Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort

Pregnancy-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...

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Published in:	Annals of clinical microbiology and antimicrobials Vol. 23; no. 1; p. 21
Main Authors:	Ribeiro-do-Valle, Carolina C, Bonet, Mercedes, Brizuela, Vanessa, Abalos, Edgardo, Baguiya, Adama, Bellissimo-Rodrigues, Fernando, Budianu, Mihaela, Puscasiu, Lucian, Knight, Marian, Lissauer, David, Dunlop, Catherine, Jacob, Shevin T, Shakoor, Sadia, Gadama, Luis, Assarag, Bouchra, Souza, João Paulo, Cecatti, Jose G
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 24-02-2024 BioMed Central BMC
Subjects:	Abortion Anti-Bacterial Agents - therapeutic use Antibiotic Antibiotics Antimicrobial agents Causes of Ceftriaxone Cephalosporins Cephalosporins - therapeutic use Dosage and administration Drug resistance Drug therapy E coli Female Genital tract Gloss Health facilities Humans Income Industrialized nations Infections Intensive care International aspects Length of stay Low income areas Maternal morbidity Maternal mortality Maternal sepsis Metronidazole Metronidazole - therapeutic use Microbiology Morbidity Obstetrics Pathogens Pregnancy Pregnancy Complications, Infectious - drug therapy Pregnant women Sepsis Soft tissues Statistics Urinary tract infections Urinary Tract Infections - drug therapy Urogenital system Womens health World Health Organization Antibiotic Maternal morbidity Infections Maternal sepsis
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Summary:	Pregnancy-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. We 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. We 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. Differences 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1476-0711 1476-0711
DOI:	10.1186/s12941-024-00681-8