Evolving microbiological epidemiology and high fetal mortality in 135 cases of bacteremia during pregnancy and postpartum

Surgers, Laure; Valin, Nadia; Carbonne, Bruno; Bingen, Édouard; Lalande, V.; Pacanowski, Jérôme; Meyohas, Marie-Caroline; Girard, Pierre‐Marie; Meynard, J.-L.

doi:10.1007/s10096-012-1724-5

Cited by 46 publications

(81 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This combination is associated with hospital mortality rates greater than 40%. 1 Sepsis in obstetrical cases can be directly pregnancyrelated or as a condition aggravated by normal pregnancy physiology, which ultimately have the potential to progress to severe sepsis and septic shock. The focus of sepsis can vary according to the stage of pregnancy and includes genital tract sepsis (which may extend from cervicitis and endometritis through to pelvic thrombophlebitis and peritonitis), urosepsis, surgical site infection, pneumonia, empyema and mastitis.…”

Section: Discussionmentioning

confidence: 99%

Descriptive audit of maternal sepsis in a tertiary care centre of North India

Kumari¹,

Suri²,

Mittal³

2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

INTRODUCTIONMaternal sepsis is a leading cause of preventable maternal morbidity and mortality in our country. Mostly, it is due to peripartum factors and the instigating organisms are usually from the polymicrobial flora of the genitourinary tract.1 However, non-obstetric infections that may get aggravated due to physiological alterations in pregnancy, also make a significant contribution to morbidity due to infectious etiologies in pregnancy.The majority of the cases of sepsis present within 24-48 hours of delivery, abortion, or rupture of membranes. 2The expeditious recognition of maternal sepsis and meticulous and appropriate management can prevent the progression to severe sepsis and septic shock. ABSTRACTBackground: Maternal sepsis is one of the leading causes of maternal mortality around the world. The aim of this study was to study the prevalence, clinical profile and fetomaternal outcome of maternal sepsis at a dedicated Obstetric critical care unit of a tertiary care centre of North India. It was retrospective study conducted in tertiary care centre in North India Methods: Women diagnosed as sepsis or septic shock at any point in pregnancy and up to 6 weeks postpartum (irrespective of the source of infection) were included in the study. Demographic, clinical, microbiological and outcome data were recorded from the case sheets of all patients admitted in obstetrical critical care unit between January to December 2016. Outcome measures: Prevalence, bacterial organism, source of infection, mode of delivery, period of gestation, maternal and fetal outcome. Results: The prevalence of maternal sepsis was 16.5/10,000 live births. The number of maternal deaths attributable to sepsis were 35, making the maternal mortality ratio due to sepsis 128/100,000 live births. 87% of the cases were unbooked. 22% presented antenatally while 58% were postpartum and 20% were postabortal. Genital tract infection was most common source of infection. E. coli was the predominant organism in 28% followed by Methicillin resistant staphylococcus aureus in 12%. The mortality from sepsis was very high (78%). 54% of cases required mechanical ventilation and around 7% had to be shifted to intensive care unit for advanced life support and care. Sepsis was associated with preterm delivery and a high perinatal mortality rate. Conclusions: Early recognition of the severity of infection and prompt management by a multidisciplinary team of intensivists, anesthetists, neonatologists, obstetrician, midwives are the key to success. Vigilant infection control measures must be strictly practiced during all pregnancy events.

show abstract

Section: Discussionmentioning

confidence: 99%

Descriptive audit of maternal sepsis in a tertiary care centre of North India

Kumari¹,

Suri²,

Mittal³

2017

Int J Reprod Contracept Obstet Gynecol

View full text Add to dashboard Cite

show abstract

“…8 The incidence of maternal sepsis is reported to be 0.1-0.3%. [9][10][11][12] Sepsis has significantly reduced since the 1970s, when the incidence of obstetric bacteraemia was reported to be 0.7-0.75%. 13,14 The most common source of bacteraemia during pregnancy is chorioamnionitis or genital tract infection.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 The most common source of bacteraemia during pregnancy is chorioamnionitis or genital tract infection. 9 Bacteraemia during pregnancy is associated with a 10-28% fetal mortality 9,11,15 and preterm delivery is associated with a 2.4-2.7-fold risk for sepsis, compared with term delivery. [9][10][11] The most frequent organisms isolated include Escherichia coli, Group B Streptococcus, Staphylococcus aureus, anaerobic bacteria and Listeria monocytogenes.…”

Section: Introductionmentioning

confidence: 99%

Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study

Knowles

O’Sullivan

Meenan

et al. 2014

BJOG: Int J Obstet Gy

156

142

View full text Add to dashboard Cite

Objective To determine the incidence of maternal bacteraemia during pregnancy and for 6 weeks postpartum, describe the gestation/stage at which sepsis occurs, the causative microorganisms, antibiotic resistance and review maternal, fetal and neonatal outcome. Design Prospective review.Setting Two tertiary referral, maternity hospitals in Dublin, Ireland.Population During 2005-2012 inclusive, 150 043 pregnant women attended and 24.4% of infants born in Ireland were delivered at the hospitals.Methods Demographic, clinical, microbiological and outcome data was collected from women with sepsis and compared with controls.Main outcome measures Incidence, bacterial aetiology, gestation/ stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome.Results The sepsis rate was 1.81 per 1000 pregnant women. Escherichia coli was the predominant pathogen, followed by Group B Streptococcus. Sepsis was more frequent among nulliparous women (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07-1.79) and multiple births (OR 2.04; 95% CI 0.98-4.08). Seventeen percent of sepsis episodes occurred antenatally, 36% intrapartum and 47% postpartum. The source of infection was the genital tract in 61% (95% CI 55.1-66.6) of patients and the urinary tract in 25% (95% CI 20.2-30.5). Sepsis was associated with preterm delivery (OR 2.81; 95% CI 1.99-3.96) and a high perinatal mortality rate (OR =5.78; 95% CI 2.89-11.21). Almost 14% of women required admission to augmented care. The most virulent organisms were Group A Streptococcus linked to postpartum sepsis at term and preterm Escherichia coli sepsis.Conclusions Maternal sepsis is associated with preterm birth, a high perinatal mortality rate and nulliparous women.

show abstract

“…otitis media [215], congenital pneumonia [216,217], admission to the neonatal intensive care unit [202,218], respiratory distress syndrome or chronic lung disease [218–220], congenital sepsis [19,218,219,221], cerebral palsy [112–114,117,118, 222–230] and necrotizing enterocolitis [147,163,231]). Moreover, intra-amniotic infection is associated with clinical chorioamnionitis [217,231–233] and puerperal endometritis [234], and may be complicated by maternal sepsis [235,236] and disseminated intravascular coagulation [237,238]. …”

Section: Discussionmentioning

confidence: 99%

The diagnostic performance of the Mass Restricted (MR) score in the identification of microbial invasion of the amniotic cavity or intra-amniotic inflammation is not superior to amniotic fluid interleukin-6

Romero

Kadar

Miranda

et al. 2013

The Journal of Maternal-Fetal & Neonatal Medicine

View full text Add to dashboard Cite

Objective Intra-amniotic infection/inflammation are major causes of spontaneous preterm labor and delivery. However, diagnosis of intra-amniotic infection is challenging because most are subclinical and amniotic fluid (AF) cultures take several days before results are available. Several tests have been proposed for the rapid diagnosis of microbial invasion of the amniotic cavity (MIAC) or intra-amniotic inflammation. The aim of this study was to examine the diagnostic performance of the AF Mass Restricted (MR) score in comparison with interleukin-6 (IL-6) and matrix metalloproteinase-8 (MMP-8) for the identification of MIAC or inflammation. Methods AF samples were collected from patients with singleton gestations and symptoms of preterm labor (n = 100). Intra-amniotic inflammation was defined as >100 white blood cells/mm3 (WBCs) in AF; MIAC was defined as a positive AF culture. AF IL-6 and MMP-8 were determined using ELISA. The MR score was obtained using the Surface-Enhanced Laser Desorption Ionization Time of Flight (SELDI-TOF) mass spectrometry. Sensitivity and specificity were calculated and logistic regression models were fit to construct receiver-operating characteristic (ROC) curves for the identification of each outcome. The McNemar’s test and paired sample non-parametric statistical techniques were used to test for differences in diagnostic performance metrics. Results (1) The prevalence of MIAC and intra-amniotic inflammation was 34% (34/100) and 40% (40/100), respectively; (2) there were no significant differences in sensitivity of the three tests under study (MR score, IL-6 or MMP-8) in the identification of either MIAC or intra-amniotic inflammation (using the following cutoffs: MR score >2, IL-6 >11.4 ng/mL, and MMP-8 >23 ng/mL); (3) there was no significant difference in the sensitivity among the three tests for the same outcomes when the false positive rate was fixed at 15%; (4) the specificity for IL-6 was not significantly different from that of the MR score in identifying either MIAC or intra-amniotic inflammation when using previously reported thresholds; and (5) there were no significant differences in the area under the ROC curve when comparing the MR score, IL-6 or MMP-8 in the identification of these outcomes. Conclusions IL-6 and the MR score have equivalent diagnostic performance in the identification of MIAC or intra-amniotic inflammation. Selection from among these three tests (MR score, IL-6 and MMP-8) for diagnostic purposes should be based on factors such as availability, reproducibility, and cost. The MR score requires a protein chip and a SELDI-TOF instrument which are not widely available or considered “state of the art”. In contrast, immunoassays for IL-6 can be performed in the majority of clinical laboratories.

show abstract

Evolving microbiological epidemiology and high fetal mortality in 135 cases of bacteremia during pregnancy and postpartum

Cited by 46 publications

References 22 publications

Descriptive audit of maternal sepsis in a tertiary care centre of North India

Descriptive audit of maternal sepsis in a tertiary care centre of North India

Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study

The diagnostic performance of the Mass Restricted (MR) score in the identification of microbial invasion of the amniotic cavity or intra-amniotic inflammation is not superior to amniotic fluid interleukin-6

Contact Info

Product

Resources

About