article · Antimicrobial Resistance and Infection Control
A study at Felege Hiwot Referral Hospital in Northwest Ethiopia assessed bacterial causes and antibiotic susceptibility in 166 post-partum and post-abortion women suspected of puerperal sepsis. Bacteria were identified in 33.7 percent of the women, with Gram-negative organisms accounting for 55.4 percent and Gram-positive organisms for 44.6 percent of isolates. Staphylococcus aureus was the most common Gram-positive pathogen, while Escherichia coli was the predominant Gram-negative species. High levels of resistance were detected, including complete resistance to ampicillin and tetracycline among tested isolates, with an overall multidrug resistance rate of 84 percent. Furthermore, women with multiparous parity faced significantly higher odds of puerperal sepsis than primiparous women, whilst other examined clinical and socio-demographic factors showed no significant association.
Puerperal sepsis remains a leading cause of maternal morbidity and death in low-income countries. Identifying that more than eight out of ten bacterial isolates are multidrug resistant highlights an urgent clinical challenge. These findings demonstrate the necessity of maintaining robust hospital infection controls and using accurate antimicrobial susceptibility testing to guide antibiotic therapy and improve maternal survival rates.
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Abstract Background Puerperal sepsis is any bacterial infection of the genital tract that occurs after childbirth. It is among the leading causes of maternal morbidity and mortality especially in low-income countries including Ethiopia. The aim of this study was to determine the proportion of bacterial isolates, their antimicrobial susceptibility profile and factors associated with puerperal sepsis among post-partum/aborted women at a Referral Hospital in Bahir Dar, Northwest Ethiopia. Methods A cross sectional study was conducted from January to May 2017 among 166 post-partum/aborted women admitted to Felege Hiwot Referral Hospital for medical services and suspected for puerperal sepsis.. Socio-demographic data and associated factors were collected using structured questionnaire. Bacteria were isolated and identified from blood samples on Trypton soya broth, blood, Chocolate and MacConkey agars following standard bacteriological procedures. The VITEK 2 identification and susceptibility testing system was used to determine the antimicrobial susceptibility profiles of bacterial isolates. Data were entered and analyzed using SPSS version 20. Factors associated with puerperal sepsis were considered statistically significant at P -value < 0.05. Results The overall proportion of bacterial isolates among post-partum/aborted women was 33.7% (56/166); of which 55.4% was caused by Gram-negative and 44.6% was by Gram-positive bacteria. The most frequently isolated bacteria were Escherichia coli (32.1%) from Gram-negatives and Staphylococcus aureus ( 33.9%) from Gram-positives. The proportion of other isolates was ( 7.2%) for Coagulase Negative Staphylococci (CoNS), (12.5%) for Klebsiella pneumoniae , ( 10.7%) for Acinetobacter baumanni and ( 3.6%) for Raoultella ornithinolytica . All isolates of Gram-positive and Gram-negative bacteria were resistant to tetracycline (100%). The gram negatives show resistance to Cefazolin (72.7%), Tetracycline (93.9%) and Ampicillin (100%). The overall prevalence of multidrug resistance (MDR) was 84%. Women having multiparous parity were more likely to develop puerperal sepsis than primiparous parity (AOR 4.045; 95% CI: 1.479–11.061; P < 0.05). Other socio-demographic and clinical factors had no significant association with puerperal sepsis. Conclusion About one third of post-partum/aborted women suspected for puerperal sepsis were infected with one or more bacterial isolates. Significant proportion of bacterial isolates showed mono and multi-drug resistance for the commonly prescribed antibiotics. Women with multiparous parity were more likely to develop puerperal sepsis than primiparous parity.
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DOI: 10.1186/s13756-019-0676-2
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