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Cited by 7Urinary Tract Infections ManagementMaternal and Perinatal Health InterventionsOcular Infections and Treatments

Multidrug-Resistant Escherichia coli Resulting in Postpartum Necrotizing Endomyometritis

Open access
Tymon-Rosario, Joan, Chuang, Meleen·2019·Case Reports in Obstetrics and Gynecology
DOI 10.1155/2019/6715974PMC PMC6500617
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Abstract

Background. Postpartum endometritis is a fairly common postoperative complication occurring in up to 11 percent of all cesarean deliveries. Multidrug-resistant pathogenic organism is increasingly a factor in postoperative source of infection. Postpartum endomyometritis from a multidrug-resistant Escherichia coli infection resulting in uterine is one such rare clinical circumstance where there is minimal information in the literature to guide its treatment and management. Case. A 29-year-old G1P0 who underwent a primary cesarean delivery for a failed induction of labor developed endomyometritis on post-op day one and was treated with multiple broad-spectrum antibiotic regimens. The source of infection was found to be multidrug-resistant Escherichia coli with uterine involvement and pelvic abscesses, requiring hysterectomy and drainage of pelvic abscesses. Severe uterine necrosis from this multidrug-resistant Escherichia coli infection was noted intraoperatively. After three weeks of antibiotic therapy, she had resolution of her infection. Conclusion. Multidrug-resistant Escherichia coli is a highly pathogenic organism that can cause endomyometritis, persistent bacteremia, and uterine necrosis, which necessitates definitive surgical management with hysterectomy to achieve resolution of the infection.

AI snapshot

Written from the paper’s full text.

TL;DR

A 29-year-old G1P0 developed multidrug-resistant *Escherichia coli* endomyometritis after primary cesarean delivery, with persistent bacteremia, pelvic abscesses, and uterine necrosis requiring hysterectomy and drainage. She recovered after surgical management and antibiotic therapy.

Key findings

  • Postpartum day one: fever 38.8°C, hypotension 80–95/40–55, tachycardia 120–140; blood and urine cultures grew *Escherichia coli*, later found to be multidrug-resistant.
  • Imaging showed a 2.6 × 2.5 cm hysterotomy defect with fluid, then a new 3.3 × 0.9 cm abscess along the anterior uterus/rectouterine space; intraoperatively there was purulent ascites and a severely necrotic uterus.
  • She underwent exploratory laparotomy, abdominal washout, total abdominal hysterectomy, bilateral salpingectomy, and Jackson Pratt drain placement on postoperative day nine; surgical cultures grew primarily *Escherichia coli* and *Enterococcus faecalis*.
  • After hysterectomy, bacteremia resolved but fevers continued through postoperative day five; two pelvic abscesses were ultrasound-guided drained, and she was discharged on postoperative day eleven on Bactrim and Augmentin for one week, with complete healing at six weeks.

Methods

  • Single case report of a healthy 29-year-old G1P0 at 39w5d admitted for labor induction, who underwent primary cesarean delivery for Category II fetal heart rate tracing and arrest of dilation at 5 cm.
  • Clinical course described with vital signs, laboratory studies, blood/urine cultures, transabdominal ultrasound, CT abdomen/pelvis, infectious disease consultation, antibiotic regimens, and surgical findings.
  • No formal comparative analysis; management was individualized and included broad-spectrum antibiotics, hysterectomy, and drainage of pelvic abscesses.

Limitations

  • The authors state this is a single case report of a personalized treatment plan, which limits application of the findings to other patients.
  • Evident from the text: no control or comparison group, and outcomes are limited to this patient’s hospital course and six-week postoperative visit.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1155/2019/6715974

Cites

9 of 9 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 9 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Severe uterine necrosis from the MDR Escherichia coli infection was noted intraoperatively.

    “Severe uterine necrosis from this multidrug-resistant Escherichia coli infection was noted intraoperatively.”
    Quote in the paperSubstantial claim
  • Findingown data

    The Escherichia coli isolate was multidrug-resistant.

    “Sensitivities of the organism demonstrated a multidrug resistant (MDR) Escherichia coli”
    Quote in the paperSubstantial claim
  • Findingown data

    The patient was diagnosed with sepsis from endomyometritis on postoperative day one.

    “On postoperative day one, the patient was febrile (38.8°C), hypotensive (80-95/40-55), and tachycardic (120-140). The patient was diagnosed with sepsis from endomyometritis”
    Quote in the paperNot a substantial claim
  • Findingown data

    After three weeks of antibiotic therapy, the patient had resolution of her infection.

    “After three weeks of antibiotic therapy, she had resolution of her infection.”
    Quote in the paperNot a substantial claim
  • Interpretationown data

    MDR Escherichia coli can cause endomyometritis.

    “Multidrug-resistant Escherichia coli is a highly pathogenic organism that can cause endomyometritis, persistent bacteremia, and uterine necrosis”
    • Also stated in: § 3. Discussion · plain
      “This case shows how MDR Escherichia coli can cause severe postcesarean infections and necrotizing endomyometritis.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 8
  • May combine two claims. 6

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    MDR Escherichia coli infection is usually associated with urinary tract related infections and bacteremia.

    “MDR Escherichia coli infection is usually associated with urinary tract related infections and bacteremia [6–9].”
    Quote in the paperNot a substantial claim1 of 4 sources checked
    • cites [6] 2013, Emerging Infectious Diseases

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [7] source

      The Introduction identifies uropathogenic E. coli as a major cause of urinary tract infections and says extraintestinal pathogenic strains can colonize the blood. It does not establish that multidrug-resistant E. coli infections are usually associated with urinary tract infections and bacteremia; the resistance qualifier and usual association with bacteremia are unsupported. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [8] 2010, Journal of Medical Microbiology source
    • cites [9] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The patient underwent a primary cesarean delivery for Category II fetal heart rate tracing and arrest of dilation at 5 centimeters, and the cesarean delivery was performed without complication.

    “She underwent a primary cesarean delivery for Category II fetal heart rate tracing and arrest of dilation at 5 centimeters. The cesarean delivery was performed without complication.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient required hysterectomy and drainage of pelvic abscesses.

    “requiring hysterectomy and drainage of pelvic abscesses”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The patient had no significant past medical or surgical history except baseline anemia during pregnancy.

    “She has no past medical (significant for baseline anemia (hemoglobin of 9.0) during pregnancy) or surgical history.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The patient's infection involved the uterus and pelvic abscesses.

    “The source of infection was found to be multidrug-resistant Escherichia coli with uterine involvement and pelvic abscesses”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Blood and urine cultures were positive for Escherichia coli.

    “The urine culture and blood cultures were positive for Escherichia coli.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The patient had no risk factors for severe infection: she was nondiabetic, nonobese, nonsmoker, not immunocompromised, and underwent uncomplicated cesarean delivery that did not require uterine artery embolization or a compression suture.

    “She was without any prior medical problems (nondiabetic, nonobese, nonsmoker, and not immunocompromised) and underwent uncomplicated cesarean delivery that did not require uterine artery embolization or a compression suture.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Group A or B beta-hemolytic Streptococcus organisms cause postpartum necrotizing myometritis.

    “There are several established reports of group A or B beta-hemolytic Streptococcus organisms causing postpartum necrotizing myometritis [3–5].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [3] 2003, The Journal of Reproductive Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] source
    • cites [5] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Uterine necrosis has been reported after placement of B-Lynch compression suture, uterine artery embolization, or surgical ligation techniques during management of postpartum hemorrhage.

    “The reports in literature are of uterine necrosis after placement of B-Lynch compression suture, uterine artery arterial embolization, or surgical ligation techniques during management of postpartum hemorrhage.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Rivlin et al. described uterine necrosis after cesarean delivery from group B beta-hemolytic Streptococcus.

    “Rivlin et al. described uterine necrosis after cesarean delivery from group B beta-hemolytic Streptococcus [3].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] 2003, The Journal of Reproductive Medicine

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    These procedures may be risk factors for infection because the tissue is devascularized.

    “These procedures may be risk factors for infection as the tissue is devascularized.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    This is a single case report of a personalized treatment plan, which limits the application of the findings to other patients.

    “We acknowledge this is a single case report of a personalized treatment plan, which limits the application of our findings to other patients.”
    Quote in the paperSubstantial claim
12 of 12

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. 2016, ournal of Clinical and Diagnostic Research, 10
  2. 2003, The Journal of Reproductive Medicine, 48, 687
  3. 2013, Emerging Infectious Diseases, 19, 1699

Cited by

Sorted by citations

Related

Authors
Tymon-Rosario, J., & Chuang, M.
Affiliations
  • Montefiore Medical Center, Department of Obstetrics & Gynecology and Women’s Health, Bronx, NY, USA
  • Albert Einstein College of Medicine (US)
Corresponding author
Chuang, Meleen
ORCID
Chuang, Meleen
Venue
Case Reports in Obstetrics and Gynecology
Publisher
Wiley
Published
2019-04-17
Volume
2019
Pages
1-3
ISSN
  • 2090-6684 (ISSN-L)
  • 2090-6692
DOI
10.1155/2019/6715974
PMC
PMC6500617
OpenAlex
W2938621416
Semantic Scholar
45cdb7b3dd42776a063328a0dc41f1345cc5c393
Cited by
6
References
9
Citations by year
2024: 1 · 2023: 2 · 2021: 2 · 2020: 1
FWCI
0.50
Type
journal article
Language
en
Open access
Licence
Locations
  • Case Reports in Obstetrics and Gynecology (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by)
  • PubMed Central (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Urinary Tract Infections Management
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Ophthalmology › Ocular Infections and Treatments
Keywords
multidrug-resistant Escherichia coli, cesarean section, pelvic abscess, hysterectomy, persistent bacteremia, failed induction of labor, postoperative infection, antibiotic resistance

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-18.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-18.

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Statistics and arithmetic are recomputed, not judged.

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