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

WHO GLOSS research group, Carolina C. Ribeiro-do-Valle, Mercedes Bonet, Vanessa Brizuela, Edgardo Abalos, Adama Baguiya, Fernando Bellissimo-Rodrigues, Mihaela Budianu, Lucian Puscasiu, Marian Knight, David Lissauer, Catherine Dunlop, Shevin T. Jacob, Sadia Shakoor, Luis Gadama, Bouchra Assarag, João Paulo Souza, Jose G. Cecatti*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Downloads (Pure)

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.
Original languageEnglish
Article number21
Number of pages12
JournalAnnals of Clinical Microbiology and Antimicrobials
Volume23
Issue number1
DOIs
Publication statusPublished - 24 Feb 2024

Bibliographical note

Funding:
This study was financially supported by the UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored programme executed by the World Health Organization (WHO) (Project A65787), Merck Sharp & Dohme, a wholly owned subsidiary of Merck (Kenilworth, NJ, USA), through its Merck for Mothers programme, and the United States Agency for International Development (Grant GHA-G-00-09-00003). CRV received a scholarship from CAPES (PDSE-20187876856).

Keywords

  • Infections
  • Antibiotic
  • Maternal sepsis
  • Maternal morbidity

Fingerprint

Dive into the research topics of 'Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort'. Together they form a unique fingerprint.

Cite this