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Despite oxacillin therapy, Barbara’s condition continued to worsen over the next several days. Her fever increased to 40.1 °C (104.2 °F) and she began to experience chills, rapid breathing, and confusion. Her doctor suspected bacteremia by a drug-resistant bacterium and admitted Barbara to the hospital. Cultures of the surgical site and blood revealed Staphylococcus aureus . Antibiotic susceptibility testing confirmed that the isolate was methicillin-resistant S. aureus (MRSA). In response, Barbara’s doctor changed her antibiotic therapy to vancomycin and arranged to have the port and venous catheter removed.
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A type of sepsis called puerperal sepsis , also known as puerperal infection, puerperal fever , or childbed fever, is a nosocomial infection associated with the period of puerperium—the time following childbirth during which the mother’s reproductive system returns to a nonpregnant state. Such infections may originate in the genital tract, breast, urinary tract, or a surgical wound. Initially the infection may be limited to the uterus or other local site of infection, but it can quickly spread, resulting in peritonitis, septicemia, and death. Before the 19th century work of Ignaz Semmelweis and the widespread acceptance of germ theory (see Modern Foundations of Cell Theory ), puerperal sepsis was a major cause of mortality among new mothers in the first few days following childbirth.
Puerperal sepsis is often associated with Streptococcus pyogenes , but numerous other bacteria can also be responsible. Examples include gram-positive bacterial (e.g. Streptococcus spp., Staphylococcus spp., and Enterococcus spp.), gram-negative bacteria (e.g. Chlamydia spp., Escherichia coli , Klebsiella spp., and Proteus spp.), as well as anaerobes such as Peptostreptococcus spp., Bacteroides spp., and Clostridium spp. In cases caused by S. pyogenes , the bacteria attach to host tissues using M protein and produce a carbohydrate capsule to avoid phagocytosis. S. pyogenes also produces a variety of exotoxin s, like streptococcal pyrogenic exotoxin s A and B, that are associated with virulence and may function as superantigen s.
Diagnosis of puerperal fever is based on the timing and extent of fever and isolation, and identification of the etiologic agent in blood, wound, or urine specimens. Because there are numerous possible causes, antimicrobial susceptibility testing must be used to determine the best antibiotic for treatment. Nosocomial incidence of puerperal fever can be greatly reduced through the use of antiseptics during delivery and strict adherence to handwashing protocols by doctors, midwives, and nurses.
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