Obstetric Infections Research Articles

Pattern of disease and type of operation of Surgical Site Infection in obstetrics and gynecology at Dr Soetomo Hospital, Surabaya, Indonesia

Objectives: to find correlation between risk factors and classification of SSI, the distribution of SSI, and cost in Soetomo Hospital.Materials and Methods: descriptive retrospective observational with correlation analysis between risk factors and SSI classification according to Centers for Disease Control (CDC) definition with univariate analysis. Sub-group descriptive analysis on microbiology result, length of stay (LOS) and cost was also performed. All patients was diagnosed SSI between January 2015 until June 2017.Results: age, referral cases, Body Mass Index, Hemoglobin and Albumin results, types of surgery, types of case are the risk factors we included. Analysis result shows no strong and significance correlation in all risk factors (r 0.053 – 0.447; p 0.072 – 0.971). According to SSI types, the distribution are: superficial (7; 13.2%), deep (26; 49.1%), organ/space (20; 37.7%). Extended-Spectrum Beta-Lactamase (ESBL) was obtained in 19 (14 Obstetrics; 5 Gynecology) from 28 patients with microbiology results. Five deaths occured in ESBL patients (1 Obstetrics; 4 Gynecology; ratio 1 : 11.2). Mean length of stay in Obstetrics and Gynecology was 41.7 and 19.2 days, respectively. Mean cost per day in Obstetrics and Gynecology was 1.2 amd 2.6 million rupiah, respectively.Conclusions: no strong and significant results in all risk factors. Death rate in SSI and malignancy with positive ESBL result are high. Less cost needed for SSI patients, but with longer LOS. Comprehensive approaches are needed to patients at risk of SSI, further study with larger sample are needed.

Increasing Prevalence of Chronic Hepatitis C Virus Infection in a Southern Academic Obstetrical Clinic.

The opioid epidemic has resulted in rising rates of hepatitis C virus (HCV) infection in women of childbearing age. With this changing epidemiology in mind, the Infectious Diseases Society of America/American Association for the Study of Liver Diseases guidelines were updated in 2018 to recommend screening all pregnant women for HCV infection, irrespective of risk factors. Because HCV infection can affect maternal-fetal health and result in vertical transmission, presentation for pregnancy-related medical care represents an opportunity to diagnose and manage HCV infection, as well as prepare for treatment postpartum. We performed a retrospective chart review spanning 2007-2016 to examine the epidemiology of HCV infection and opioid use disorder in a southern academic obstetrical clinic and to explore the impact of new screening guidelines if implemented. Composite data from the electronic health record and individual chart review were used to determine rates of HCV infection and opioid use disorder in obstetrics, explore patient demographics, and examine perinatal outcomes. Rates of both opioid use disorder and chronic HCV infection increased significantly during the 10-year period of analysis. Patients diagnosed as having chronic HCV infection were primarily white (95%) and there was no observed impact of HCV on perinatal outcomes. HCV testing in pregnancy, even when patients had documented opioid use disorder, was infrequent (0.7% of all pregnancies). Documented follow-up for HCV postpartum for both mothers and infants was incomplete, with only one-third of identified HCV-exposed infants referred and only 9% receiving HCV testing at our institution. HCV prevalence increased between 2007 and 2016, but screening and treatment of HCV in this southern obstetrical cohort was infrequent. The implementation of universal screening in pregnancy will likely identify additional cases, and an improved cascade of care will be necessary to address the HCV epidemic.

A rare cause of postpartum acute hyponatremia.

SummaryA previously healthy 24-year-old female underwent an emergent caesarean section without a major bleeding described. During the first post-operative days (POD) she complained of fatigue, headache and a failure to lactate with no specific and conclusive findings on head CT. On the following days, fever rose with a suspicion of an obstetric surgery-related infection, again with no evidence to support the diagnosis. On POD5 a new-onset hyponatremia was documented. The urine analysis suggested SIADH, and following a treatment failure, further investigation was performed and demonstrated both central hypothyroidism and adrenal insufficiency. The patient was immediately treated with hydrocortisone followed by levothyroxine with a rapid resolution of symptoms and hyponatremia. Further laboratory investigation demonstrated anterior hypopituitarism. The main differential diagnosis was Sheehan’s syndrome vs lymphocytic hypophysitis. Brain MRI was performed as soon as it was available and findings consistent with Sheehan’s syndrome confirmed the diagnosis. Lifelong hormonal replacement therapy was initiated. Further complaints on polyuria and polydipsia have led to a water deprivation testing and the diagnosis of partial central insipidus and appropriate treatment with DDAVP.Learning points:Sheehan’s syndrome can occur, though rarely, without an obvious major post-partum hemorrhage.The syndrome may resemble lymphocytic hypophysitis clinically and imaging studies may be crucial in order to differentiate both conditions.Hypopituitarism presentation may be variable and depends on the specific hormone deficit.Euvolemic hyponatremia workup must include thyroid function test and 08:00 AM cortisol levels.

Predicting common maternal postpartum complications: leveraging health administrative data and machine learning.

We aimed to predict the risk of common maternal postpartum complications requiring an inpatient episode of care. Maternal data from the beginning of gestation up to and including the delivery, and neonatal data recorded at delivery, were used to predict postpartum complications. Administrative health data of all inpatient live births (n=422509) in the Australian state of Queensland between January 2009 and October 2015. Gradient boosted trees were used with five-fold cross-validation to compare model performance. The best performing models for each outcome were then assessed in the independent validation data using the area under the receiver operating curve (AUC-ROC). Postpartum complications occurring in the first 12weeks after delivery requiring hospital admission. Postpartum hypertensive disorders obtained good discrimination in the independent validation data (AUC=0.879, 95% CI 0.846-0.912), as did obstetric surgical wound infection (AUC=0.856, 95% CI 0.838-0.873), whereas postpartum sepsis and haemorrhage obtained poor discrimination. Our study suggests that routinely collected health data have the potential to play an important role in helping determine women's risk of common postpartum complications leading to hospital admission. This information can be presented to clinical staff after delivery to help guide immediate postpartum care, delayed discharge, and post-discharge patient follow up. For such a system to be effective and valued, it must produce accurate predictions, and our findings suggest areas where routine data collection could be strengthened to this end. Improved prediction of maternal postnatal hypertensive disorders and wound infection via machine learning.

Group A Streptococcus puerperal sepsis: an emerging obstetric infection?

Group A Streptococcus puerperal sepsis: an emerging obstetric infection?

Spotlight on … infection in obstetrics and gynaecology

Spotlight on … infection in obstetrics and gynaecology

Empirical Antibiotic Treatment of Obstetric and Gynecologic Surgical Site Infections: Are the Right Pathogens Being Targeted?

Abstract Objective: The aim of this research was to assess the microbiologic diversity and the adequacy of empirical antibiotic treatment of surgical site infections (SSIs) following cesarean secti...

Antibiotics for the Prevention and Treatment of Postsurgical Obstetric Infections.

ImportanceInfectious complications contribute significantly to maternal morbidity and mortality. Antibiotics are a cornerstone of prevention and management of postsurgical infections in obstetrics. However, antibiotic resistance from inappropriate use of antibiotics is an emerging global health threat.ObjectiveThe aim of this study was to review the evidence and provide recommendations for antibiotic selection for prevention and treatment of postsurgical infections in obstetrics.Evidence AcquisitionPublished literature was retrieved through a search of PubMed. Relevant original research articles, systematic reviews, review articles, and practice guidelines were identified and included.ResultsAvailable evidence supports the use of a first-generation cephalosporin for an unlabored cesarean delivery, with the addition of adjunctive azithromycin for women undergoing labored cesarean delivery. Limited data also support the use of a second-generation cephalosporin at the time of obstetric anal sphincter injury repair. Limited retrospective studies suggest against the use of prophylactic antibiotics for manual removal of the placenta. Data are insufficient to recommend prophylactic antibiotics for postpartum dilation and curettage. Evidence from a systematic review supports clindamycin and gentamicin as the optimal regimen for the treatment of postpartum endometritis. Original obstetric research for the treatment of other postsurgical obstetric infections is limited, and recommendations provided are based on expert opinion.Conclusions and RelevanceObstetric providers should be familiar with available evidence and guidelines regarding antibiotic selection for the prevention and treatment of obstetric infections. Widespread selection of the narrowest effective antibiotic regimen has the potential to combat the rising threat of antibiotic resistance while ensuring appropriate prevention and treatment of postsurgical infections in obstetrics.Target AudienceObstetricians and gynecologists, family physicians.Learning ObjectivesAfter completing this activity, the learner should be better able to (1) categorize the most common bacterial isolates responsible for obstetric postsurgical infections; (2) determine which obstetric operative interventions warrant antibiotic prophylaxis based on evidence-based guidelines; and (3) select appropriate, effective, and targeted antibiotics for the treatment of postsurgical infections in obstetrics patients.

Procalcitonin; a feasible biomarker for severe bacterial infections in Obstetrics and Gynecology?

Procalcitonin; a feasible biomarker for severe bacterial infections in Obstetrics and Gynecology?

СТРУКТУРА ВНУТРИБОЛЬНИЧНЫХ ИНФЕКЦИОННО-ВОСПАЛИТЕЛЬНЫХ ОСЛОЖНЕНИЙ ПОСЛЕ АБДОМИНАЛЬНОГО РОДОРАЗРЕШЕНИЯ

Objective: Analysis of the frequency and structure of postoperative infectious and inflammatory complications in the puerperae after abdominal delivery, which were under treatment in the specialized department of the third-level hospital for 2017. Methods: s: Examined and treated of 66 parturient women with infectious complications after cesarean section. The spectrum of nosocomial microflora and resistance to antimicrobial agents determined using an automatic microbiological analyzer based on mass spectrometry. Results: The main recorded nosological form was infection of the area of surgical intervention. In 3% of cases, postoperative metroendometritis complicated by the inconsistency of sutures on the uterus with the development of obstetric peritonitis, and in 7.6% by sepsis. The structure of isolated microflora in postoperative infection was different after planned and emerged delivery, which should be taken into account when developing a local form of perioperative antibiotic prophylaxis and therapy. Conclusion: At present, there is an underestimation of the severity of metroendometritis after cesarean section with premature discharge or a belated transfer from the maternity hospital to the specialized observatory department of the multi-profile hospital. One in five postoperative metroendometritis caused by multidrug-resistant hospital microflora. Keywords: Caesarean section, infectious complications, observational department, obstetric wound infection, postnatal metroendometritis, postpartum sepsis, obstetric peritonitis.

Variation in obstetric infection prevention and control at caesarean section

Variation in obstetric infection prevention and control at caesarean section

Obstetricia: Aporte de 70 años de vida institucional de la Sociedad Peruana de Obstetricia y Ginecología

La Sociedad Peruana de Obstetricia y Ginecología ha tenido y continuará su contribución con el desarrollo de la obstetricia en el Perú, mediante sus actividades académicas y los artículos científicos publicados en la Revista Peruana de Ginecología y Obstetricia. En el campo de Obstetricia, se han difundido diversos temas relacionadas a mortalidad materna, diagnóstico y manejo de la hemorragia obstétrica, preeclampsia, infecciones en obstetricia, aborto y evaluación de la técnica de cesárea.

Infecciones en ginecología y obstetricia: producción científica de la Sociedad Peruana de Obstetricia y Ginecología en sus setenta años de vida institucional

Las infecciones en ginecología y obstetricia son patologías que afectan a la mujer en todas las etapas y condiciones de la vida, constituyendo algunas de ellas problemas de salud pública. La Sociedad Peruana de Obstetricia y Ginecología desde su fundación hasta la actualidad, en su septuagésimo aniversario, mantiene la preocupación constante sobre las infecciones en la mujer. Para ello ha promovido y publicado a través de los años diversas investigaciones y reportes sobre el tema, a cargo de los miembros de la Sociedad e instituciones donde laboran, los mismos que son expuestos en el presente artículo con especial énfasis en las investigaciones históricas, pioneras, o las que por su relevancia mantienen vigencia y que fueron publicadas en la Revista Peruana de Ginecología y Obstetricia, órgano oficial de publicación científica de la Sociedad.

Risk factors for surgical site infections in obstetrics: a retrospective study in an Ethiopian referral hospital

BackgroundPregnant women are at risk of infection during labor and delivery. Infection in obstetrics accounts for the second most common cause of maternal mortality next to post partum hemorrhage. Knowing the prevalence and associated risk factors would help to undertake optimal precautions and standard surgical techniques to reduce surgical site infection which poses increased hospital cost and total hospital stay of the patients.MethodFacility based retrospective observational study design was carried out purposively to assess the prevalence of surgical site infections and associated risk factors among mothers who had delivery related surgery at obstetric ward of Assela teaching referral hospital from April, 23, 2015 to September 5, 2015. A total of 384 women who had surgery for delivery were included in the study. The risk associated with SSIs was assessed by multivariate regression logistic analysis.ResultsThe age of the women ranged from 17 to 40 years with the mean age of 26 (±5) years. The rate of surgical site infection was 9.4%(36/384). The risk factors for surgical site infection were age less than 19 (OR = 3.5, 95%CI 1.17–10.01), preterm gestation age (OR = 4.225 95%CI 1.254–14.238), duration of labor ≥24 h (OR = 2.219 95%CI1.054–4.670), duration of rupture of membrane ≥12 h (OR = 5.99, 95% CI2.75–13.02),chorioamnionitis (OR = 9.743, 95%CI 3.077–30.848), vertical skin incision(OR = 4,95%CI 1.709–13.322), pre operation Hematocrit (OR = 6.4,95%CI1.021–40.137),perioperative blood transfusion(OR = 6.75,95%CI 2.47,18.49), abdominal hysterectomy(OR = 7.9,95%CI1.698–36.960), and diabetic mellitus (OR = 3.7,95%CI 1.112–12.519).ConclusionsObstetric ward of Assela teaching referral hospital are encouraged to use properly WHO surgical safety checklist and examine how to sensibly integrate these essential safety steps into their normal operative workflow. Prophylactic antibiotic administration should be provided within one hour before the surgical incision or within two hours if the patient is receiving vancomycin or floroquinolones.

Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology.

Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. Estimate the rate of SSIs and associated predisposing factors. Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and30. A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting.

Characteristics of TLR reactions to the urogenital infections pathogens in pregnancy

Simultaneous TLR gene expression estimation (the prognosis of abortion and miscarriage), mucosal microbiocenoses types, mucosal immunity state estimation, presence or absence of clinical manifestation of miscarriage, pregnancy course (unfavorable prognosis-immunological rejection of the fetus or complicated pregnancy course and miscarriage, favorable prognosis-immunological irritation or normal fetal development, abortion-miscarriage), presence or absence of infection and/or clinical manifestation of infectious and inflammatory conditions can be objective additional criteria for estimation and prognosis of pregnancy course as well as to personalize the adequate treatment and prevention of abortion and miscarriage. Pathogenetic (concomitant increased reaction of mucosal epithelial cells receptors for developing fetus and infectious process leads to abortion and miscarriage) and TLR diagnostic role in pregnancy is established. In obstetric infections in pregnant women levels of gene expression of TLR-2 – 21.2 and above, TLR-4 – 23.0 and above, TLR-8 – 25.7 and above indicate a high degree of infection with clinical manifestations of urogenital infections, and in the levels of genes expression of TLR-8 - 26 and below verifies chronic urogenital infections, while levels of gene expression TLR-8 above 26 verifies acute course of urogenital infections TLR-8 level above 28 is a predictor of pregnancy termination and miscarriage.

Aerobic Bacteria from Surgical Wound Infections in Obstetrics and Gynecology Ward in Specialist Hospital Sokoto – North West Nigeria

Aerobic Bacteria from Surgical Wound Infections in Obstetrics and Gynecology Ward in Specialist Hospital Sokoto – North West Nigeria

410: Differences and similarities in obstetrical versus gynecological surgical site infections- practical implications

410: Differences and similarities in obstetrical versus gynecological surgical site infections- practical implications

Nosocomial obstetric infections: Yesterday, today, tomorrow

Antibiotic resistance of microorganisms is one of the most acute problems of modern obstetrics. The paper analyzes current antibiotic resistance. It considers the mechanisms of its formation and ways to overcome the resistance.

Characterization of Vaginal Escherichia coli Isolated from Pregnant Women in Two Different African Sites

The relevance of vaginal colonization of pregnant women by Escherichia coli is poorly understood, despite these strains sharing a similar virulence profile with other extraintestinal pathogenic E. coli producing severe obstetric and neonatal infections. We characterized the epidemiology, antimicrobial susceptibility and virulence profiles of 84 vaginal E. coli isolates from pregnant women from Rabat (Morocco) and Manhiça (Mozambique), two very distinct epidemiological settings. Low levels of antimicrobial resistance were observed to all drugs tested, except for trimethoprim-sulfamethoxazole in Manhiça, where this drug is extensively used as prophylaxis for opportunistic HIV infections. The most prevalent virulence factors were related to iron acquisition systems. Phylogroup A was the most common in Rabat, while phylogroups E and non-typeable were the most frequent in Manhiça. Regardless of the apparently “low virulence” of these isolates, the frequency of infections is higher and the outcomes more devastating in constrained-resources conditions, especially among pregnant women and newborns.