Hookham Lauren, Tusubira Valerie, Wamawobe Amusa, Shelley Dan R, Farley Caitlin, Portal Edward A R, Beach Simon, Davies Hannah G, Karampatsas Konstantinos, Kyohere Mary, Peacock Joseph, Musoke Philippa, Spiller Owen B, Heath Paul T, Sekikubo Musa, Le Doare Kirsty
Institute for Infection and Immunity, St George's University of London, London, UK.
Makerere University-Johns Hopkins University (MUJHU) Research Collaboration, Kampala, Uganda.
Open Forum Infect Dis. 2025 Mar 10;11(Suppl 3):S165-S172. doi: 10.1093/ofid/ofae606. eCollection 2024 Dec.
Every year an estimated 2-3 million babies are stillborn, with a high burden in Africa. Infection is an important driver of stillbirth. There is a lack of data on the bacterial causes of stillbirth in Uganda, contributing to a lack of interventions such as effective prophylaxis and development of maternal vaccine options against the most implicated pathogens.
The PROGRESS study was an observational cohort study undertaken in Kampala, Uganda, between November 2018 and April 2021. If a woman delivered a stillborn baby, consent was sought for the collection of a heart-blood aspirate. One to three mL of blood was collected and sent for culture using the BD Bactec blood culture system. Organism identification was performed using biochemical testing and matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Susceptibilities to appropriate panels of antimicrobials were determined by agar dilution.
Kawempe Hospital registered 34 517 births in the study period, of which 1717 (5.0%) were stillbirths. A total of 581 (33.8%) were recruited into the study, and heart blood aspirates were performed on 569 (97.9%). Blood samples were sufficient for analysis of 476, with a total of 108 positive cultures (22.7% of sampled stillbirths). Fifty-nine of 108 blood cultures contained organisms that were considered potential pathogens, giving a pathogen positivity rate of 12.4%. Common pathogens included spp. (n = 14), (n = 13), viridans streptococci (n = 18), (n = 6), and group B (n = 5). Gram-negative organisms were frequently resistant to commonly used first-line antimicrobials.
The high proportion of stillbirths caused by likely pathogenic bacteria in Uganda highlights the potential for prevention with prophylaxis and stresses the need for further investment in this area.
据估计，每年有200万至300万婴儿死产，非洲负担沉重。感染是死产的一个重要驱动因素。乌干达缺乏关于死产细菌病因的数据，这导致缺乏诸如有效预防措施以及针对最主要病原体开发母体疫苗等干预措施。
PROGRESS研究是一项于2018年11月至2021年4月在乌干达坎帕拉进行的观察性队列研究。如果一名妇女分娩出死产婴儿，会征求其同意采集心脏血液抽吸物。采集1至3毫升血液，使用BD Bactec血液培养系统送去培养。使用生化检测和基质辅助激光解吸/电离飞行时间质谱法进行微生物鉴定。通过琼脂稀释法确定对合适抗菌药物组合的敏感性。
在研究期间，卡韦姆佩医院登记了34517例分娩，其中1717例（5.0%）为死产。共有581例（33.8%）被纳入研究，对569例（97.9%）进行了心脏血液抽吸。血液样本足以进行分析的有476例，共有108例培养阳性（占抽样死产的22.7%）。108例血培养中有59例含有被认为是潜在病原体的微生物，病原体阳性率为12.4%。常见病原体包括 菌属（n = 14）、 菌（n = 13）、草绿色链球菌（n = 18）、 菌（n = 6）和B组 菌（n = 5）。革兰氏阴性菌对常用一线抗菌药物常常耐药。
乌干达由可能的致病细菌导致的死产比例很高，这凸显了通过预防措施进行预防的潜力，并强调了在该领域进一步投资的必要性。
