{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:40:10Z","timestamp":1758861610282,"version":"3.44.0"},"reference-count":21,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:00:00Z","timestamp":1756512000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCMSA"],"abstract":"<jats:p>Background:\u00a0Pregnancy-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.Methods:\u00a0In 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.Results:\u00a0Twenty-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\u00a0Acinetobacter baumannii\u00a0(n\u00a0= 11, 26%),\u00a0E. coli\u00a0(n\u00a0= 8, 19%),\u00a0Klebsiella\u00a0species (n\u00a0= 6, 14%) and\u00a0Enterococcus faecalis\u00a0(n\u00a0= 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.Conclusion:\u00a0Hysterectomy 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.Contribution:\u00a0A. baumannii\u00a0was the most common species isolated as the cause of infection.<\/jats:p>","DOI":"10.4102\/jcmsa.v3i1.216","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T06:34:48Z","timestamp":1756449288000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of hysterectomy for puerperal sepsis at an Academic Hospital: A retrospective study"],"prefix":"10.4102","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7175-3958","authenticated-orcid":false,"given":"Esther","family":"Olusola","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-2225","authenticated-orcid":false,"given":"Admire","family":"Chikandiwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9302-8218","authenticated-orcid":false,"given":"Evelyn Ngwa","family":"Lumngwena","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1879-7137","authenticated-orcid":false,"given":"Poovangela","family":"Naidoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2580","published-online":{"date-parts":[[2025,8,30]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Burlinson CEG, Sirounis D, Walley KR, Chau A. Sepsis in pregnancy and the puerperium. Int J Obstetr Anesth. 2018;36:96\u2013107. https:\/\/doi.org\/10.1016\/j.ijoa.2018.04.010","DOI":"10.1016\/j.ijoa.2018.04.010"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Knowles SJ, O\u2019Sullivan NP, Meenan AM, Hanniffy R, Robson M. Maternal sepsis incidence, aetiology and outcome for mother and fetus: A prospective study. BJOG. 2015;122(5):663\u2013671. https:\/\/doi.org\/10.1111\/1471-0528.12892","DOI":"10.1111\/1471-0528.12892"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Al-Ostad G, Kezouh A, Spence AR, Abenhaim HA. Incidence and risk factors of sepsis mortality in labor, delivery and after birth: Population-based study in the USA. J Obstetr Gynaecol Res. 2015;41(8):1201\u20131206. https:\/\/doi.org\/10.1111\/jog.12710","DOI":"10.1111\/jog.12710"},{"key":"ref3","unstructured":"Shamsher S, Rauf B. Puerperal sepsis \u2013 Still a major threat for parturient. J Ayub Med Coll Abbottabad [serial online]. 2010 [cited 2020 May 31];22. Available from: http:\/\/www.ayubmed.edu.pk\/JAMC\/PAST\/22-3\/Shamshad.pdf"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Kramer HMC, Schutte JM, Zwart JJ, Schuitemaker NWE, Steegers EAP, Van Roosmalen J. Maternal mortality and severe morbidity from sepsis in the Netherlands. Acta Obstetr Gynecol Scand. 2009;88(6):647\u2013653. https:\/\/doi.org\/10.1080\/00016340902926734]","DOI":"10.1080\/00016340902926734"},{"key":"ref5","unstructured":"NCCEMD. Saving mothers report 2021\u20132023. National Committee for Confidential Enquiry into Maternal Deaths: Annual Report for 2023 [homepage on the Internet]. [cited 2025 Feb 10]. Available from: https:\/\/www.health.gov.za\/wp-content\/uploads\/2024\/10\/Saving-Mothers-Report-2023.pdf"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Liu P, Zhang X, Wang X, et al. Maternal sepsis in pregnancy and the puerperal periods: A cross-sectional study. Front Med. 2023;10:1126807. https:\/\/doi.org\/10.3389\/fmed.2023.1126807","DOI":"10.3389\/fmed.2023.1126807"},{"key":"ref7","unstructured":"Moodley J, Fawcus S, Pattinson R. Saving Mothers 2017\u20132019: Seventh triennial report on confidential enquiries into maternal deaths in South Africa [homepage on the Internet]. [cited 2025 Feb 10]. Available from: https:\/\/www.health.gov.za\/wp-content\/uploads\/2023\/11\/Saving-Mothers-2017-2019-Technical-Report-FINAL-2-1.pdf"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Stokes M, Olson A, Algeo C, et al. Clinical and sociodemographic characteristics associated with emergency peripartum hysterectomy due to puerperal sepsis in Malawi. Int J Matern Child Health AIDS IJMA [serial online]. 2022 [cited 2024 Jan 03];11(1). Available from: https:\/\/mchandaids.org\/clinical-and-sociodemographic-characteristics-associated-with-emergency-peripartum-hysterectomy-due-to-puerperal-sepsis-in-malawi\/","DOI":"10.21106\/ijma.535"},{"key":"ref9","unstructured":"World Health Organization. Reproductive health and research, World Health Organization, Special Programme of Research D. WHO recommendations for prevention and treatment of maternal peripartum infections [homepage on the Internet]. [cited 2019 Oct 15]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/186171\/9789241549363_eng.pdf?sequence=1"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"De JJ. Importance of timely and adequate source control in sepsis and septic shock. J Intens Med. 2024;4(3):281\u2013286. https:\/\/doi.org\/10.1016\/j.jointm.2024.01.002","DOI":"10.1016\/j.jointm.2024.01.002"},{"key":"ref11","unstructured":"Moodley J, Pattinson R.C. Saving mothers 2011\u20132013: Fifth report on the confidential enquiries into maternal deaths in South Africa [homepage on the Internet]. [cited 2025 Feb 11]. Available from: http:\/\/www2.kznhealth.gov.za\/mcwh\/Maternal\/Saving-Mothers-2011-2013-short-report.pdf"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Wandabwa J, Businge B, Longo-Mbenza B, Mdaka MJ, Kiondo P. Peripartum hysterectomy: Two years experience at Nelson Mandela Academic Hospital, Mthatha, Eastern Cape South Africa. Afr Health Sci. 2013;13(2):469\u2013474. https:\/\/doi.org\/10.4314\/ahs.v13i2.38","DOI":"10.4314\/ahs.v13i2.38"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Mmabatswa RN, Wadee R, Bhoora S. An audit of the indications for peripartum hysterectomies performed at a Tertiary Institution in Johannesburg, South Africa: A retrospective study. Int J Gynecol Obstet 2025;168(3):1060\u20131066. https:\/\/doi.org\/10.1002\/ijgo.15957","DOI":"10.1002\/ijgo.15957"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Plante LA, Pacheco LD, Louis JM. SMFM Consult Series #47: Sepsis during pregnancy and the puerperium. Am J Obstetr Gynecol. 2019;220(4):2\u201310. https:\/\/doi.org\/10.1016\/j.ajog.2019.01.216","DOI":"10.1016\/j.ajog.2019.01.216"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Ribeiro-do-Valle CC, Bonet M, Brizuela V, et al. Aetiology and use of antibiotics in pregnancy-related infections: Results of the WHO Global Maternal Sepsis Study (GLOSS), 1-week inception cohort. Ann Clin Microbiol Antimicrob. 2024;23(1):21.","DOI":"10.1186\/s12941-024-00681-8"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Johnson A N, Buchmann E.J. Puerperal infection after caesarean section at Chris Hani Baragwanath Academic Hospital, Johannesburg. S Afr J Obstetr Gynaecol. 2012;18 (3):90\u201391. https:\/\/doi.org\/10.7196\/sajog.559","DOI":"10.7196\/sajog.559"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Moodley J, Onyangunga OA, Maharaj NR. Hypertensive disorders in primigravid Black South African women: A one-year descriptive analysis. Hyperten Pregnan. 2016;35(4):529\u2013535. https:\/\/doi.org\/10.1080\/10641955.2016.1193190","DOI":"10.1080\/10641955.2016.1193190"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Heitkamp A, Seinstra J, Van Den Akker T, et al. A district-wide population-based descriptive study of emergency peripartum hysterectomy in a middle-income country. Int J Gynecol Obstet. 2019;146(1):103\u2013109. https:\/\/doi.org\/10.1002\/ijgo.12837","DOI":"10.1002\/ijgo.12837"},{"key":"ref19","unstructured":"Boushra M, Rahman O. Postpartum infection [homepage on the Internet]. Treasure Island, FL: StatPearls Publishing; 2023 [cited 2024 Oct 05]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560804\/"},{"key":"ref20","unstructured":"Woldesenbet SA, Lombard C, Manda S, et al. The 2019 national antenatal sentinel HIV survey, South Africa. Johannesburg: National Department of Health and the National Institute for Communicable Diseases (NICD); 2021."}],"container-title":["Journal of the Colleges of Medicine of South Africa"],"original-title":[],"link":[{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/viewFile\/216\/713","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/viewFile\/216\/714","content-type":"application\/epub+zip","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/viewFile\/216\/715","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/viewFile\/216\/716","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/viewFile\/216\/716","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T04:17:28Z","timestamp":1758860248000},"score":1,"resource":{"primary":{"URL":"https:\/\/jcmsa.org.za\/index.php\/jcmsa\/article\/view\/216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,30]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,6]]}},"URL":"https:\/\/doi.org\/10.4102\/jcmsa.v3i1.216","relation":{},"ISSN":["2960-110X","3105-4331"],"issn-type":[{"type":"electronic","value":"2960-110X"},{"type":"print","value":"3105-4331"}],"subject":[],"published":{"date-parts":[[2025,8,30]]}}}