Postpartum Endometritis and Sepsis Associated with Gardnerella vaginalis and Anaerococcus tetradius: Case Report and Literature Review

<b>Background and Clinical Significance:</b><i>Anaerococcus tetradius</i> (<i>A. tetradius</i>) and <i>Gardnerella vaginalis</i> (<i>G. vaginalis</i>) are rare etiological factors for postpartum endometritis and are typically associated with bacterial vaginosis. However, in some cases, <i>G. vaginalis</i> and <i>A. tetradius</i> can cause serious postpartum endometritis with complications such as sepsis. <b>Case Presentation:</b> 26-year-old pregnant woman expecting monochorionic diamniotic twins presented to the hospital at 35 weeks and 3 days of gestation and two male infants were delivered via the Cesarean section. On the fifth day after delivery, the patient began to complain of intense abdominal pain, a fever of 37.9 °C, and overall weakness. Blood tests revealed neutrophilic leukocytosis, increased C-reactive protein (CRP) of 225.4 mg/L. Upon examination, abdominal distension, tenderness on palpation, and positive symptoms of peritoneal irritation were present and the site of the abdominal incision was inflamed with flowing foul-smelling greenish pus. Ultrasound examination revealed free fluid collection in the peritoneal cavity, under the liver, and around the uterus. Later, the condition of the patient worsened with progressing hypotension and respiratory distress. As a result, suppurative peritonitis and sepsis was suspected and the patient underwent urgent total hysterectomy without oophorectomy. Acute endometritis, focal myometritis, and chronic cervicitis were concluded from histopathological examination of the removed uterus. Microbiological tests showed the most abundant growth of <i>A. tetradius</i> in the wound cultures and great abundance of <i>G. vaginalis</i> in the abdominal cavity cultures. After trying three different treatment schemes and difficulties with determining the antibiotic sensitivity tests for pathogens, the antibacterial therapy was escalated to Meropenem, which was found to be effective, and the patient was discharged home. <b>Conclusions:</b> This case report highlights the severity of complications of postpartum endometritis that can be caused by rare pathogens (such as <i>G. vaginalis</i> and <i>A. tetradius</i>), and strategies for how to manage it. The clinical presentation of a patient should be monitored closely for several days after Cesarean section and if endometritis is suspected, microbiological cultures are necessary to determine the cause of infection and implement an appropriate treatment.