Puerperal sepsis: predisposing factors, microbial agents, and antiPuerperal sepsis: predisposing factors, microbial agents, and antimicrobial susceptibility patterns among patients admitted at Muhimbili national hospital.microbial susceptibility patterns among patients admitted at Muhimbili national hospital.

Maternal mortality due to puerperal sepsis at Muhimbili National Hospital in the year 2000 was almost 17%. There are no data showing causes of puerperal sepsis. The common aetiological agents and their corresponding ant microbial susceptibility pattern are also unknown. This study sought to address this gap. Objectives: To determine the predisposing factors, microbial agents and antimicrobial susceptibility pattern among women with puerperal sepsis admitted at Muhimbili National Hospital from July 2002 - January 2003. Study population: Puerperal women with a diagnosis of puerperal sepsis (cases) and a comparison group of women without puerperal sepsis. Study design: Case control study. Data collected: Information on socio-economic status, antenatal clinic problems, intrapartum events, haemoglobin level, malaria parasitaemia and HIV status was collected from fifty-nine cases and referents. Others investigations including endocervical swab, mid-stream urine, blood for culture and antimicrobial susceptibility pattern, were done in all cases. IU'ult«; Socio-dcmoitriiphic (acton, tntotWUA din'tc booking MA >kly 'tndeti (UMl) were similar In case# and Cftntrol, Prolonged labour, rnuhtptc va#)ral examination >4-ti men, prolonwul rupture of membrane# (ROM) \2 Yu ran were significantly more prevalent in case armpuraJ to referent*, More ca%«* than cortf/oJ* had delivered by caesarean section and had higher rate of intrapartum foetal !//♦, and the difference was statistically significant. Postpartum unaernia (iHy'K)J) O/dt) vm significant more prevalent among the cases, (71/2%) than referent», (32/2%), and there was no statistically significant difference in HIV seropositive status among the case (23.9%) and referents (17/6%)/ About 47.4% (28/59) endocervical swabs and 27.1 %f I 6/59) mid-stream urine M.SIJ) samples yielded bacteria growth. IttcherlchUi coll 3(X4%04/46j and Klebsiella *pp 39.1% (18/46) were prominent isolates, the isolates showed susceptibility to ceftriaxone, ceftazidime, ciprofloxacin, ceclor and gentamycin and were resistant to chloramphenicol and ampicillin. Conclusion: Strategies needs to be developed to prevent prolonged labour and its related risk factors for developing puerperal sepsis such as prolonged ROM and multiple vagina] examinations. Similarly, when conditions mentioned above are present give ant microbial agents. And treatment of puerperal sepsis should be guided by ant microbial susceptibility pattern.