Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital.
Antimicrobial-resistant infections among postpartum women at a Ugandan referral hospital.
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DOI：
10.1371/journal.pone.0175456
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Boum Y 2nd
中科院分区：
文献类型：
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作者：
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 DR;Riley LE;Boum Y 2nd
产褥期脓毒症导致非洲10%的孕产妇死亡，但缺乏关于发病率、微生物学和抗菌素耐药性的前瞻性研究。我们对4，231名前往地区转诊医院分娩或产后护理的乌干达妇女进行了前瞻性队列研究，测量了分娩后的生命体征，进行了结构化体格检查，症状问卷调查，并对发热和体温过低的妇女进行了微生物学评价。疟疾快速诊断检测、血液和尿液培养在Epicentre Mbarara研究中心无菌进行和处理。根据EUCAST标准，使用纸片扩散法测定抗菌剂敏感性和折点。医院的诊断、治疗和结果都是从病历中提取出来的。平均年龄为25岁，12%的人感染艾滋病毒，50%的人剖腹产。约5%（205/4176）记录了≥1次体温测量值，发生产后发热或体温过低;从174例（85%）中采集了血液和尿液样本，并对另外17例进行了临床评价。84例（48%）至少有一种感染源：临床产后尿道炎39%（76/193），尿路感染14%（25/174），血流感染3%（5/174）。另有3%（5/174）患有疟疾。总体而言，30/174（17%）例患者的血液或尿液培养呈阳性，不动杆菌属是分离出的最常见细菌。在25株革兰阴性菌中，20株（80%）为多重耐药菌，对头孢吡肟不敏感。对于乌干达农村产后发热的妇女，我们发现泌尿道和血液感染培养中抗生素耐药率很高，包括头孢菌素耐药的不动杆菌属。增加微生物学检测的可用性以告知适当的抗生素使用，开发抗菌药物管理计划，以及加强感染控制实践应该是高度优先事项。
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.