Postpartum cryptococcosis in an HIV-negative patient

PURPOSE AND METHODS

We present an unusual case of an HIV-negative patient with postpartum pulmonary cryptococcosis and cryptococcemia.

RESULTS

The diagnostic methods and treatment of cryptococcosis in a postpartum patient are presented in this case report. Due to anaphylaxis to liposomal amphotericin B, desensitisation to the drug was performed.

CONCLUSION

We would like to raise awareness about rare infections such as cryptococcosis in pregnancy and the postpartum period. In addition, we were able to document a successful desensitisation to liposomal amphotericin B.

Manual Placenta Removal is Associated with Increased Postpartum Prescriptions of Antibiotics: a Retrospective Cohort Study of Data from the Anti-Infection Tool

Purpose

No consensus exists whether to administer prophylactic antibiotics in conjunction with manual placenta removal. This study aimed to investigate the postpartum risk of a new prescription of antibiotic treatment, a possible indirect variable for infection, after manual placenta removal.

Methods

Obstetric data were merged with data from the Anti-Infection Tool (Swedish antibiotic registry). All vaginal deliveries (n = 13 877) at Helsingborg Hospital, Helsingborg, Sweden, from January 1st, 2014 until June 13th, 2019 were included. Diagnosis codes for infection can be lacking, while the Anti-Infection Tool is complete as it is unavoidable in the computerized prescription system. Logistic regression analyses were performed. The risk of a prescription of antibiotics 24 h to 7 days postpartum was analyzed in the entire study population, and in a subgroup of women not having received any antibiotics 48 h prior to delivery until 24 h after delivery, referred to as "antibiotic-naïve."

Results

Manual placenta removal was associated with an increased risk of an antibiotic prescription, adjusted (a) OR = 2.9 (95%CI 1.9-4.3). In the antibiotic-naïve subgroup, manual placenta removal was associated with an increased risk of antibiotic prescription, in general, aOR = 2.2 (95%CI 1.2-4.0), endometritis-specific antibiotics, aOR = 2.7 (95%CI 1.5-4.9), and intravenous antibiotics, aOR = 4.0 (95%CI 2.0-7.9).

Conclusion

Manual placenta removal is associated with an increased risk of antibiotic treatment postpartum. An antibiotic-naïve population might benefit from prophylactic antibiotics to reduce the risk of infection, and prospective studies are needed.

Patient volumes and pre- and postdischarge postpartum infection: A retrospective cohort study

BACKGROUND

To examine the association between hospital and clinician obstetric volume and postpartum infection risk in the pre- and postdischarge periods.

METHODS

We used data from the 2011 New York State Inpatient and Emergency Department Databases to fit generalized estimating equation models to examine the effect of hospital and clinician obstetric volume on infection before discharge and in the 30 days after discharge after delivery.

RESULTS

Higher clinician volume was associated with lower predischarge infection risk (odds ratio [OR] for first vs third quartile was 0.84; 95% confidence interval [CI], 0.77-0.98). There was an uncertain trend toward higher predischarge infection risk in higher volume hospitals (OR for first vs third quartile was 1.36; 95% CI, 0.79-2.34). We found no associations between patient volumes and postdischarge infections; however, power was insufficient to rule out small associations. The joint association of hospital and clinician volumes with postdischarge infection appeared submultiplicative (product term OR = 0.95; 95% CI, 0.92-0.98).

CONCLUSION

This study adds to the evidence that hospital obstetric volume is positively associated with predischarge postpartum infections, whereas clinician volume may be negatively associated with those predischarge infections. The associations between hospital obstetric volume and postdischarge infection appear to differ. These results underscore the importance of including postdischarge follow-up in hospital-based studies of postpartum infection.