Outcomes of hysterectomy for puerperal sepsis at an Academic Hospital: A retrospective study

Pregnancy-related sepsis contributes significantly to maternal mortality. While there is substantial information on postpartum hysterectomy, information on outcomes of hysterectomy as source control for puerperal sepsis is limited. Knowledge of the common causative organisms and their antimicrobial sensitivity may assist with targeted antibiotic therapy to improve patient outcomes. This study described the indications and outcomes of surgery in patients following hysterectomy as source control for puerperal sepsis.

In a retrospective study, we analysed the intra-operative and histological findings and the results of microbial culture and antibiotic sensitivity of women who underwent a hysterectomy for puerperal sepsis at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, from January 2019 to December 2019.

Twenty-nine (88%) of the 33 women with hysterectomy for puerperal sepsis studied had a caesarean section (CS), 14 (48%) of whom had a CS performed for foetal distress. Eight of these 33 women (24%) had hypertensive-related disorders. The most common organisms cultured in the intra-abdominal fluid were Acinetobacter baumannii (n = 11, 26%), E. coli (n = 8, 19%), Klebsiella species (n = 6, 14%) and Enterococcus faecalis (n = 6, 14%) of a total of 42 organisms were identified from all sites. Puerperal sepsis was confirmed in 28 (85%) of the uterine histology samples, with a mortality rate of 6% in this study.

Hysterectomy for puerperal sepsis was most frequently associated with CS, with hypertensive-related disorders the most common indication. Histological confirmation of sepsis is required, as the histological findings differed by 15% with surgical diagnosis.

A. baumannii was the most common species isolated as the cause of infection.