Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort
Carolina C. Ribeiro‐do‐Valle, Mercedes Bonet, Vanessa Brizuela, Edgardo Ábalos, Adama Baguiya, Fernando Bellissimo‐Rodrigues, Mihaela Alexandra Budianu, Lucian Pușcașiu, Marian Knight, D. Lissauer, Catherine Dunlop, Shevin T. Jacob, Sadia Shakoor, Luis Gadama, Bouchra Assarag, João Paulo Souza, José Guilherme Cecatti, Mohammad Iqbal Aman, Bashir Noormal, Virginia Díaz, Marisa Espinoza, Julia Pasquale, C. Leroy, Kristien Roelens, Griet Vandenberghe, Christian Agossou, Sourou Goufodji Keke, Christiane Tshabu Aguèmon, Patricia Soledad Apaza Peralta, Víctor Conde Altamirano, Rosalinda Hernández Muñoz, José Guilherme Cecatti, Carolina C. Ribeiro‐do‐Valle, Vincent Batiene, Kadari Cissé, Henri Gautier Ouédraogo, Cheang Kannitha, Lam Phirun, Tung Rathavy, Elie Simo, Pierre Marie Tebeu, Emah Irene Yakana, Javier Carvajal, María Fernanda Escobar, Paula Fernández, Lotte Berdiin Colmorn, Jens Langhoff‐Roos, Wilson Mereci, Paola Vélez, Yasser Salah Eldin, Alaa Sultan, Abdulfetah Abdulkadir Abdosh, Alula M. Teklu, Dawit Worku Kassa, Richard Adanu, Philip Govule, Charles Noora Lwanga, William Enrique Arriaga Romero, María Guadalupe Flores Aceituno, Carolina Bustillo, Rigoberto Castro, Bredy Lara, Vijay Kumar, Vanita Suri, Sonia Trikha, Irene Cetin, Serena Donati, C. Personeni, Guldana Baimussanova, Saule Kabylova, Balgyn Sagyndykova, George Gwako, Alfred Osoti, Zahida Qureshi, Raisa Asylbasheva, Aigul Boobekova, Damira Seksenbaeva, Faysal El Kak, Saad Eddine Itani, Sabina Abou Malham, Meilė Minkauskienė, Diana Ramašauskaitė, Owen Chikhwaza, Eddie Malunga, Haoua Dembelé, Hamadoun Sangho, Fanta Eliane Zerbo, Filiberto Dávila Serapio, Nazarea Herrera Maldonado, Juan I. Islas Castañeda, T. Caraus, Ala Curteanu, Victor Petrov, Buyanjargal Yadamsuren, Seded Khishgee, Bat-Erdene Lkhagvasuren, Amina Essolbi, Rachid Moulki, Nafissa Osman, Zara Jaze
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.