Abstract
This study aimed to assess the prevalence of multidrug resistance (MDR) and its associated factors among pregnant Peruvian women with bacteremia. In an 18-month cross-sectional study, all pregnant women were routinely tested with a presumptive diagnosis of sepsis admitted to the largest reference maternity hospital (Instituto Nacional Materno Perinatal) in Lima, Peru for bacteremia. Every isolate was tested for antimicrobial susceptibility as defined by the Institute of Clinical and Laboratory Standards (CLSI). Additionally, associated factors were assessed with MDR and the number of resistant antimicrobial categories using robust Poisson regression models with link log, especially focused on its association with age and bacterial families or species. A total of 236 blood cultures of pregnant women (33.4 ± 11.4 years old) was analyzed. The prevalence of MDR was 70% (95% confidence interval [CI]: 64%-76%). The main etiological agent was Escherichia coli (65%), showing an MDR rate of 74% (68%-81%). Overall, we observed that the MDR rate was associated with Enterobacteriales (adjusted prevalence rate, (aPR) = 1.29; 95% CI: 1.03-1.61) and age 35 or older (PR = 1.18; 95% CI: 1.01-1.39). However, the number of resistant antimicrobial categories was associated with Enterobacteriales (aPR = 1.44; 95% CI: 1.25-1.67) and hospital-acquired infections (PR = 0.81; 95% CI: 1.01-1.39). The prevalence of MDR among pregnant women with sepsis was alarmingly high, being even higher among women age 35 or older and among those with hospital-acquired infections.
Highlights
This study aimed to assess the prevalence of multidrug resistance (MDR) and its associated factors among pregnant Peruvian women with bacteremia
Case-fatality rates associated with bacteremia range from 35% to 50% in patients admitted to intensive care units (ICU) and are commonly associated with MDR, extended-spectrum beta-lactamases (ESBL), and carbapenems resistant bacteria [7]
A total of 236 pregnant women (33 ± 11 years old) tested positive for bacterial bloodstream infections (BSI) during the study period (Table 1). Most of these pregnant women were under 35 years of age (66%) and tested bacteremia positive during hospitalization (70%), including 11% who tested bacterial bloodstream infections positive when admitted to ICUs
Summary
This study aimed to assess the prevalence of multidrug resistance (MDR) and its associated factors among pregnant Peruvian women with bacteremia. We observed that the MDR rate was associated with Enterobacteriales (adjusted prevalence rate, (aPR) = 1.29; 95% CI: 1.03–1.61) and age 35 or older (PR = 1.18; 95% CI: 1.01–1.39). The number of resistant antimicrobial categories was associated with Enterobacteriales (aPR = 1.44; 95% CI: 1.25–1.67) and hospital-acquired infections (PR = 0.81; 95% CI: 1.01–1.39). Conclusions: The prevalence of MDR among pregnant women with sepsis was alarmingly high, being even higher among women age 35 or older and among those with hospital-acquired infections. It is known that adequate antibiotic therapy for MDR has a substantial impact on reducing the length of hospitalization and the risk of mortality overall in adults, but little is known regarding its effects on pregnant women [8]
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