As just one example, from a previous job: they were using SQL Alchemy in the code that interacted with the work queue, but somehow didn't realize that the DBAPI being implicitly transactional meant they'd need to manage transaction-state themselves. Consequently, they never released the implicitly opened transactions that every poll for new work created. No-one thought it was strange that the work queue system needed to be shut down weekly, so that a VACUUM FULL could reclaim the gibibytes of space that were wasted because the db couldn't clean up tuples (row version) that still appeared live to stale, abandoned transactions. Until I was all, "Uh, guys?"
The fix was obvious: disable implicit transactions. But that's just one example, if particularly egregious. I've seen and heard countless more.