Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study

Abstract

Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks’ gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80–6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.

Evaluation of microbiological epidemiology and clinical characteristics of maternal bloodstream infection: a 10 years retrospective study

“…This may explain the persistence of S. agalactiae-associated maternal infection even with a large initiation of screening for S. agalactiae. Consistent with previous studies (Surgers et al, 2013;Zou et al, 2021;Ornaghi et al, 2022), E. coli was the predominant pathogen of maternal BSI. However, in studies conducted in African countries, Salmonella typhi and Streptococcus pneumoniae were the dominant pathogens in Malawi (Musicha et al, 2017), and Staphylococcus aureus and K. pneumoniae were the major pathogens in Rwanda (Habyarimana et al, 2021).…”

Epidemiology, antimicrobial resistance profile and management of Carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

“…The ndings revealed that women with speci c clinical outcomes, such as indwelling catheters, alcoholism, repeated abortions, ICU admission, cesarean delivery, a history of not using antimicrobial agents within eight weeks, and recurrent UTIs, were at greater risk of developing sepsis. These ndings are similar to those of studies on the risk factors associated with sepsis, which exacerbates severe morbidity and mortality at community and health facilities (Table 2); these ndings have also been reported by many researchers [7,8,18,19,25,28,33,32,42]. The occurrence of risk factors associated with maternal factors (host factors) [1,27,34,43] and bacterial factors [8,29] leads to the widespread spread of highly virulent strains [18, 20, 21, 28] and antimicrobial resistance, which includes strains that are pandrug resistance [8,11,26].…”

“…7.7%[35], and Beyene et al 8.8%[46]. The percentage obtained in this study is slightly lower than that reported by Tsegaye et al43.3%[34]; similarly, the prevalence of PDR K. pneumoniae was 28.1%, which is higher than that reported in studies performed by Beyene et al 0.8%[46], Awoke et al 1.5%[37] and Tsegaye et al 1.8%[34].…”

“…Similarly, this could be vertical or horizontal genome transfer [17,20,21,28]. We are actively working toward addressing the challenge of multidrugresistant strains, including K. pneumoniae, which pose a signi cant obstacle to achieving our goal of reducing maternal and newborn morbidity and mortality rates in a sustainable manner [7,18,19,27]. In the present study, the prevalence of extensively drug-resistant K. pneumoniae was 28.1%, which is higher than the rates reported in studies by Abera et al 4.3 Carbapenem-resistant, carbapenemase-/ESBL-producing K. pneumoniae…”

“…On the other hand, mothers can also contract sepsis through bacterial contamination at health facilities. Up to 50% of sepsis survivors may experience lasting disabilities, including myopathy, neuropathy, chronic pelvic pain, infertility, and psychological distress [7,8].…”