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Background
Postpartum endometritis is the most common infectious complication of pregnancy, which has a serious impact on women's health and can lead to severe sepsis.
Material and methods
We encountered 150 women with clinical evidence of early (1–48 h) post-partum endometritis and SIRS (fever, tachycardia, tachypnea and increased white blood cell count and C-reactive protein) after either vaginal delivery or caesarian section. We obtained blood cultures (aerobic and anaerobic) at 38.5°C and before administration of antibiotics.
Results
Fifteen samples (10%) were positive proving bacteremia of which 12 (80%) were indicative of aerobic and 3 (20%) of anaerobic bacteria. There were also 7 cases of contamination due to Staphylococcus epidermidis. Isolated aerobic Gram negative bacteria (10/15, 66.6%) were Escherichia coli (6), Pseudomonas cepacia (1), Enterobacter aerogenes (1), Salmonella group C (1), Klebsiella pneumoniae (1) and Gram positive cocci (2/15, 13.3%) were Enterococcus faecalis (1) and Streptococcus group A (1). Anaerobic bacteria (3/15, 20%) were Bacteroides fragilis (2) and Clostridium sp (1). All patients were treated empirically until antibiotic sensitivity tests were available with ceftriaxone 2 gr×1 iv, netilmicin 300 mg×1 iv and metronidazole 500 mg×3 iv. Outcome was successful in all patients. None of the isolated bacteria was multi-drug resistant.
Conclusion
Bacteremia in early post-partum endometritis was confirmed in 10% of cases. Isolated bacteria were similar to those referred to in the literature (80% Gram negative bacteria, 20% Gram positive and anaerobic bacteria). Early recognition and appropriate management ensures successful outcome and prevention of complications such as severe sepsis.