Aetiology and use of antibiotics in pregnancy-related infections: results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort
Authors: Ribeiro-do-Valle Carolina C. , Bonet Mercedes , Brizuela Vanessa , Abalos Edgardo , Baguiya Adama , Bellissimo-Rodrigues Fernando , Budianu Mihaela , Puscasiu Lucian , Knight Marian , Lissauer David , Dunlop Catherine , Jacob Shevin T. , Shakoor Sadia , Gadama Luis , Assarag Bouchra , Souza João Paulo , Cecatti Jose G. ,   the WHO GLOSS research group, Aman Mohammad Iqbal , Noormal Bashir , Díaz Virginia , Espinoza Marisa , Pasquale Julia , Leroy Charlotte , Roelens Kristien , Vandenberghe Griet , Christian Urlyss Agossou M. , Keke Sourou Goufodji , Aguemon Christiane Tshabu , Peralta Patricia Soledad Apaza , Altamirano Víctor Conde , Muñoz Rosalinda Hernández , Cecatti José Guilherme , Ribeiro-Do-Valle Carolina C. , Batiene Vincent , Cisse Kadari , Ouedraogo Henri Gautier , Kannitha Cheang , Phirun Lam , Rathavy Tung , Simo Elie , Tebeu Pierre-Marie , Yakana Emah Irene , Carvajal Javier , Escobar María Fernanda , Fernández Paula , Colmorn Lotte Berdiin , Langhoff-Roos Jens , Mereci Wilson , Vélez Paola , Eldin Yasser Salah , Sultan Alaa , Abdosh Abdulfetah Abdulkadir , Teklu Alula M. , Kassa Dawit Worku , Adanu Richard , Govule Philip , Lwanga Charles Noora , Romero William Enrique Arriaga , Aceituno María Guadalupe Flores , Bustillo Carolina , Castro Rigoberto , Lara Bredy , Kumar Vijay , Suri Vanita , Trikha Sonia , Cetin Irene , Donati Serena , Personeni Carlo , Baimussanova Guldana , Kabylova Saule , Sagyndykova Balgyn , Gwako George , Osoti Alfred , Qureshi Zahida , Asylbasheva Raisa , Boobekova Aigul , Seksenbaeva Damira , El Kak Faysal , Itani Saad Eddine , Malham Sabina Abou , Minkauskienė Meilė , Ramašauskaitė Diana , Chikhwaza Owen , Malunga Eddie , Dembele Haoua , Sangho Hamadoun , Zerbo Fanta Eliane , Serapio Filiberto Dávila , Maldonado Nazarea Herrera , Castañeda Juan Ismael Islas , Caraus Tatiana , Curteanu Ala , Petrov Victor , Buyanjargal Yadamsuren , Khishgee Seded , Lkhagvasuren Bat-Erdene , Essolbi Amina , Moulki Rachid , Osman Nafissa Bique , Jaze Zara , Mariano Arlete , Einda Hla Mya Thway , Maung Thae Maung , Tin Khaing Nwe , Gurung Tara , Shrestha Amir Babu , Shrestha Sangeeta , Bloemenkamp Kitty , Rijken Marcus J , Van Den Akker Thomas , Estrada María Esther , Pavón Néstor J. Gómez , Adesina Olubukola , Aimakhu Chris , Fawole Bukola , Chaudhri Rizwana , Hamid Saima , Adnan Khan M. , del Huatuco PilarHernández María , Zavaleta Nelly M. Pimentel , Andal Maria Lu , Martin Carolina Paula , Recidoro Zenaida Dy , Budianu Mihaela-Alexandra , Puşcaşiu Lucian , Diouf Léopold , Guirassy Dembo , Moreira Philippe Marc , Borovsky Miroslav , Kovac Ladislav , Kristufkova Alexandra , Cebekhulu Sylvia , Cornelissen Laura , Soma-Pillay Priya , Cararach Vicenç , López Marta , Benedé María José Vidal , Jayakody Hemali , Jayaratne Kapila , Rowel Dhammica , Elsheikh Mohamed , Nabag Wisal , Omer Sara , Tsoy Victoria , Uzakova Urunbish , Yunusova Dilrabo , Siriwachirachai Thitiporn , Tangsiriwatthana Thumwadee , Pérez Aquilino M. , Roman Jhon , Vitureira Gerardo , Tuan Dinh Anh , Truong Luong Ngoc , Hanh Nghiem Thi Xuan , Madziyire Mugove , Magwali Thulani , Munjanja Stephen , Chamillard Mónica , Fawole Bukola , Kouanda Seni , Lumbiganon Pisake , Nabhan Ashraf , Nadisauskiene Ruta , Bartlett Linda , Jacob Shevin T. , Yunis Khalid , Campodónico Liana , Cuesta Cristina , Gamerro Hugo , Giordano Daniel , Althabe Fernando , Metin Gülmezoglu A. 
Published: February 2024

Abstract
Background
Pregnancy-related infections are important contributors to maternal sepsis and mortality. We aimed to describe clinical, microbiological characteristics and use of antibiotics by source of infection and country income, among hospitalized women with suspected or confirmed pregnancy-related infections.

Methods
We used data from WHO Global Maternal Sepsis Study (GLOSS) on maternal infections in hospitalized women, in 52 low-middle- and high-income countries conducted between November 28th and December 4th, 2017, to describe the frequencies and medians of maternal demographic, obstetric, and clinical characteristics and outcomes, methods of infection diagnosis and causative pathogens, of single source pregnancy-related infection, other than breast, and initial use of therapeutic antibiotics. We included 1456 women.

Results
We found infections of the genital (n = 745/1456, 51.2%) and the urinary tracts (UTI) (n = 531/1456, 36.5%) to be the most frequent. UTI (n = 339/531, 63.8%) and post-caesarean skin and soft tissue infections (SSTI) (n = 99/180, 55.0%) were the sources with more culture samples taken and microbiological confirmations. Escherichia coli was the major uropathogen (n = 103/118, 87.3%) and Staphylococcus aureus (n = 21/44, 47.7%) was the commonest pathogen in SSTI. For 13.1% (n = 191) of women, antibiotics were not prescribed on the same day of infection suspicion. Cephalosporins (n = 283/531, 53.3%) were the commonest antibiotic class prescribed for UTI, while metronidazole (n = 303/925, 32.8%) was the most prescribed for all other sources. Ceftriaxone with metronidazole was the commonest combination for the genital tract (n = 98/745, 13.2%) and SSTI (n = 22/180, 12.2%). Metronidazole (n = 137/235, 58.3%) was the most prescribed antibiotic in low-income countries while cephalosporins and co-amoxiclav (n = 129/186, 69.4%) were more commonly prescribed in high-income countries.

Conclusions
Differences in antibiotics used across countries could be due to availability, local guidelines, prescribing culture, cost, and access to microbiology laboratory, despite having found similar sources and pathogens as previous studies. Better dissemination of recommendations in line with antimicrobial stewardship programmes might improve antibiotic prescription.