Bacterial Profile, Antimicrobial Susceptibility Patterns, and Associated Factors of Puerperal Sepsis in Asella, Central Ethiopia: A Cross-sectional Study

Abstract

Sepsis, caused by various bacterial pathogens, is a significant contributor to maternal mortality worldwide. In many developing countries, including Ethiopia, empirical or syndromic treatment is commonly employed for puerperal sepsis, which may promote antimicrobial resistance (AMR). We conducted a cross-sectional study to investigate bacterial pathogens, their antimicrobial susceptibility patterns, and associated factors among women with suspected puerperal sepsis attending Asella Referral and Teaching Hospital from September 2020 to August 2021. A total of 174 participants were enrolled, and the sociodemographic and obstetric data were collected using a pretested structured questionnaire and checklist, respectively. Blood samples (approximately 20 ml) were collected from all study participants and incubated in BacT/ALERT® 3D automated blood culture system. In addition, endocervical swabs were collected in Amies transport media. Bacterial isolation and identification were performed following standard bacteriological methods. Antimicrobial susceptibility profiles of bacterial isolates were determined using the disc diffusion method. Data were entered into EpiData version 4.6 and analyzed using SPSS version 25.0. The overall positivity rate of bacterial isolates among puerperal sepsis-suspected women was 48.9%. Among these, 87.1% of the isolates were Gram-negative bacteria. The most common isolates were Escherichia coli (54.1%), followed by Klebsiella spp. (23.5%) and Staphylococci aureus (10.6%). High resistance rates were observed in E. coli to piperacillin (87%), in Klebsiella spp. to aztreonam (65%) and ceftriaxone (65%), and in S. aureus to trimethoprim-sulfamethoxazole (66.6%). Multidrug-resistant bacterial pathogens accounted for 81.2% of the isolates in this study. Multivariate regression analysis did not reveal any statistically significant association between the presence of bacteria and the sociodemographic and obstetrics factors. Our findings emphasize the urgency of strengthening microbiology services to optimize patient management and combat AMR in puerperal sepsis.