A Retrospective Audit of Clinically Significant Maternal Bacteraemia in a Specialist Maternity Hospital from 2001 to 2014

Abstract

Maternal sepsis is a significant problem in obstetrics, with almost one in four maternal deaths related to severe sepsis. We carried out a retrospective review of clinically significant bacteraemia in obstetric patients attending Rotunda Hospital over 14 years. From 2001 to 2014, there were 252 clinically significant positive blood culture episodes in obstetric patients. There were 112,361 live births >500 g during the study period giving an overall rate of 2.24 clinically significant positive maternal blood culture episodes per 1000 live births >500 g. The median rate over the 14 years was 2.12 episodes per 1000 live births >500 g, with an interquartile range of 1.74–2.43 per 1000 live births >500 g. There was no discernable increasing or decreasing trend over the 14 years. E. coli was the most commonly isolated organism (n = 92/252, 37%), followed by group B Streptococcus (n = 64/252, 25%), Staphylococcus aureus (n = 28/252, 11%), and anaerobes (n = 11/252, 4%). These top four organisms represented three-quarters of all positive blood culture episodes (n = 195/252, 77.3%). Of note, there were only five cases of listeriosis, representing a rate of 4.4 cases per 100,000 live births >500 g. The rate of invasive group A streptococcal infection was also very low at 5.3 cases per 100,000 live births >500 g.

Maternal Disease With Group B Streptococcus and Serotype Distribution Worldwide: Systematic Review and Meta-analyses

“…Group B Streptococcus (GBS; Streptococcus agalactiae ), part of the normal flora in the intestine, vagina, and rectum, is likely an important pathogen in maternal sepsis because around 1 in 5 pregnant women are colonized worldwide [ 21 ], and in pregnancy there is increased risk of invasive GBS disease [ 11 , 22–25 ]. Indeed, GBS is frequently identified as a pathogen in maternal sepsis [ 9 , 10 , 14 , 19 , 26 ]; GBS accounted for 25% of clinically significant bacteremia in hospitalized pregnant women in Ireland [ 27 ] and 20% of hospitalized women with puerperal bacteremia in the United States [ 19 ]. Few publications, however, have specifically estimated the incidence of maternal GBS disease.…”

SMFM Consult Series #47: Sepsis during pregnancy and the puerperium

“…21 The most frequently isolated organisms in maternal sepsis are Escherichia coli and group A and group B Streptococcus, 9,20 although staphylococci, Gram-negative and anaerobic bacteria, and many other organisms have been reported. 18,22 Mixed infections are also possible; in 15% of maternal sepsis deaths in which organisms could be identified, the infection was polymicrobial. 23 This finding lends support to the recommendation to start empiric broad-spectrum antimicrobial therapy until a pathogen is identified.…”

Maternal Bacteremia Caused by Staphylococcus Aureus With a Focus on Infective Endocarditis

“…Maternal sepsis in the United States continues to be a common cause of mortality and morbidity, accounting for up to 15% of all maternal deaths and up to 5% of intensive care unit (ICU) admissions [ 1 ]. It is generally caused by Escherichia coli or other common sources of genitourinary infections [ 2 ]. Throughout the years, there has been an increase in published case reports on Staphylococcus aureus bacteremia and infective endocarditis (IE) in pregnant patients [ 3–5 ].…”

“…Recent increases in the incidence of people who inject drugs (PWID), even among pregnant patients, have led to subsequent infection-related complications such as hepatitis C, skin and soft tissue infections, IE, and death [ 7 ]. The incidence of bacteremia in the pregnant population has been found to be ~2 in 1000 live births [ 2 , 8 , 9 ]. The incidence of IE in pregnant women, although rare (1 in 100 000), can lead to devastating complications, including increased maternal and fetal morbidity and mortality [ 10 ].…”