Background There is a high prevalence of infections and sepsis in pregnancy in Malawi, with evidence of a rising incidence of antimicrobial resistance. Lack of resources to inform the organism-specific therapy of maternal infections results in a significant proportion of maternal deaths being due to infections and sepsis. Through the implementation of a microbiology services for obstetrics patients, we aimed to describe the epidemiology and antimicrobial resistance profile of maternal infections in a tertiary hospital in Blantyre, Malawi, and investigate the impact of maternal infections surveillance platform on pregnancy outcomes.

Methods Data on pregnant women from a maternal infections surveillance project serving a tertiary hospital in Blantyre, Malawi from 1 February 2021 to 30 March 2023 was used for the analysis. Descriptive statistics were used to describe the prevalence of infection and antimicrobial resistance. The association between infection from different samples and adverse delivery outcomes (a composite created through theory-driven grouping of a priori defined variables) was tested using multivariate logistics regression.

Results Preliminary analysis on urine sample data for 347 patients shows the prevalence of infections in urine in this population was 41.2% (95% CI of 36.0% to 46.4%), with up to two-thirds (57.3%) of the patients being on at least one empirical antibiotic on admission. 29.2% of the cultures grew Escherichia coli, and 8.2% grew Klebsiella pneumoniae. There were high levels of antimicrobial resistance demonstrated by the commonest isolates, especially Pseudomonas aeruginosa. Infection in urine was associated with adverse delivery outcomes 1.95 (95% CI 1.24 to 3.10, p=0.004). Having a culture result significantly informed the choice of antibiotic prescribed to a patient.

Conclusion These results suggest that having an infection in urine is associated with a greater prevalence of adverse delivery outcomes. Additional studies of a prospective nature are required to rigorously investigate this association.