Alarming Rates of Antibiotic Resistance Among Organisms Causing Post-Cesarean Section Peritonitis in Rwanda [19J]

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Abstract

INTRODUCTION:

Antimicrobial resistance (AMR) is one of the most serious global health threats today, particularly in the developing world. AMR limits the number of antibiotics available to treat severe illnesses like sepsis. Abdominal sepsis due to post-partum infections, such as post-cesarean section peritonitis, is being encountered with considerable frequency at the main referral hospital in Kigali, Rwanda and is associated with a mortality rate of 25%. Understanding resistance patterns of bacterial isolates can help tailor initial therapy in these high-risk patients.

METHODS:

We performed a prospective study at the University Teaching Hospital Kigali (CHUK) from January until September 2015. All patients admitted with the diagnosis of post-cesarean section peritonitis undergoing exploratory laparotomy at CHUK were enrolled. We evaluated the antibiotic sensitivity patterns of bacterial pathogens cultured from peritoneal fluid of patients at time of initial laparotomy.

RESULTS:

Culture results were available for 29 patients. Twenty-two samples (76%) had gram-negative bacterial isolates and 7 (24%) had no growth. No gram-positive bacteria were isolated. Escherichia coli and Klebsiella were isolated from 31% and 34% of specimens, respectively. The overall resistance rates were 88% to ampicillin; 76% to amoxicillin-clavulanate; 71% to co-trimoxazole; 54%, 58%, and 63% to ceftazidime, ceftriaxone, and cefotaxime, respectively; 58% to gentamicin, 56% to amikacin, and 32% to ciprofloxacin. Only imipenem retained sensitivity to all isolates.

CONCLUSION:

Antimicrobial resistance rates are alarmingly high among patients presenting with abdominal sepsis from post-cesarean section peritonitis, limiting first-line antibiotic choices. This could lead to increased morbidity and mortality in this high-risk population.

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