title: Diagnostic methods to determine microbiology of postpartum endometritis in South Asia: laboratory methods protocol used in the Postpartum Sepsis Study: a prospective cohort study.
abstract: BACKGROUND
  The South Asian region has the second highest risk of maternal death in the world. To prevent maternal deaths due to sepsis and to decrease the maternal mortality ratio as per the World Health Organization Millenium Development Goals, a better understanding of the etiology of endometritis and related sepsis is required. We describe microbiological laboratory methods used in the maternal Postpartum Sepsis Study, which was conducted in Bangladesh and Pakistan, two populous countries in South Asia.
  
  
  METHODS
  Postpartum maternal fever in the community was evaluated by a physician and blood and urine were collected for routine analysis and culture. If endometritis was suspected, an endometrial brush sample was collected in the hospital for aerobic and anaerobic culture and molecular detection of bacterial etiologic agents (previously identified and/or plausible).
  
  
  CONCLUSIONS
  The results emanating from this study will provide microbiologic evidence of the etiology and susceptibility pattern of agents recovered from patients with postpartum fever in South Asia, data critical for the development of evidence-based algorithms for management of postpartum fever in the region.
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. sadia.shakoor@aku.edu.|Department of Pathology and Laboratory Medicine, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. sadia.shakoor@aku.edu.
authors.forename: Sadia
authors.initials: S
authors.lastname: Shakoor
authors.affiliation: Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, 615 N. Wolfe Street, Baltimore, MD, USA. mreller1@jhmi.edu.
authors.forename: Megan E
authors.initials: ME
authors.lastname: Reller
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA. alefevre@jhsph.edu.
authors.forename: Amnesty
authors.initials: A
authors.lastname: LeFevre
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. aneeta.hotwani@aku.edu.
authors.forename: Aneeta
authors.initials: A
authors.lastname: Hotwani
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. shahida.qureshi@aku.edu.
authors.forename: Shahida M
authors.initials: SM
authors.lastname: Qureshi
authors.affiliation: Department of Obstetrics and Gynecology, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. farheen.yousuf@aku.edu.
authors.forename: Farheen
authors.initials: F
authors.lastname: Yousuf
authors.affiliation: The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh. msohag10@yahoo.com.
authors.forename: Mohammad Shahidul
authors.initials: MS
authors.lastname: Islam
authors.affiliation: The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh. connorne@icddrb.org.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Connor
authors.affiliation: The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh. iftekharrafiqullah@gmail.com.
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Rafiqullah
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. fatima.mir@aku.edu.
authors.forename: Fatima
authors.initials: F
authors.lastname: Mir
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. shabina.ariff@aku.edu.
authors.forename: Shabina
authors.initials: S
authors.lastname: Arif
authors.affiliation: Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. sajid.soofi@aku.edu.
authors.forename: Sajid
authors.initials: S
authors.lastname: Soofi
authors.affiliation: Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA. linda.bartlett@jhu.edu.
authors.forename: Linda A
authors.initials: LA
authors.lastname: Bartlett
authors.affiliation: The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh. samirk.sks@gmail.com.
authors.forename: Samir
authors.initials: S
authors.lastname: Saha
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D058345:Asymptomatic Infections; D001437:Bacteriuria / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000652:urine; D001459:Bangladesh; D015331:Cohort Studies; D003150:Community Health Workers; D065246:Culturally Competent Care / Q000208:ethnology; D003906:Developing Countries; D052978:Disk Diffusion Antimicrobial Tests; D004716:Endometritis / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology / Q000652:urine; D004717:Endometrium / Q000382:microbiology; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D006094:Gram-Positive Bacteria / Q000145:classification / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D006792:House Calls; D006801:Humans; D058889:Molecular Typing; D010154:Pakistan; D049590:Postpartum Period; D011446:Prospective Studies; D011645:Puerperal Infection / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology / Q000652:urine; D060737:Reproductive Tract Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology / Q000652:urine; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000382:microbiology / Q000652:urine
chemical_list: D000900:Anti-Bacterial Agents