Risk of Invasive<i>Haemophilus influenzae</i>Infection During Pregnancy and Association With Adverse Fetal Outcomes

Collins, Sarah; Ramsay, Mary; Slack, Mary; Campbell, Helen; Flynn, Sally; Litt, David; Ladhani, Shamez

doi:10.1001/jama.2014.1878

Cited by 47 publications

(22 citation statements)

References 30 publications

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“…Higher H. influenzae notification rates for infants, particularly neonates, the elderly, and women of childbearing age, were described before ( 30 , 31 ) and after ( 32 – 34 ) the introduction of routine Hib vaccination. In addition, several studies showed an increased burden of NTHi in groups more susceptible to infection, with high proportions of intensive care admission, high case-fatality rates, and frequent sequelae among survivors ( 2 , 29 , 32 , 35 ).…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of InvasiveHaemophilus influenzaeDisease, Europe, 2007–2014

Whittaker¹,

Economopoulou²,

Dias³

et al. 2017

Emerg. Infect. Dis.

131

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We describe the epidemiology of invasive Haemophilus influenzae disease during 2007–2014 in 12 European countries and assess overall H. influenzae disease trends by serotype and patient age. Mean annual notification rate was 0.6 cases/100,000 population, with an increasing annual trend of 3.3% (95% CI 2.3% to 4.3%). The notification rate was highest for patients <1 month of age (23.4 cases/100,000 population). Nontypeable H. influenzae (NTHi) caused 78% of all cases and showed increasing trends among persons <1 month and >20 years of age. Serotype f cases showed an increasing trend among persons >60 years of age. Serotype b cases showed decreasing trends among persons 1–5 months, 1–4 years, and >40 years of age. Sustained success of routine H. influenzae serotype b vaccination is evident. Surveillance systems must adopt a broad focus for invasive H. influenzae disease. Increasing reports of NTHi, particularly among neonates, highlight the potential benefit of a vaccine against NTHi.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of InvasiveHaemophilus influenzaeDisease, Europe, 2007–2014

Whittaker¹,

Economopoulou²,

Dias³

et al. 2017

Emerg. Infect. Dis.

131

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“…Three cases were associated with second trimester fetal loss (Table ). Haemophilus influenzae is known to be associated with an increased risk of invasive infection during pregnancy, fetal loss and preterm birth …”

Section: Discussionmentioning

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

162

142

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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.

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“…Population-based studies have proposed increased susceptibility to invasive H. influenzae infections during pregnancy. According to a surveillance data from England, pregnant women had 17-fold increased risk of invasive NTHi compared with non-pregnant women [7]. Among pregnant women with invasive H. influenzae, the incidence of pregnancy loss was 61%, 20% of which were lost prior to 25 weeks' gestation [7].…”

Section: Discussionmentioning

confidence: 99%

“…There is accumulating evidence indicating a strong association between invasive NTHi infection during pregnancy and early pregnancy loss as well as invasive neonatal disease [6,7]. As the diagnosis relies on microbiological investigation of post-mortem placental and foetal samples, a significant proportion of NTHi-related pregnancy loss remains undiagnosed.…”

Section: Introductionmentioning

confidence: 99%

Non-typeable Haemophilus influenzae-associated early pregnancy loss: an emerging neonatal and maternal pathogen

2019

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Objectives There is increasing evidence indicating an association between invasive non-typeable Haemophilus influenzae (NTHi) infection in pregnancy and early pregnancy loss. As the diagnosis relies on microbiological investigation of postmortem placental and foetal samples, a significant proportion of NTHi-related pregnancy loss remains unrecognised. To better characterise NTHi in septic abortion, we report NTHi cases associated with early pregnancy loss. Methods We reviewed all post-mortems at <24 weeks gestation with histologically proven acute chorioamnionitis on placental histology and enrolled cases with at least one matched foetal and placental sample culture positive for NTHi. The study was approved by the NHS Lothian Caldicott Guardian. Results In our cohort, invasive NTHi has accounted for 20% of infections associated with early pregnancy loss prior to 24 weeks gestation. All patients were young and healthy pregnant women at < 20 weeks' gestation who presented with abdominal pain, PV bleed /discharge and were septic at the time of presentation. One patient with previous history of miscarriage who presented with cervical incompetence had more severe pathology suggestive of early intrauterine pneumonia. Conclusion The burden of invasive NTHi disease in early pregnancy loss is likely to be much larger than currently recognised. NTHi should be considered in pregnant women presenting with abdominal pain and PV bleed/discharge in whom clinical signs of sepsis are present. Active surveillance should be considered in this patient group including septic abortion to capture the true prevalence of this emerging pathogen to inform preventative and therapeutic approaches.

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Risk of InvasiveHaemophilus influenzaeInfection During Pregnancy and Association With Adverse Fetal Outcomes

Cited by 47 publications

References 30 publications

Epidemiology of InvasiveHaemophilus influenzaeDisease, Europe, 2007–2014

Epidemiology of InvasiveHaemophilus influenzaeDisease, Europe, 2007–2014

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

Non-typeable Haemophilus influenzae-associated early pregnancy loss: an emerging neonatal and maternal pathogen

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