To investigate the clinical characteristics, the predictive value of inflammatory indicators and pathogenic bacteria distribution of puerperium patients complicated with bloodstream infection.

Total of 31 puerperal infection cases with positive blood culture, and 60 cases of puerperal infection without positive blood culture were reviewed from March 2012 to June 2019 in Department of Obstetrics and Gynecology, Beijing Anzhen Hospital, Capital Medical University. The clinical characteristics and predictive value of temperature, white blood cell (WBC), neutrophil percentage and C-reactive protein (CRP) of the two groups were analyzed, retrospectively. The pathogens distribution and antibiotic resistance were also analyzed.

There were no significant differences in age [(29.6 ± 3.84) years old vs. (30.5 ± 3.94) years old; t =-1.049, P = 0.297], gestational age [39.0 (34.5, 40.0) weeks vs. 38.0 (38.0, 40.0) weeks; U =-0.468, P = 0.640], mode of delivery (cesarean section: 90.32% vs. 91.67%; χ² = 0.000, P = 1.000) and postpartum hemorrhage [225 (200, 500) ml vs. 300 (200, 500) ml; U =-1.536, P = 0.124] between patients of puerperal infection with and without positive blood culture. The highest body temperature [(39.1 ± 0.7) ℃ vs. (38.5 ± 0.6) ℃; t = 4.677, P < 0.001], WBC [(14.8 ± 4.6) × 10⁹/L vs. (13.1 ± 3.3) × 10⁹/L; t = 2.044, P = 0.044], neutrophil percentage [(88.7 ± 4.9)% vs. (85.9 ± 4.8)%; t = 2.599, P = 0.011] and CRP [(140.9 ± 56.7) mg/L vs. (112.7 ± 61.6) mg/L; t = 2.126, P = 0.036] of puerperal infection with positive blood culture group was significantly higher than that of puerperal infection without positive blood culture group, with significant differences. Receiver operating characteristic curve (ROC) analysis showed that the area under the curves (AUC) of temperature, WBC, neutrophil percentage and CRP for the discrimination of puerperal bloodstream infection were 0.760 (95%CI: 0.658-0.862), 0.603 (95%CI: 0.478-0.729), 0.718 (95%CI: 0.594-0.841) and 0.660 (95%CI: 0.722-0.903), respectively. The optimum cut-off values were temperature 38.7 ℃, WBC 11.3 × 10⁹/L, neutrophil percentage 86.0% and CRP 85.2 mg/L, respectively. The AUC of ROC of four indexed combined was 0.813 (95%CI: 0.722-0.903), which was significantly different compared with WBC and CRP (Z = 2.531, P = 0.011, Z = 2.438, P = 0.015); but there were no significant difference with the AUC of ROC of temperature and neutrophil percentage alone (Z = 1.639, P = 0.101; Z = 1.249, P = 0.212); and resulted in a specificity of 86.7% and a sensitivity of 64.5%. Total of 31 bacteria strains were isolated, among which Gram-negative and Gram-positive bacteria were 20 strains (64.5%) and 11 strains (35.5%), which included Escherichia coli (54.8%) and coagulase negative Staphylococcus (16.1%). The resistance rates of Escherichia coli to ampicillin, ceftazidime and ceftriaxone were 100.0%, 82.3% and 88.2%, respectively, and the sensitivity rates to amikacin, imipenem, piperacillin/tazobactam were all 100.0%. The resistance rates of coagulase negative Staphylococci to clindamycin and erythromycin were both 60.0%. The sensitivity rates of coagulase negative Staphylococci to penicillin, ciprofloxacin, levofloxacin, gentamicin were all 80%, and the sensitivity rates to linezolid and vancomycin were both 100%.

Body temperature, WBC, neutrophil percentage and CRP of puerperium patients complicated with bloodstream infection were all significantly increased, and the combined application of the four indexes had a better ability to predict bloodstream infection in puerperium patients than those of single detection of WBC or CRP. Most of the patients were with Gram-negative bacterial infection and serious antibiotic resistance, which should be identified and treated as early as possible.