Melissa E Bauer1, Michelle Housey1, Samuel T Bauer2, Sydney Behrmann1, Anthony Chau3, Caitlin Clancy4, Erin A S Clark5, Sharon Einav6, Elizabeth Langen7, Lisa Leffert4, Stephanie Lin5, Manokanth Madapu4, Michael D Maile1, Emily McQuaid-Hanson4, Kristina Priessnitz1, Hen Y Sela8, Anuj Shah9, Paul Sobolewski2, Paloma Toledo10,11, Lawrence C Tsen3, Brian T Bateman3. 1. From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan. 2. Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan. 3. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 4. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. 5. Department of Obstetrics and Gynecology, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, Utah. 6. Intensive Care Unit, Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel. 7. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan. 8. Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Jerusalem, Israel. 9. Feinberg School of Medicine, Northwestern University, Evanston, Illinois. 10. Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 11. Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Abstract
BACKGROUND: Given the significant morbidity and mortality of maternal sepsis, early identification is key to improve outcomes. This study aims to evaluate the performance characteristics of the systemic inflammatory response syndrome (SIRS), quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA), and maternal early warning (MEW) criteria for identifying cases of impending sepsis in parturients. The secondary objective of this study is to identify etiologies and risk factors for maternal sepsis and to assess timing of antibiotics in patients diagnosed with sepsis. METHODS: Validated maternal sepsis cases during the delivery hospitalization from 1995 to 2012 were retrospectively identified at 7 academic medical centers in the United States and Israel. Control patients were matched by date of delivery in a 1:4 ratio. The sensitivity and specificity of SIRS, qSOFA, and MEW criteria for identifying sepsis were calculated. Data including potential risk factors, vital signs, laboratory values, and clinical management were collected for cases and controls. RESULTS: Eighty-two sepsis cases during the delivery hospitalization were identified and matched to 328 controls. The most common causes of sepsis were the following: chorioamnionitis 20 (24.4%), endometritis 19 (23.2%), and pneumonia 9 (11.0%). Escherichia coli 12 (14.6%), other Gram-negative rods 8 (9.8%), and group A Streptococcus 6 (7.3%) were the most commonly found pathogens. The sensitivities and specificities for meeting criteria for screening tools were as follows: (1) SIRS (0.93, 0.63); (2) qSOFA (0.50, 0.95); and (3) MEW criteria for identifying sepsis (0.82, 0.87). Of 82 women with sepsis, 10 (12.2%) died. The mortality rate for those who received antibiotics within 1 hour of diagnosis was 8.3%. The mortality rate was 20% for the patients who received antibiotics after >1 hour. CONCLUSIONS: Chorioamnionitis and endometritis were the most common causes of sepsis, together accounting for about half of cases. Notable differences were observed in the sensitivity and specificity of sepsis screening tools with the highest to lowest sensitivity being SIRS, MEW, and qSOFA criteria, and the highest to lowest specificity being qSOFA, MEW, and SIRS. Mortality was doubled in the cohort of patients who received antibiotics after >1 hour. Clinicians need to be vigilant to identify cases of peripartum sepsis early in its course and prioritize timely antibiotic therapy.
BACKGROUND: Given the significant morbidity and mortality of maternal sepsis, early identification is key to improve outcomes. This study aims to evaluate the performance characteristics of the systemic inflammatory response syndrome (SIRS), quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA), and maternal early warning (MEW) criteria for identifying cases of impending sepsis in parturients. The secondary objective of this study is to identify etiologies and risk factors for maternal sepsis and to assess timing of antibiotics in patients diagnosed with sepsis. METHODS: Validated maternal sepsis cases during the delivery hospitalization from 1995 to 2012 were retrospectively identified at 7 academic medical centers in the United States and Israel. Control patients were matched by date of delivery in a 1:4 ratio. The sensitivity and specificity of SIRS, qSOFA, and MEW criteria for identifying sepsis were calculated. Data including potential risk factors, vital signs, laboratory values, and clinical management were collected for cases and controls. RESULTS: Eighty-two sepsis cases during the delivery hospitalization were identified and matched to 328 controls. The most common causes of sepsis were the following: chorioamnionitis 20 (24.4%), endometritis 19 (23.2%), and pneumonia 9 (11.0%). Escherichia coli 12 (14.6%), other Gram-negative rods 8 (9.8%), and group A Streptococcus 6 (7.3%) were the most commonly found pathogens. The sensitivities and specificities for meeting criteria for screening tools were as follows: (1) SIRS (0.93, 0.63); (2) qSOFA (0.50, 0.95); and (3) MEW criteria for identifying sepsis (0.82, 0.87). Of 82 women with sepsis, 10 (12.2%) died. The mortality rate for those who received antibiotics within 1 hour of diagnosis was 8.3%. The mortality rate was 20% for the patients who received antibiotics after >1 hour. CONCLUSIONS:Chorioamnionitis and endometritis were the most common causes of sepsis, together accounting for about half of cases. Notable differences were observed in the sensitivity and specificity of sepsis screening tools with the highest to lowest sensitivity being SIRS, MEW, and qSOFA criteria, and the highest to lowest specificity being qSOFA, MEW, and SIRS. Mortality was doubled in the cohort of patients who received antibiotics after >1 hour. Clinicians need to be vigilant to identify cases of peripartum sepsis early in its course and prioritize timely antibiotic therapy.
Authors: Megan E Foeller; Lillian Sie; Timothy M Foeller; Anna I Girsen; Suzan L Carmichael; Deirdre J Lyell; Henry C Lee; Ronald S Gibbs Journal: Am J Perinatol Date: 2019-09-17 Impact factor: 1.862
Authors: Margo S Harrison; Ephrem Kirub; Tewodros Liyew; Biruk Teshome; Andrea Jimenez-Zambrano; Margaret Muldrow; Teklemariam Yarinbab Journal: J Womens Health Dev Date: 2021-04-14