Outcomes associated with antibiotic administration for isolated maternal fever in labor

Bank, Tracy Caroline; Nuss, Emily; Subedi, Keshab; Hoffman, Matthew; Sciscione, Anthony

doi:10.1016/j.ajog.2021.07.020

Cited by 10 publications

(3 citation statements)

References 19 publications

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“…The impact of an isolated maternal fever is described by the ACOG Committee Opinion [ 13 ] as the maternal temperature between 38.0 and 38.9 °C with no additional risk factors present is still under debate. A recent publication by Bank et al [ 14 ], reported a lower rate of treatment of endometritis among women who were treated with antibiotics for this indication. However, they noticed a lower 5-min Apgar score in comparison to women with isolated intrapartum fever who were not treated.…”

Section: Discussionmentioning

confidence: 99%

Intrapartum fever complicated with maternal bacteremia: prevalence, bacteriology, and risk factors

Attali,

Kern,

Warshaviak

et al. 2024

Arch Gynecol Obstet

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Purpose To assess the prevalence, microbial profile, and clinical risk factors of maternal bacteremia associated with intrapartum fever (IPF). Methods A retrospective cohort study, in a single tertiary university-affiliated medical center between 2012 and 2018. Demographic and labor characteristics of women, who delivered at term (37+0/7–41+6/7) and developed bacteremia following IPF were compared to a control group of women with IPF but without bacteremia. Results During the study period there were 86,590 deliveries in our center. Of them, 2074 women (2.4%) were diagnosed with IPF, of them, for 2052 women (98.93%) the blood maternal cultures were available. In 26 patients (1.25%) maternal bacteremia was diagnosed. A lower rate of epidural anesthesia (84.6% vs 95.9%, p = 0.02) and a higher rate of antibiotics prophylaxis treatment prior to the onset of fever (30.8%.vs 12.1%, p = 0.006) were observed in patients who developed maternal bacteremia in comparison to those who have not. Maternal hyperpyrexia developed after initiation of antibiotics or without epidural anesthesia remained significantly associated with maternal bacteremia after applying a multivariate analysis, (Odds Ratio 3.14 95% CI 1.27–7.14, p = 0.009; 4.76 95% CI 1.35–12.5, p = 0.006; respectively). Conclusion Maternal fever developing after initiation of antibiotics or without epidural is associated with maternal bacteremia.

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Section: Discussionmentioning

confidence: 99%

Intrapartum fever complicated with maternal bacteremia: prevalence, bacteriology, and risk factors

Attali,

Kern,

Warshaviak

et al. 2024

Arch Gynecol Obstet

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“…Although the American College of Obstetricians and Gynecologists made a distinction in 2017 between intra-amniotic infection-chorioamnionitis and fever higher than 38°C in labor without other clinical risk factors, they recommended that both be treated with antibiotics. 12,13 Several follow-up studies comparing these two diagnostic criteria found similar maternal and neonatal risks of serious infection complications. 14 Among the 59 facilities in this study, there were no standard criteria for chorioamnionitis, and diagnosis was left to the clinical judgment of the clinician.…”

Section: Methodsmentioning

confidence: 99%

Performance Characteristics of Sepsis Screening Tools During Delivery Admissions

Main,

Fuller,

Kovacheva

et al. 2023

Obstetrics &Amp; Gynecology

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OBJECTIVE: To evaluate the screening performance characteristics of existing tools for the diagnosis of sepsis during delivery admissions. METHODS: This was a case–control study using electronic health record data, including vital signs and laboratory results, for all delivery admissions of patients with sepsis from 59 nationally distributed hospitals. Patients with sepsis were matched by gestational age at delivery in a 1:4 ratio with patients without sepsis to create a comparison group. Patients with chorioamnionitis and sepsis were compared with a complete cohort of patients with chorioamnionitis without sepsis. Multiple screening criteria for sepsis were evaluated: the CMQCC (California Maternal Quality Care Collaborative), SIRS (Systemic Inflammatory Response Syndrome), the MEWC (the Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System), and the MEWT (Maternal Early Warning Trigger Tool). Sensitivity, false-positive rates, and C-statistics were reported for each screening tool. Analyses were stratified into cohort 1, which excluded patients with chorioamnionitis–endometritis, and cohort 2, which included those patients. RESULTS: Delivery admissions at 59 hospitals were extracted for patients with sepsis. Cohort 1 comprised 647 patients with sepsis, including 228 with end-organ injury, matched with a control group of 2,588 patients without sepsis. Cohort 2 comprised 14,591 patients with chorioamnionitis–endometritis, of whom 1,049 had sepsis and 238 had end-organ injury. In cohort 1, the CMQCC and the UKOSS pregnancy-adjusted criteria had the lowest false-positive rates (6.9% and 9.6%, respectively) and the highest C-statistics (0.92 and 0.91, respectively). Although other screening criteria, such as SIRS and the MEWC, had similar sensitivities, it was at the cost of much higher false-positive rates (21.3% and 38.3%, respectively). In cohort 2, including all patients with chorioamnionitis–endometritis, the highest C-statistics were again for the CMQCC (0.67) and UKOSS (0.64). All screening tools had high false-positive rates, but the false-positive rates for the CMQCC and UKOSS were substantially lower than those for SIRS and the MEWC. CONCLUSION: During delivery admissions, the CMQCC and UKOSS pregnancy-adjusted screening criteria have the lowest false-positive results while maintaining greater than 90% sensitivity rates. Performance of all screening tools was degraded in the setting of chorioamnionitis–endometritis.

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“…There are several shortcomings to IAP: first, resource-limited settings may lack laboratory capacity to perform large-scale GBS screenings; second, the increasing antimicrobial resistance of GBS strains may reduce the effectiveness of IAP; third, exposure to antibiotics during pregnancy can influence the composition of the infant gut microbiome, which is an important determinant of future disease risk [3]. Finally, IAP does not prevent LOD, which can be transmitted from mother to child after birth [4], or preterm birth, which can occur prior to GBS screening and detection [5].…”

Section: Introductionmentioning

confidence: 99%

Rectovaginal Colonization with Serotypes of Group B Streptococci with Reduced Penicillin Susceptibility among Pregnant Women in León, Nicaragua

et al. 2022

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Group B Streptococci (GBS) are important causes of neonatal sepsis and meningitis globally. To elucidate the potential benefits of maternal GBS vaccines, data is needed on the epidemiology of maternal GBS rectovaginal colonization, distribution of serotypes, and resistance to intrapartum antibiotic prophylaxis (IAP). We collected rectal and vaginal samples from 305 pregnant women in León, Nicaragua between 35 and 40 weeks gestation. Samples were cultured for GBS and confirmed using latex agglutination. GBS isolates underwent serotyping by quantitative polymerase chain reaction, and antimicrobial susceptibility testing by disk diffusion and microdilution following Clinical Laboratory Standard Institute guidelines. Sixty-three women (20.7%) were colonized with GBS in either the rectum or the vagina. Of 91 GBS isolates collected from positive cultures, most were serotypes II (28.6%), Ia (27.5%), and III (20.9%). Most GBS isolates (52.9%) were resistant to penicillin, the first-line prophylactic antibiotic. Penicillin resistance was highly correlated with resistance to vancomycin, ceftriaxone, and meropenem. The results of our study suggest that one-fifth of pregnant women in the urban area of León, Nicaragua are colonized with GBS and risk transmitting GBS to their offspring during labor. High resistance to commonly available antibiotics in the region suggests that prophylactic maternal GBS vaccination would be an effective alternative to IAP.

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Outcomes associated with antibiotic administration for isolated maternal fever in labor

Cited by 10 publications

References 19 publications

Intrapartum fever complicated with maternal bacteremia: prevalence, bacteriology, and risk factors

Intrapartum fever complicated with maternal bacteremia: prevalence, bacteriology, and risk factors

Performance Characteristics of Sepsis Screening Tools During Delivery Admissions

Rectovaginal Colonization with Serotypes of Group B Streptococci with Reduced Penicillin Susceptibility among Pregnant Women in León, Nicaragua

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