Puerperal sepsis: bacterial profile, antimicrobial Susceptibility pattern and associated factors at asella Referral and teaching hospital, central ethiopia

Abstract

Background: Puerperal sepsis is any infection of the female reproductive tract or bloodstream occurring at any time between the onset of the rupture of membranes or labor and forty-two days of delivery or abortion/miscarriage. It is among the leading causes of maternal morbidity and mortality both in developing and developed countries. Objectives: To determine bacterial profiles, their antimicrobial susceptibility patterns, and factors associated with puerperal sepsis. Methods: A cross-sectional study was conducted among puerperal sepsis suspected postpartum/aborted women attending Asella Referral and Teaching Hospital, central Ethiopia from September 2020 to August 2021 G.C. A total of 174 study participants were enrolled. Sociodemographic and obstetric data of the participants were collected using a pretested structured questionnaire and checklist respectively. About 20 ml blood sample was collected from all study participant into BacT/ALERT ® 3D blood culture bottles (about 10 ml each into aerobic and anaerobic) and incubated into BacT/ALERT ® 3D automated blood culture system. Endocervical swab was also collected into Aime's transport media. All endocervical swabs and positive blood cultures were inoculated on MacConkey agar, blood agar, and chocolate agar plates for bacterial isolation and identification. Data were entered into EpiData version 4.6 and transferred to SPSS version 25.0 for analysis. Descriptive statistics were calculated to show frequency, bivariate and multivariate regression analysis were calculated to see the association of dependent and independent variables. Results: The overall positivity rate of bacterial isolates among puerperal sepsis women suspected was 48.9%. Out of these 87.1% of the isolates were Gram negative bacteria. The most common isolates were E. coli (54.1%) followed by Klebsiella spp. (23.5%) and S. aureus (10.6%). E. coli were showed a higher resistance rate to Piperacillin (87%) and Trimethoprim-sulfamethoxazole (65.2%). Klebsiella species were showed a higher resistance rate to Aztreonam (65%) and Ceftriaxone (65%). S. aureus showed a higher resistance rate to Trimethoprim-sulfamethoxazole (66.6%). In this study, 81.2% of the isolates were multi-drug resistant bacterial pathogens. Multivariate regression analysis showed no statistically significant association between sociodemographic, obstetrics factors, and having bacteria. Conclusion and Recommendation: The overall positivity rate in this study was around half. We reported E. coli, Klebsiella species, and S. aureus were the most common isolated bacteria. High numbers of multidrug-resistant bacterial isolates were identified. Our finding recommends the need for strengthening microbiology services to culture samples before starting antibiot