Perinatal Outcomes Among Patients With Sepsis During Pregnancy

Blauvelt, Christine A.; Nguyen, Kiana C.; Cassidy, Arianna G.; Gaw, Stephanie L.

doi:10.1001/jamanetworkopen.2021.24109

Cited by 23 publications

(21 citation statements)

References 42 publications

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“…UTI in pregnant women is a unique and complicated situation, which is responsible for adverse maternal and fetal events, like preterm birth, septicemia, respiratory failure, etc. The patients may present with asymptomatic bacteriuria if the bacteria are restricted in the urine but may present with obvious symptoms when bacterial invasion into the renal parenchyma and urinary tract occurs, after which the patients can have either cystitis or APN [ 8 ]. Although APN can lead to severe cases of sepsis, patients in the early stage are mostly asymptomatic and the disease onset is relatively insidious.…”

Section: Discussionmentioning

confidence: 99%

“…Another study pointed out that CRP, ESR, WBC count, neutrophil count and ratio were efficient biomarkers to predict the existence or escalation of UTI, including cystitis and APN [ 10 ]. More importantly, PCT was believed to maintain the potential to differentially diagnose cystitis and APN [ 8 ]. A systematic review and meta-analysis found a pooled sensitivity of 0.86 and specificity of 0.74 in differentiating APN from other forms of UTI in children with the help of PCT, the effect of which was superior to CRP and EST [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Stents in a Pregnant Woman: A Case Report and Literature Review

2022

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Patient: Female, 26-year-old Final Diagnosis: Acute pyelonephritis • kidney stones • hydronephrosis Symptoms: Bacteriuria • lumbar pain • septic shock Medication: — Clinical Procedure: — Specialty: Obstetrics and Gynecology Objective: Unusual clinical course Background: Bacteriuria occurs in many pregnant women which may result in symptomatic urinary tract infection (UTI), including acute pyelonephritis (APN), which can lead to septic shock. However, there was no standard protocol of managing pregnant women with APN about the regimen, timing, length of antibiotic appliance as well as the indication of implanting double-J ureteral stents in those with kidney stones. Case Report: A 26-year-old pregnant woman (G1P0, 27 weeks plus 3 days) presented to our hospital on account of fever and pain in the flanks and was admitted on account of suspected UTI due to bacteriuria and elevated inflammatory markers. Elevated WBC count of 18.26×10 9 /L, PCT of 2.75, CRP of 198 mg/L, existence of kidney stones, renal and perirenal inflammation were observed. Cefoperazone sodium sulbactam sodium was given. The patient experienced septic shock on day 2 with a low blood pressure of 81/52 mmHg. Double-J ureteral stents were implanted due to upper urinary tract obstruction on day 3 with continuous use of meropenem based on urine culture and antibiotic sensitivity results. From day 7, the antibiotics were changed to cefoperazone-sulbactam. The patient’s laboratory results (biochemistry, PCT, and CRP) all gradually went to normal, and she was discharged on day 15. Conclusions: We learned that urine culture and antibiotic sensitivity examination were suggested after bacteriuria was observed in pregnant women to guide further treatment. Once APN was suspected, antibiotic therapy should be commenced and early-stage drainage by double-J ureteral stents could be considered if warranted in appropriate patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Stents in a Pregnant Woman: A Case Report and Literature Review

2022

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“…2 3 4 5 6 7 8 Importantly, it is the second leading cause of maternal mortality in the United States, with studies attributing 12.7% of maternal deaths to sepsis annually. 3 9 10…”

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confidence: 99%

“…Maternal sepsis has increased in recent years and is a leading cause of maternal morbidity. [2][3][4][5][6][7][8] Importantly, it is the second leading cause of maternal mortality in the United States, with studies attributing 12.7% of maternal deaths to sepsis annually. 3,9,10 Early recognition improves outcomes for maternal sepsis.…”

mentioning

confidence: 99%

“…[2][3][4][5][6][7][8] Importantly, it is the second leading cause of maternal mortality in the United States, with studies attributing 12.7% of maternal deaths to sepsis annually. 3,9,10 Early recognition improves outcomes for maternal sepsis. 2 However, 63% of U.S. women with maternal sepsis-related deaths received substandard care, typically delayed recognition.…”

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Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

et al. 2022

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Objective: To develop and evaluate a scoring system—called Sepsis-Associated Adverse Outcomes in Pregnancy (SAAP) Score—to identify individuals with maternal infection that have composite maternal adverse outcomes (CMAO). Study Design: Using ICD codes, we identified pregnant and postpartum (up to 6 weeks after birth) individuals admitted at our center with a primary diagnosis of infection. The primary outcome was CMAO, which included any of the following: maternal intensive care unit admission, surgical intervention, vasopressor use, acute respiratory distress syndrome, pulmonary edema, mechanical ventilation, high flow nasal cannula, disseminated intravascular coagulation, dialysis, organ failure, venous thromboembolism, or maternal death. Regularized logistic regression was used to identify variables that best discriminate CMAO status. Variables were chosen for inclusion following evaluation of statistical and clinical significance. Model performance was evaluated using area under the curve (AUC) with 95% confidence intervals (CI), sensitivity, specificity, and predictive values. Results: Of the 23,235 deliveries during the study period, 227 (0.9%) individuals met inclusion criteria and among them CMAO occurred in 39.2% (95% CI 33.1% to 45.7%). The SAAP score consisted of 6 variables (white blood cell count, systolic blood pressure, respiratory rate, heart rate, lactic acid, and abnormal diagnostic imaging) with scores ranging from 0 to 11 and a score  7 being abnormal. An abnormal SAAP score had an AUC of 0.80 (95% CI 0.74-0.86) for CMAO. The sensitivity and specificity of the SAAP score for CMAO was 0.71 (95% CI 0.60 to 0.80) and 0.73 (95% CI 0.64 to 0.80), respectively. The positive predictive value was 0.62 (95% CI 0.52 to 0.72) and negative predictive value, 0.79 (95% CI 0.71 to 0.86). Conclusion: Pending external validation, the 6 variable SAAP score, may permit early recognition of pregnant and postpartum individuals with infection who are likely to develop adverse maternal outcomes.

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Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre

Mohn,

Reimer,

Mar

et al. 2023

Intl J Gynecology & Obste

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ObjectiveTo evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes.MethodsRetrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018.ResultsThe incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first‐ and third‐generation cephalosporins, respectively. Clinical sources of infection included intra‐amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%).ConclusionPeripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first‐line antibiotics.

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Perinatal Outcomes Among Patients With Sepsis During Pregnancy

Cited by 23 publications

References 42 publications

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Stents in a Pregnant Woman: A Case Report and Literature Review

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Stents in a Pregnant Woman: A Case Report and Literature Review

Development of the Sepsis-Associated Adverse Outcomes in Pregnancy Score

Empiric antibiotics for peripartum bacteremia: A chart review from a quaternary Canadian centre

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