感染/子宫内膜炎（115 例，67.6%）、上尿路感染和/或下尿路感染（23 例，13.5%）和软组织感染（8 例，4.7%）。在 137 例（83.0%）病例中，给予了适当的经验性抗生素治疗。有 7 例（4.2%）入住 ICU，18 例（9.9%）妊娠丢失，9 例（5.5%）新生儿死亡和 6 例（3.7%）新生儿菌血症。
围产期菌血症仍然少见，但与产妇发病率和新生儿发病率及死亡率相关。目前我们医院的经验性抗菌药物方案仍然合适，但鉴于存在对一线抗生素耐药的病原体，持续监测抗菌药物耐药模式至关重要。
