Predictors of infection with resistant pathogens and the possibility of risk stratification in surgical obstetrics

Objective: Identification of the most significant predictors of infection with antibiotic-resistant pathogens in puerperas with endometritis after abdominal delivery.

Materials and methods: Retrospective analysis of 648 cases of cesarean section (406 – endometritis after cesarean section, 242 – uncomplicated postoperative period) and the results of microbiological examination of lochia (identification of microorganisms and determination of antibiogram). The number of concomitant extragenital diseases was calculated according to the cumulative illness rating scale (CIRS).

Results: 106 (26.1%) drug-resistant isolates were verified in post-caesarean section endometritis (p<0.001). MDR strains of the rESKAPE group were isolated from every sixth postpartum woman (16.8%) with endometritis.

The lowest (25%) and highest (97%) prevalence of susceptibility were observed with clindamycin and vancomycin, respectively. The main drug-resistant pathogens include gram-negative ESBL producers of the order Enterobacterales.

The vast majority of the main predictors of endometritis development after abdominal delivery were also associated with an aggravated somatic background: emergency CS during labor with a long anhydrous interval of ≥12 hours, a sum of 4 points or more according to the CIRS system, anemia of inflammation/chronic disease, extragenital infections during this pregnancy, the presence of a cervical cerclage/pessary, a body mass index of ≥30.00 kg/m2, asymptomatic bacteriuria and a fasting venous plasma glucose level during pregnancy of >5.1 mmol/l. Conclusion: Comorbidity (4 points or more according to the CIRS) was the most reliable predictor of colonization with multidrug-resistant pathogens and a risk factor for the development of endometritis after CS. An important predictor of MDR pathogen isolation was emergency CS in combination with a long (≥12 h) anhydrous interval and long (≥10 h) labor before surgery. The risk of carriage of drug-resistant strains was influenced by «antibacterial history» and hospitalizations/invasive procedures or surgeries in the second half of pregnancy.