Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital

Lisa M. Bebell, Joseph Ngonzi, Joel Bazira, Yarine Fajardo, Adeline A. Boatin, Mark J. Siedner, Ingrid V. Bassett, Dan Nyehangane, Deborah Nanjebe, Yves Jacquemyn, Jean Pierre Van Geertruyden, Juliet Mwanga-Amumpaire, David Bangsberg, Laura E. Riley, Yap Boum

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Introduction: Puerperal sepsis causes 10% of maternal deaths in Africa, but prospective studies on incidence, microbiology and antimicrobial resistance are lacking. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish (US)
Article numbere0175456
JournalPLoS One
Volume12
Issue number4
DOIs
StatePublished - Apr 1 2017

Fingerprint

Postpartum Period
fever
Microbiology
Acinetobacter
Blood
Fever
urine
Referral and Consultation
anti-infective agents
Urine
microbiology
antibiotic resistance
malaria
blood flow
Malaria
blood
Infection
Hypothermia
infection
Prospective Studies

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Bebell, L. M., Ngonzi, J., Bazira, J., Fajardo, Y., Boatin, A. A., Siedner, M. J., ... Boum, Y. (2017). Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital. PLoS One, 12(4), [e0175456]. https://doi.org/10.1371/journal.pone.0175456

Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital. / 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; Riley, Laura E.; Boum, Yap.

In: PLoS One, Vol. 12, No. 4, e0175456, 01.04.2017.

Research output: Contribution to journalArticle

Bebell, LM, Ngonzi, J, Bazira, J, Fajardo, Y, Boatin, AA, Siedner, MJ, Bassett, IV, Nyehangane, D, Nanjebe, D, Jacquemyn, Y, Van Geertruyden, JP, Mwanga-Amumpaire, J, Bangsberg, D, Riley, LE & Boum, Y 2017, 'Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital', PLoS One, vol. 12, no. 4, e0175456. https://doi.org/10.1371/journal.pone.0175456
Bebell LM, Ngonzi J, Bazira J, Fajardo Y, Boatin AA, Siedner MJ et al. Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital. PLoS One. 2017 Apr 1;12(4). e0175456. https://doi.org/10.1371/journal.pone.0175456
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 ; Riley, Laura E. ; Boum, Yap. / Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital. In: PLoS One. 2017 ; Vol. 12, No. 4.
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