Abstract
(1) Background: Sepsis is the leading cause of maternal death in 11–15% of women worldwide. This emphasises the importance of administrating timely and appropriate antibiotic therapy to women with sepsis. We aimed to evaluate the appropriateness of antimicrobial prescribing in women diagnosed with peripartum sepsis. (2) Method: A prospective observational cohort study in a single Scottish health region with 12,233 annual live births. Data were collected on women diagnosed with sepsis in the peripartum period using physical and electronic medical records, drug Kardex® (medication administration) and ward handover records. (3) Results: A sepsis diagnosis was concluded in 89 of the 2690 pregnancy cases reviewed, with a median hospital stay of four days. Good overall adherence to the local guidelines for the empiric antimicrobial treatment of sepsis was observed. Group B Streptococcus was associated with 20.8% of maternal sepsis cases, whilst in 60% of clinical specimens tested no causative pathogen was isolated. (4) Conclusion: The lack of specific and sensitive clinical markers for sepsis, coupled with their inconsistent clinical application to inform diagnosis, hindered effective antimicrobial stewardship. This was further exacerbated by the lack of positive culture isolates from clinical specimens, which meant that patients were often continued on broader-spectrum empiric treatment.
Highlights
Sepsis is the presence of infection in conjunction with the systemic inflammatory response syndrome (SIRS) with or without organ dysfunction, and was defined in 2016 as a “life-threatening organ dysfunction caused by a dysregulated host response to infection” [1], which can be measured using the sepsis-related organ failure assessment (SOFA) or the quick-SOFA [1]
This study aims to quantify the types of antibiotic agents prescribed and evaluate their appropriateness in women diagnosed with peripartum sepsis., observe the clinical parameters used to assist the diagnosis of peripartum sepsis and describe bacterial isolates in patients with suspected or confirmed sepsis
In 89.9% (n = 80) of cases women were treated in maternity wards, while 7.9% (n = 7) of the women were treated in high dependency units (HDUs) and 2.2%
Summary
Sepsis is the presence of infection in conjunction with the systemic inflammatory response syndrome (SIRS) with or without organ dysfunction, and was defined in 2016 as a “life-threatening organ dysfunction caused by a dysregulated host response to infection” [1], which can be measured using the sepsis-related organ failure assessment (SOFA) or the quick-SOFA (qSOFA) [1]. Sepsis is the leading cause of maternal death in 11–15% of women worldwide [2,3]. Sepsis is the second most common cause of obstetric admission to critical care units [6], responsible for up to 22% of intensive care unit (ICU) admissions in the maternity population [7]. The physiological changes associated with an obstetric population, especially within the third trimester, increase the diagnostic challenge of applying abnormal SIRS parameters as a sign of infection [10]. A confirmed microbial infection takes at least 24 h and it only occurs in 30–40% of Pharmacy 2020, 8, 0211; doi:10.3390/pharmacy8040211 www.mdpi.com/journal/pharmacy
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