Chorioamnionitis and maternal sepsis caused by AmpC β-lactamase-producing Escherichia coli infection: A case report

Ryuto Tsushima; Kaori Iino; Shuang Song; Norihiro Saito; Kanji Tanaka; Yoshihito Yokoyama

doi:10.1016/j.ijscr.2023.108781

Chorioamnionitis and maternal sepsis caused by AmpC β-lactamase-producing Escherichia coli infection: A case report

Int J Surg Case Rep. 2023 Oct:111:108781. doi: 10.1016/j.ijscr.2023.108781. Epub 2023 Sep 4.

Authors

Ryuto Tsushima¹, Kaori Iino², Shuang Song³, Norihiro Saito⁴, Kanji Tanaka¹, Yoshihito Yokoyama¹

Affiliations

¹ Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan.
² Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan. Electronic address: iino-ka@hirosaki-u.ac.jp.
³ Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, 5 Zaifu Hirosaki, Aomori 036-8562, Japan; Department of Obstetrics and Gynecology, Shengjing Hospital, China Medical University, Shenyang, China.
⁴ Department of Clinical Laboratory Medicine, Hirosaki University Hospital, Hirosaki, 53 Honcho, Hirosaki, Aomori 036-8563, Japan; Division of Infection Control and Prevention, Hirosaki University Hospital, Hirosaki, 53 Honcho, Hirosaki, Aomori 036-8563, Japan.

Abstract

Introduction: Multidrug resistant bacteria have increasingly become a concern regarding infection treatment. The clinical course of chorioamnionitis (CAM) caused by multidrug-resistant bacteria is not well understood.

Presentation of case: We report a case of CAM caused by AmpC-type β-lactamase (AmpC)-producing Escherichia coli (E. coli), a multidrug-resistant bacterium. A 35-year-old primipara was hospitalized with preterm membrane rupture at 36 weeks of gestation and was started on oral ampicillin. On the fourth day after admission, the patient was diagnosed with CAM owing to high fever development and uterine tenderness; therefore, an emergency cesarean section was performed. AmpC-producing E. coli were detected in blood and amniotic fluid cultures. Post-operation, the patient received treatment for septic shock and was discharged on the 15th post-operative day.

Discussion: The patient initially had no symptoms of infection but later experienced fever and uterine pain. She underwent an emergency cesarean section, and both mother and baby were successfully treated with broad-spectrum antibiotics. CAM associated with multidrug-resistant bacteria is more challenging to manage compared to infections in other parts of the body, as it occurs in unique environments such as the uterus, during pregnancy, and in the presence of compromised immunity.

Conclusion: The development of new diagnostic criteria and effective biomarkers is needed to improve early detection, and adherence to standard precautions can help prevent the acquisition of multidrug-resistant bacteria in healthcare settings.

Keywords: AmpC-producing bacteria; Case report; Chorioamnionitis; Multidrug resistant bacteria.

Publication types

Case Reports