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Microbiology and Antibiotic Resistance in Peripartum Bacteremia

Wilkie, Gianna L., MD; Prabhu, Malavika, MD; Ona, Samsiya, MD; Easter, Sarah Rae, MD; Tuomala, Ruth E., MD; Riley, Laura E., MD; Diouf, Khady, MD

doi: 10.1097/AOG.0000000000003055
Contents: Infectious Disease: Original Research
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OBJECTIVE: To examine the microbiology and associated antibiotic resistance patterns among febrile peripartum women with positive blood cultures.

METHODS: We conducted a retrospective cohort study in which we reviewed all bacteremia cases between 2009 and 2016 that occurred between 7 days before and 30 days after delivery. Institutional guidelines include obtaining blood cultures and promptly initiating intravenous antibiotics for all obstetric patients with fever of 100.4°F or higher. We describe antibiotic resistance patterns for the most frequently isolated organisms and perform univariate analyses regarding maternal and neonatal outcomes based on type of bacteremia.

RESULTS: Among 56,835 deliveries, 3,797 (6.7%) obstetric patients had blood cultures drawn and 120 (3.2%) had documented bacteremia. The most commonly cultured organisms were Escherichia coli (17.5%, n=21), Bacteroides species (10.8%, n=13), Enterococcus species (10.8%, n=13), group B streptococci (10.8%, n=13), and group A streptococci (5.0%, n=6). E coli had high rates of resistance to ampicillin (n=17, 81.0%) and extended spectrum beta lactams (n=10, 47.6%). Gram-positive bacteremia was noted in 65/120 patients (54.2%), gram-negative bacteremia in 39/120 (32.5%), and anaerobic bacteremia in 16/120 (13.3%) (P=.02). Neonatal bacteremia was identified in 8/120 cases (6.7%), of which 7/8 (87.5%) were attributable to gram-negative bacteria and 1/8 (12.5%) were attributable to gram-positive bacteremia (P=.004). There were no differences in neonatal death or maternal intensive care unit admission.

CONCLUSION: Peripartum bacteremia is uncommon, with the most frequently isolated organism being E coli. The evolution of antibiotic resistance patterns in E coli at our institution may be of clinical significance in determining antibiotic choice for peripartum fever.

Although infrequent, when women with peripartum fever are bacteremic, it is most commonly with Escherichia coli, which has a high rate of ampicillin resistance.

Departments of Obstetrics and Gynecology, Brigham and Women's Hospital, and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Department of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Women and Infants Hospital of Rhode Island, Providence Rhode Island.

Corresponding author: Gianna L. Wilkie, MD, Department of Obstetrics and Gynecology, 75 Francis St, Boston, MA 02115; email: gwilkie@partners.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B238.

Received July 30, 2018

Received in revised form October 30, 2018

Accepted November 01, 2018

© 2019 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.