ABSTRACT:

Background: Puerperal sepsis is one of the leading causes of preventable maternal morbidity and mortality. It accounts for about 11 % of maternal death worldwide, with highest prevalence being reported from low income countries. However, in Mwanza data on the proportion of postdelivery women with laboratory confirmed puerperal sepsis, bacterial patterns and associated factors are still limited.This is turn limits institution of specific antimicrobial therapies for this population.

Objective: To determine the proportion of laboratory confirmed puerperal sepsis, associated factors and bacterial patterns among post-delivery women with clinical features of puerperal sepsis admitted at BMC, SRRH and SDDH in Mwanza, Tanzania.

Methodology: A cross-sectional analytical hospital based study involving 340 post-delivery women admitted at BMC (152), SRRH (108) and SDDH (80) was conducted between October 2017 to April 2018.A structured pre-tested questionnaire was used to obtain socio- demographic, clinical and obstetric information from the participants. The endocervical swab and venous blood were aseptically taken for culture and antimicrobial susceptibility testing as per standard operating procedures. Data were analysed using STATA version 13 according to objectives of the study.

Results: The mean age of the study participant was 26.2 ± 6.5 years. The proportion of laboratory confirmed puerperal sepsis was 58.8% (200/340). Of these, 164 (82%) had positive culture for endocervical swabs, 17 (8.5%) were blood culture positive and 19 (9.5%) had positive culture results from both blood and endocervical swabs. Staphylococcus aureus were the most predominant bacteria isolate from blood culture 13 (36.1%), while the Escherichia coli 52 (26.0%) were the most predominant bacteria isolated from the endocervical swabs. All Staphylococcus aureus (except one strain) were sensitive to gentamicin and vancomycin. Over three quarter of E.coli was resistant to ampicilin, trimethoprim-sulfamethoxazole, amoxicillin-clavulanate and ceftriaxone; and none of these were resistant to meropenem. Acinetobacter spp. were mostly multidrug resistant, with variable resistant to meropenem (0% to 20%). On multivariable logistic regression analysis, primipara (OR: 10.14, 95%CI: 4.20-24.46, P<0.001), grand multipara OR: 3.85, 95%CI: 1.52-9.74, P=0.004, premature rupture of membrane with OR: 4.31, 95%CI: 1.61-11.47, P=0.003 , pre/eclampsia OR: 3.66, 95%CI: 1.7- 11.40, P=0.025, anemia OR: 2.56, 95%CI: 1.20-5.79, P=0.018 and prolonged labor duration OR: 12.69, 95%CI: 5.7-28.0, P=<0.001 were found to be independent predictors of laboratory confirmed puerperal sepsis

Conclusion: Approximately 60% of women with clinical features of puerperal sepsis had laboratory confirmed puerperal sepsis, with Staphylcococcus aureus and E. coli being predominant bacteria species. High resistant to various agents among bacteria recovered calls for laboratory guided specific antimicrobial therapies to ensure favourable patients outcomes. Patients with premature rupture of membranes, prolonged duration of labours and co-morbid conditions such as anaemia and pre/eclampsia should be targets for preventive measures against puerperal sepsis.