BackgroundPregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections.MethodsWe used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women.ResultsWe found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries.ConclusionsDifferences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.
Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort / C. C Ribeiro-do-Valle, M. Bonet, V. Brizuela, E. Abalos, A. Baguiya, F. Bellissimo-Rodrigues, M. Budianu, L. Puscasiu, M. Knight, D. Lissauer, C. Dunlop, S. T Jacob, S. Shakoor, L. Gadama, B. Assarag, J. Paulo Souza, J. G Cecatt, M. Iqbal Aman, B. Noormal, V. Díaz, M. Espinoza, J. Pasquale, C. Leroy, K. Roelens, G. Vandenberghe, M. Christian Urlyss Agossou, S. Goufodji Keke, C. Tshabu Aguemon, P. Soledad Apaza Peralta, V. Conde Altamirano, R. Hernández Muñoz, J. Guilherme Cecatti, C. C Ribeiro-Do-Valle, V. Batiene, K. Cisse, H. Gautier Ouedraogo, C. Kannitha, L. Phirun, T. Rathavy, E. Simo, P. Tebeu, E. Irene Yakana, J. Carvajal, M. Fernanda Escobar, P. Fernández, L. Berdiin Colmorn, J. Langhoff-Roos, W. Mereci, P. Vélez, Y. Salah Eldin, A. Sultan, A. Abdulkadir Abdosh, A. M Teklu, D. Worku Kassa, R. Adanu, P. Govule, C. Noora Lwanga, W. Enrique Arriaga Romero, M. Guadalupe Flores Aceituno, C. Bustillo, R. Castro, B. Lara, V. Kumar, V. Suri, S. Trikha, I. Cetin, S. Donati, C. Personeni, G. Baimussanova, S. Kabylova, B. Sagyndykova, G. Gwako, A. Osoti, Z. Qureshi, R. Asylbasheva, A. Boobekova, D. Seksenbaeva, F. El Kak, S. Eddine Itani, S. Abou Malham, M. Minkauskienė, D. Ramašauskaitė, O. Chikhwaza, E. Malunga, H. Dembele, H. Sangho, F. Eliane Zerbo, F. Dávila Serapio, N. Herrera Maldonado, J. Ismael Islas Castañeda, T. Caraus, A. Curteanu, V. Petrov, Y. Buyanjargal, S. Khishgee, B. Lkhagvasuren, A. Essolbi, R. Moulki, N. Bique Osman, Z. Jaze, A. Mariano, H. Mya Thway Einda, T. Maung Maung, K. Nwe Tin, T. Gurung, A. Babu Shrestha, S. Shrestha, K. Bloemenkamp, M. J Rijken, T. Van Den Akker, M. Esther Estrada, N. J Gómez Pavón, O. Adesina, C. Aimakhu, B. Fawole, R. Chaudhri, S. Hamid, M. Adnan Khan, M. Del Huatuco PilarHernández, N. M Pimentel Zavaleta, M. Lu Andal, C. Paula Martin, Z. Dy Recidoro, M. Budianu, L. Puşcaşiu, L. Diouf, D. Guirassy, P. Marc Moreira, M. Borovsky, L. Kovac, A. Kristufkova, S. Cebekhulu, L. Cornelissen, P. Soma-Pillay, V. Cararach, M. López, M. José Vidal Benedé, H. Jayakody, K. Jayaratne, D. Rowel, M. Elsheikh, W. Nabag, S. Omer, V. Tsoy, U. Uzakova, D. Yunusova, T. Siriwachirachai, T. Tangsiriwatthana, A. M Pérez, J. Roman, G. Vitureira, D. Anh Tuan, L. Ngoc Truong, N. Thi Xuan Hanh, M. Madziyire, T. Magwali, S. Munjanja, M. Chamillard, B. Fawole, S. Kouanda, P. Lumbiganon, A. Nabhan, R. Nadisauskiene, L. Bartlett, S. T Jacob, K. Yunis, L. Campodónico, C. Cuesta, H. Gamerro, D. Giordano, F. Althabe, A. Metin Gülmezoglu. - In: ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS. - ISSN 1476-0711. - 23:1(2024 Feb 24), pp. 21.1-21.12. [10.1186/s12941-024-00681-8]
Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort
I. CetinMembro del Collaboration Group
;
2024
Abstract
BackgroundPregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections.MethodsWe used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women.ResultsWe found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries.ConclusionsDifferences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.
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