Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre

Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre

Objective To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. Methods Retrospective chart review...

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Published in:International journal of gynecology and obstetrics Vol. 164; no. 2; pp. 786 - 792
Main Authors: Mohn, Sarah F., Reimer, Renee, Mar, Nicole, Katelieva, Angela, Paquette, Vanessa, Albert, Arianne Y. K., Roberts, Ashley, Tilley, Peter, McClymont, Elisabeth, Ting, Joseph, Boucoiran, Isabelle, Elwood, Chelsea
Format: Journal Article
Language:English
Published: United States 01-02-2024
Subjects:
Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents
antimicrobial resistance
antimicrobial stewardship
bacteremia
Bacteremia - drug therapy
Bacteremia - epidemiology
Canada
Escherichia coli
Female
Humans
Infant, Newborn
infectious diseases
neonatal
peripartum
Peripartum Period
Pregnancy
Retrospective Studies
sepsis
Canada
antimicrobial stewardship
antimicrobial resistance
infectious diseases
peripartum
pregnancy
neonatal
sepsis
bacteremia
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Summary:Objective To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. Methods Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018. Results The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first‐ and third‐generation cephalosporins, respectively. Clinical sources of infection included intra‐amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%). Conclusion Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first‐line antibiotics. Synopsis Peripartum bacteremia was most associated with Escherichia coli, and while resistance to first‐line empiric antimicrobials is a concern, current antibiotic protocols remain appropriate.
Bibliography:Sarah F. Mohn and Renee Reimer are joint first authors.
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ISSN:0020-7292
1879-3479
DOI:10.1002/ijgo.15048