Rate Of Infectious Morbidity Research Articles

Mode of delivery in chorioamnionitis: impact on neonatal and maternal outcomes

BackgroundThe impact of mode of delivery in chorioamnionitis on neonatal outcomes is unclear. This retrospective cohort study compares the rate of early onset neonatal sepsis between vaginal delivery and cesarean section.MethodsSingleton pregnancies at greater than 24 + 0 weeks gestation with live birth and clinically-diagnosed chorioamnionitis from January 1, 2019 to December 31, 2021 were included. Cases with multiple gestations, terminations or histological chorioamnionitis alone were excluded. Rates of early onset neonatal sepsis, select secondary neonatal outcomes and a composite outcome of maternal infectious morbidity were compared using propensity score weighting. Subgroup analysis was done by indication for cesarean section.ResultsAfter chart review, 378 cases were included with 197 delivering vaginally and 181 delivering via cesarean section. The groups differed on age, parity, hypertension, renal disease, gestational age, corticosteroid use, magnesium sulfate use, presence of meconium and percentage meeting Gibbs criteria before propensity score weighting. Rate of early onset neonatal sepsis was greater in the cesarean section group (13.8% versus 3.1%, adjusted risk difference 8.3% [3.5–13.1], p < 0.001). Secondary neonatal outcomes were similar between groups. When compared by indication, the rate of early onset neonatal sepsis was greater in the cesarean section for abnormal fetal surveillance group compared to vaginal delivery but not in the cesarean section for other reasons group. Adjusted rates of secondary neonatal outcomes did not differ between groups. The rate of maternal infectious morbidity was greater with cesarean section. (13.8% versus 1.5% [adjusted risk difference 13.0% [7.1–18.9], p < 0.0001). No other difference in maternal secondary outcomes was identified.ConclusionsThe rate of early onset neonatal sepsis was highest in the cesarean section group, particularly in those with abnormal fetal surveillance. Fetuses affected by or vulnerable to sepsis likely have a greater need for cesarean section.

Perioperative Antibiotic Choice and Postoperative Infectious Complications in Pelvic Organ Prolapse Surgery

ObjectiveThe objective of this study was to determine how rates of postoperative infectious complications after pelvic organ prolapse surgery differ based on perioperative antibiotic administered. In particular, we sought to determine whether anaerobic coverage is associated with reduced rates of infectious complications. DesignThis was a retrospective cohort study. SettingPremier Healthcare U.S. national database, a comprehensive all-payer dataset capturing patients from urban and rural nonprofit, community, and teaching hospitals. ParticipantsAdult patients who underwent vaginal, laparoscopic, and/or abdominal prolapse surgery with or without hysterectomy from January 2000 to March 2020. Procedures with and without mesh were included. InterventionsRates of infectious complications were compared among patients who received guideline-concordant antibiotic regimens, including those with anaerobic coverage. The primary outcome was any surgical site infection within 30 days of surgery without mesh or 90 days of surgery involving mesh. ResultsAmong 130,198 prolapse surgeries, the most common antibiotic regimens were cefazolin (n = 97,058, 74.5%), second-generation cephalosporin (n = 16,442, 12.6%), clindamycin + aminoglycoside (n = 8,397, 6.4%) and cefazolin + metronidazole (n = 4,328, 3.3%). On multivariable logistic regression, only clindamycin + aminoglycoside was associated with a higher rate of surgical site infections (OR = 1.37; 95% CI 1.09–1.72) and other infectious morbidity (OR = 1.26; 95% CI 1.12–1.42) when compared to cefazolin alone. The addition of metronidazole to cefazolin was not associated with reduced rates of surgical site infections (OR = 1.09; 95% CI 0.82–1.45). Obesity (OR = 1.22; 95% CI 1.03–1.43), diabetes without complication (OR = 1.30; 95% CI 1.08–1.57), Charlson comorbidity score >0 (OR = 1.24; 95% CI 1.06–1.45), and tobacco use (OR = 1.22, 95% CI 1.05–1.40) were also associated with increased composite surgical site infection. ConclusionCompared with cefazolin alone, the use of alternative perioperative antibiotics, including those with anaerobic coverage, was not associated with reduced infectious complications after pelvic organ prolapse surgery in this U.S. national sample.

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort.

In Italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. The aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. A database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. The primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. The results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. A total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). Group A versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). A mean postoperative duration of stay difference of 0.86 days was detected between groups. No difference was recorded between the two groups for all the other endpoints. This study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery.

Morbidity and Mortality of HIV-Exposed Uninfected Infants in a Tertiary Referral Facility in Yaoundé, Cameroon.

Following the recorded progress in the prevention of mother-to-child transmission of HIV in Yaoundé, Cameroon, the proportion of HIV-exposed infants who are uninfected (UIH) is increasing. These children are subject to infectious and non-infectious fragility. The purpose of this study was to assess infectious morbidity and mortality rates among UIH in Yaoundé, Cameroon. We conducted a retrospective cohort study. Infants were included in the study and defined as the study subjects if they were between the ages of 24 months or younger, if they were born to HIV-positive mothers, and if they were confirmed to be HIV-negative. The main study outcomes were morbidity rate (defined as infectious, clinical events that required consultation or hospitalization) and death. Data were entered and saved in the Census and Survey Processing System (Cspro) 7.3. Statistical analyses were performed in R Software 3.6.2. The significance level was set at 0.05. In total, 240 subjects were recruited of whom 53.3% were males. Most of the HIV-positive mothers (95.7%) had used combination antiretroviral (ARV) therapy for at least four weeks during pregnancy. Among the subjects, 93.2% received ARV prophylaxis, 68.7% were exclusively breastfed for six months, 94.7% were fully vaccinated, and 60.6% had received cotrimoxazole up to the detection of the non-infection. Overall, the morbidity rate stood at 34.2%. The incidence of morbidity was 3 per 1,000 child months of the follow-up. The main pathologies were acute respiratory infections (60.79%) and malaria (17.65%). Three deaths were recorded, representing an overall mortality rate of 1.25% for an incidence of 1.1 per 1,000 child months of the follow-up (FU). Clinical events were more frequent in mothers diagnosed with HIV during pregnancy under the azidothymidine (AZT) + lamivudine (3TC) + névirapine (NVP) -based protocol (odds ratio of 3.83 [1.09-14.45; p = 0.039]). Morbidity was also higher for the follow-up periods of less than six months. The overall mortality rate among UIH was low. However, the morbidity rate was considerably higher. Emphasis should be focused on in-care retention for up to 24 months for all UIH, which should include monitoring of HIV-infected mothers prior to pregnancy.

Association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis among patients undergoing induction of labor at term

Rectovaginal colonization with Group B Streptococcus during pregnancy has historically been shown to be associated with an increased risk of clinical chorioamnionitis and peripartum infectious morbidity. Newer observational data in the era of intrapartum antibiotic prophylaxis suggest a possible reversal of this association; however, it is unclear if this is related to differences in labor management for those with and without Group B Streptococcus colonization. We therefore sought to assess the association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis within the context of a randomized induction of labor trial with a standardized labor protocol. We performed an exploratory secondary analysis of a randomized trial of patients undergoing term induction at a tertiary care center. Patients received third trimester Group B Streptococcus screening and intrapartum antibiotic prophylaxis as routine care. Group B Streptococcus detection was performed using a carrot broth-enhanced subculture to Group B Streptococcus Detect approach (Hardy Diagnostics, Santa Maria, CA). Labor management was protocolized per the trial. Patients with unknown Group B Streptococcus status or who did not receive intrapartum antibiotic prophylaxis, if indicated, were excluded. The primary outcome was diagnosis of clinical chorioamnionitis, compared between patients who received intrapartum antibiotic prophylaxis for known Group B Streptococcus positive status (by culture, history, or Group B Streptococcus bacteriuria) and those who were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis. Secondary outcomes included postpartum endometritis, wound infection, a composite maternal peripartum infectious morbidity, and neonatal outcomes. A total of 491 patients were enrolled in the trial. Of these, 466 had a known Group B Streptococcus status and received or did not receive intrapartum antibiotic prophylaxis accordingly and were included in this analysis: 292 (62.7%) were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis, and 174 (37.3%) were Group B Streptococcus positive and received intrapartum antibiotic prophylaxis. The majority of patients were Non-Hispanic Black (78.1%) and nulliparous (59.7%). There were no differences in demographic, clinical, induction or labor characteristics between groups. Patients who were Group B Streptococcus positive had a 49% lower rate of clinical chorioamnionitis (8.1% vs 14.7%, odds ratio, 0.51; P=.03) and a lower rate of peripartum infectious morbidity (8.1% vs 15.8%, odds ratio, 0.47; P=.02) compared to those who were Group B Streptococcus negative. Infants born to patients who were Group B Streptococcus positive were significantly less likely to be admitted to the neonatal intensive care unit (3.4% vs 15.1%, P<.001). Although Group B Streptococcus colonization has historically been considered a risk factor for clinical chorioamnionitis, in the era of universal antibiotic prophylaxis for Group B Streptococcus positive patients, our findings support the point that intrapartum antibiotic prophylaxis for Group B Streptococcus positivity is associated with lower rates of clinical chorioamnionitis and peripartum infectious morbidity among patients undergoing induction with protocolized labor management. These findings demonstrate that intrapartum antibiotic prophylaxis for Group B Streptococcus may protect against perinatal infectious morbidity, a phenomenon that warrants further investigation.

Evaluation of the Relationship among Different Haemoglobin Genotypes, Calcium, and Membrane Potential in Patients with Malaria in FMC, Umuahia

Malaria is still a major contributor to the high rate of global infectious disease-related mortality and morbidity particularly in Nigeria. The aim of this study is to assess the relationship between various Hemoglobin Genotypes, Calcium, and Membrane Potential in malaria patients. Retrospective analysis of the results of the distribution of Malaria parasitemia among suspected cases of malaria, various Haemoglobin genotypes, Calcium and Membrane Potential were conducted in Federal Medical Centre (FMC) Umuahia, Abia State. Two hundred cases were examined by Giemsa staining method using thick film. Haemoglobin genotype determination was performed by Cellulose acetate electrophoresis. Obtained data were analyzed using One-Way ANOVA. Results: One hundred and seventy (85.0%) were positive for Malaria parasite. The prevalence was 92(54.1%) and 78(46.0%) for females and males respectively and at p&lt;0.05, the result obtained from the statistics is considered significant. There are high prevalence of parasitemia in AA, 80(40.0%), with genotype SS recording the least with 30(15%). The age group 27-35 years had the highest occurrence of parasitemia with (44.1%) while the least was obtained in the age range 45-53 years with (2.4%). It was observed that the density of Malaria parasitemia was highest in the age group 27-35 years meaning that parasite density decreases with increasing age and the Haemoglobin genotype AA had the highest Malaria density. Also, the serum Calcium and Membrane Potential were significantly reduced in Sickle cell disease (HbSS) when compared to the HbAA and HbAS individuals. This signifies a low energy level in Sickle cell patients that can result in oxidative stress. This may probably indicate that serum Calcium and Membrane Potential are significantly reduced in Sickle cell patients compared with other Haemoglobin genotypes with Malaria.

The synergistic interaction of systemic inflammation, dysbiosis and antimicrobial resistance promotes growth restriction in children with acute severe malnutrition: An emphasis on Escherichia coli

A healthy development is denied to millions of children worldwide as harsh life conditions manifest themselves in an altered inflammation-prone microbiome crosstalk environment. Keynote of this tragedy is that insufficient nutritious amino acid blocks lipids-intake to sustain diverse microbiota, and promotes the generalist strategy followed by Escherichia coli -besides other proteobacteria- of shifting gut metabolism, subverting the site specificity of first immune reaction. Furthermore, it could be hypothesized that selective success lies in their ability to induce inflammation, since this phenomenon also fuels horizontal gene transfer (HGT). In this review, we dilucidate how immune mechanisms of environmental enteric dysfunction affect overgrowth restriction, infectious morbidity rate, and acquired lifelong risks among severe acute malnourished children. Also, despite acknowledging complexities of antimicrobial resistant enrichment, we explore and speculate over the links between virulence regulation and HGT as an indissociable part in the quest for new inflammatory niches by open genome bacteria, particularly when both collide in the most vulnerable.

Pre-operative Vs. Post-operative Vaginal Cleansing with Povidone-iodine and Post-caesarean Infectious Morbidity: A Randomized Controlled Study.

Post-caesarean maternal infectious morbidity is still a big challenge despite prophylactic antibiotics use and other modalities adopted to prevent it. Pre-operative or post-operative vaginal cleansing with povidone-iodine may have effect on post-caesarean maternal infectious morbidity. The aim of this study was to compare the effectiveness of pre-operative vs. post-operative vaginal cleansing with povidone-iodine in reducing post-caesarean maternal infectious morbidities in a teaching hospital, South East Nigeria. This was a randomized controlled trial involving 244 pregnant women who underwent elective or emergency lower segment caesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria. Recruited patients were randomized into two groups: Group 1 had pre-operative vaginal cleansing with 5% povidone-iodine, whereas group 2 had post-operative vaginal cleansing with 5% povidone-iodine. Post-operatively, patients were monitored for clinical symptoms and signs of endometritis, wound infection, and pyrexia daily till discharge and at 2 weeks post-partum visit. Both groups received same post-operative care. Data were analysed using Statistical Package for Social Sciences (IBM SPSS) software (version 20, Chicago, IL, USA). Continuous variables were presented as mean and standard deviation (mean ± 2SD), whereas categorical variables were presented as numbers, frequencies, and percentages. The t-test was used for comparison between groups for quantitative variables, whereas the χ2 test was used to compare categorical variables. Relative risk and 95% confidence interval were calculated for outcome measures. P-value<0.05 was considered significant. The overall infectious morbidity rate was 14.3% (34/239) in all the study participants. The rate was 1.7% (4/239) among women in the pre-operative vaginal cleansing group and 12.6% (30/239) among women in the post-operative vaginal cleansing group. This was statistically significant [(P < 0.05); relative risk (RR) 0.13, 95% confidence interval (CI) 0.05-0.36]. Endometritis occurred in 13/239 (5.4%) women with 0.8% in the pre-operative group and 4.6% in the post-operative vaginal cleansing group. This was also statistically significant (P = 0.009; RR 0.18, 95% CI 0.04-0.78). Wound infection occurred in 11/239 (4.6%) women with 0.8% in the pre-operative group and 3.8% in the post-operative vaginal cleansing group (P = 0.032; RR 0.22, 95% CI 0.05-0.98). Pyrexia occurred in 10/239 (4.2%) women with 0 (0%) in the pre-operative group and 4.2% in the post-operative vaginal cleansing group. This was also statistically significant (P = 0.0007; RR 0.01, 95% CI 0.007-0.16). These were commoners among women with ruptured foetal membranes (P =0.001; RR 0.22, CI 0.08-0.61) and those who had emergency caesarean delivery (P=0.0001; RR 0.14, CI 0.05-0.37). Pre-operative vaginal cleansing with povidone-iodine is more effective in the reduction of composite post-caesarean maternal infectious morbidity compared with immediate post-operative vaginal cleansing with povidone-iodine, especially in women with ruptured foetal membranes and those who had emergency caesarean section.

62 Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis

Abstract Aim To compare single-layer (SL) with double-layer (DL) uterine closure techniques after caesarean section in terms of ultrasonographic findings and rate of CS complications. Method PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4). Results Eighteen RCTs were included in our study. Pooled results favoured DL uterine closure in terms of residual myometrial thickness (MD = -1.15, 95% CI [-1.69, -0.60], P &amp;lt; 0.0001) and dysmenorrhea (RR = 1.36, 95% CI [1.02, 1.81], P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25, 95% CI [-3.29, -1.21], P &amp;lt; 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88, 95% CI [0.63, 5.62], P = 0.26), healing ratio (MD = -5.00, 95% CI [-12.40, 2.39], P = 0.18), maternal infectious morbidity (RR = 0.94, 95% CI [0.66, 1.34], P = 0.72), hospital stay (MD = -0.12, 95% CI [-0.30, 0.06], P = 0.18), and readmission rate (RR = 0.95, 95% CI [0.64, 1.40], P = 0.78). Conclusions DL closure of caesarean uterine scar is associated with more residual myometrial thickness and less dysmenorrhea compared with SL uterine closure. But SL closure has the advantage of the shorter operation time.

Аденовірусна інфекція в дорослих: дослідження реактивної відповіді поліморфноядерних нейтрофільних гранулоцитів

Актуальність. Частка аденовірусної хвороби в структурі гострих респіраторних вірусних інфекцій є істотною, а дана група інфекцій щороку становить до 30 % від загальної інфекційної морбідності. На сьогодні недостатньо вивчено особливості неспецифічного протиінфекційного захисту у хворих на аденовірусну інфекцію. Мета дослідження: вивчити реактивну відповідь поліморфноядерних гранулоцитів периферичної крові дорослих хворих на аденовірусну інфекцію. Матеріали та методи. У дане дослідження типу «випадок — контроль» за добровільною згодою залучено 37 осіб молодого віку з ознаками гострої респіраторної вірусної інфекції на момент звернення за медичною допомогою (за критеріями уніфікованого протоколу). Аналізували абсолютну та відносну кількість основних популяцій імунокомпетентних клітин периферичної крові, проводили розрахунок імуногематологічних показників, що характеризують реактивну відповідь основних клітин неспецифічного імунітету. Результати. Установлено зростання реактивності нейтрофільних гранулоцитів на 83,92 %, що вказує на активацію цих клітин системою цитокінів у неспецифічному протиінфекційному захисті, а тому його загальна активність зростає на 12,62 %. Запальний процес супроводжується зростанням абсолютної кількості лейкоцитів на 19,76 %, паличкоядерних нейтрофільних лейкоцитів — у 2,18 раза, лімфоцитів — на 30,30 % і моноцитів — на 48,15 %. Висновок. Вищенаведене свідчить про формування різних типів імунної відповіді на аденовірусні антигени. Специфічна імунна відповідь формується пізніше, що підтверджується зниженням індексу імунологічної реактивності організму хворих на 14,86 %. Методику оцінки реактивної відповіді нейтрофілів можна використовувати в практичній роботі лікарів для раннього прогнозування можливих зрушень у системі протиінфекційного захисту організму хворих.

Preoperative Anti-TNF Therapy is Associated with a Shorter Length of Resected Bowel in Patients Undergoing Ileocolic Resection for Crohn’s Disease

Background Massive or repeated intestinal resections for Crohn’s disease (CD) could lead to disabling consequences. The present study aimed to assess the effect of preoperative anti-TNF therapy on the length of resected bowel and identify risk factors for postoperative morbidity following ileocolic resection for CD. Methods Patients undergoing elective ileocolic resection for CD were included prospectively. Medical variables including demographics, Montréal classification, preoperative treatment, surgical details and 30-day postoperative morbidity were collected. Potential impact of preoperative anti-TNF treatment on length of ileocolic specimen and risk factors for postoperative morbidity were investigated. Results One hundred and eight-four patients were included in this study, and 66 (35.9%) of them received anti-TNF agents within 8 weeks prior to surgery. Primary anastomosis was performed in 145 patients (78.8%). The mean length of resected intestine was 10 cm shorter in subjects receiving preoperative anti-TNF treatment than those without preoperative anti-TNF therapy (P < 0.001). The rates of postoperative overall, infectious and intra-abdominal septic morbidity were 29.9%, 19.0% and 7.6%, respectively. In multivariate analysis, anti-TNF therapy < 8 weeks before surgery was independently associated with a shorter length of resected bowel but didn’t increase overall and septic complications, while systemic steroids use within 8 weeks prior to surgery independently increased overall complications and intra-abdominal sepsis. Conclusions Preoperative anti-TNF therapy was associated with a shorter length of resected bowel but not the overall and septic postoperative complications in ileocolic resection for CD. Weaning off systemic steroids before surgery may improve postoperative outcomes in patients with CD.

Maternal fever during labor and long-term infectious morbidity of the offspring

Maternal intrapartum fever (i.e., fever of over 38.0°C encountered just before or during delivery) can lead to a variety of maternal and neonatal complications and is attributed to various etiologies including benign infectious and non-infectious processes. In this study we sought to evaluate whether intrapartum fever carries an impact on the long-term infectious morbidity of the offspring. A population-based cohort analysis including deliveries between the years 1991 to 2014 in a tertiary referral hospital was conducted. Incidence of hospitalizations of the offspring up to the age of 18 years due to various infectious conditions was compared between pregnancies complicated by intrapartum fever, and those who were not. A Kaplan-Meier survival curve was used to assess cumulative hospitalization incidence. A Cox proportional hazards model was used to control for baseline selected confounders. During the study period, 249,840 pregnancies met the inclusion criteria. Of those, 407 (0.2%) were accompanied by intrapartum fever. Hospitalization rate of the offspring due to bacterial infections (0.7% vs. 0.1%; OR=5.35, 95% CI 1.7-16.73; p=0.02), ear, nose and throat infections (2.9% vs. 1.5%; OR=2.03, 95% CI 1.14-3.61; p=0.014) and total infectious morbidity (14.7% vs. 11.0%; OR=1.4, 95% CI 1.06-1.84; p=0.017) was higher among the exposed group (Table), as was the cumulative incidence of hospitalizations presented in the Kaplan-Meier survival curve (log rank p=0.005; Figure). This association remained significant after controlling for potential confounders (including gestational age, maternal age, hypertensive disorders of pregnancy and diabetes mellitus) using a Cox proportional hazards model (adjusted HR = 1.36; 95% CI 1.05–1.76, p=0.018). Maternal fever diagnosed close to delivery may influence offspring susceptibility to pediatric infections, as it is linked to higher rates of long-term infectious morbidity of the offspring.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Impact of Body Mass Index on Postpartum Infectious Morbidities and Wound Complications: A Study of Extremes.

As body mass index increases, the risk of postpartum infections has been shown to increase. However, most studies lump women with a body mass index (BMI) of above 40 kg/m2 together, making risk assessment for women in higher BMI categories challenging. The objective of this study was to evaluate the impact of extreme obesity on postpartum infectious morbidity and wound complications during the postpartum period. The present study is a secondary analysis of women who underwent cesarean delivery and had BMI ≥ 40 kg/m2 in the Maternal-Fetal Medicine Units Cesarean Registry. The primary outcome was a composite of postpartum infectious morbidity including endometritis, wound infection, inpatient wound complication prior to discharge, and readmission due to wound complications. Appropriate statistics used to compare baseline demographics, pregnancy complications, and primary outcomes among women by increasing BMI groups (40-49.9, 50-59.9, 60-69.9, and >70 kg/m2). Rates of postpartum infectious morbidity increased with BMI category (11.7% BMI: 50-59.9 kg/m2; 13.7% BMI: 60-69.9 kg/m2; and 21.9% BMI >70+ kg/m2; p = 0.001). Readmission for wound complications also increased with BMI (3.1% for BMI: 50-59.9 kg/m2; 6.2% for BMI: 60-69.9 kg/m2; and 9.4% for BMI >70+ kg/m2; p = 0.001). After adjusting for confounders, increased BMI of 70+ kg/m2 category remained the most significant predictor of postpartum infectious complications compared with women with BMI of 40 to 49.9 kg/m2 (adjusted odds ratio [aOR] = 6.38; 95% confidence interval [CI]: 1.37-29.7). The adjusted odds of readmission also increased with BMI (aOR = 2.33, 95% CI: 1.35-4.02 for BMI 50-59.9 kg/m2; aOR = 4.91, 95% CI: 2.07-11.7 for BMI of 60-69.9 kg/m2; and aOR = 36.2, 95% CI: 7.45-176 for BMI >70 kg/m2). Women with BMI 50 to 70+ kg/m2 are at an increased risk of postpartum wound infections and complications compared with women with BMI 40 to 49.9 kg/m2. These data provide increased guidance for counseling women with an extremely elevated BMI and highlight the importance of postpartum wound prevention bundles. · Women with super obesity have higher rates of wound complications.. · Women at extremes of obesity experience worse postpartum infectious morbidity.. · More research is needed on effective strategies to minimize morbidity in this population..

Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis.

Cesarean section (CS) delivery is a common procedure, and its incidence is increasing globally. To compare single-layer (SL) with double-layer (DL) uterine closure techniques after cesarean section in terms of ultrasonographic findings and rate of CS complications. PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4). Eighteen RCTs were included in our study. Pooled results favored DL uterine closure in terms of residual myometrial thickness (MD = -1.15; 95% CI -1.69, -0.60; P < 0.0001) and dysmenorrhea (RR = 1.36; 95% CI 1.02, 1.81; P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25; 95% CI -3.29, -1.21; P < 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88; 95% CI 0.63, 5.62; P = 0.26), healing ratio (MD = -5.00; 95% CI -12.40, 2.39; P = 0.18), maternal infectious morbidity (RR = 0.94; 95% CI 0.66, 1.34; P = 0.72), hospital stay (MD = -0.12; 95% CI -0.30, 0.06; P = 0.18), and readmission rate (RR = 0.95; 95% CI 0.64, 1.40; P = 0.78). Double-layer uterine closure shows more residual myometrial thickness and lower incidence of dysmenorrhea than single-layer uterine closure of cesarean section scar. But single-layer closure has the advantage of the shorter operation time. Both methods have comparable blood loss amount, healing ratio, hospital stay duration, maternal infection risk, readmission rate, and uterine dehiscence or rupture risk.

POSTER ABSTRACTS: P34 MATERNAL MORBIDITY AFTER EXPECTANT MANAGEMENT OF PREVIABLE PRELABOR RUPTURE OF MEMBRANES

Objectives: Prior to 2020, pregnancy termination was not routinely offered at our institution for patients diagnosed with previable prelabor rupture of membranes (PROM), and most patients were expectantly managed. We sought to define the rate of Severe Maternal Morbidity (SMM) as defined by the Centers for Disease Control and Prevention among women with expectantly managed previable PROM. Secondary outcomes included the rates of infectious and hemorrhagic morbidity, of suction curettage for retained products of conception, and of neonatal survival.

Vaginal preparation with povidone-iodine or chlorhexidine before hysterectomy: a propensity score matched analysis

Antiseptic vaginal preparation is recommended before gynecologic surgery; however, there is a lack of data regarding the effectiveness of different agents. To compare rates of postoperative infectious complications and hospital utilization with preoperative vaginal preparation using povidone-iodine or chlorhexidine before hysterectomy. This was a retrospective analysis of patients who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was postoperative infectious complications (including urinary tract infection, surgical site infections involving superficial, deep, or organ space tissues, or cellulitis) within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of.005 was performed to create cohorts that had vaginal preparation with either povidone-iodine or chlorhexidine and did not differ in observable characteristics. We compared the rates of infectious morbidity and hospital utilization (emergency department visits, readmission, reoperation) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received povidone-iodine and 3018 who received chlorhexidine. After propensity score matching of 2935 pairs, the povidone-iodine and chlorhexidine groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach. Povidone-iodine was associated with a lower rate of infectious morbidity (3.0% vs 4.3%; P=.01), urinary tract infection (1.1% vs 1.7%; P=.03) and emergency department visits (7.9% vs 9.7%; P=.01) than with chlorhexidine. There were nonsignificant trends of lower rates of surgical site infection (2.0% vs 2.7%; P=.07) and reoperation (1.6% vs 2.1%; P=.18). This propensity score matched analysis provides evidence that povidone-iodine is preferable to chlorhexidine for vaginal preparation before hysterectomy because of lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were approximately 1%, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.

Effect of Post Episiotomy Antibiotic on Maternal Infectious Morbidity(Clinical trial)

AbstractBackground: Episiotomy is a surgical wound done with sterile scissors to widen the vaginal opening. There is little information on the prevalence of post-episiotomy infection worldwide. Contrary to WHO recommendations, prophylactic antibiotics still prescribed in many hospitals including our hospital, to prevent the episiotomy site infection in all women after childbirth.Aim: To compare infectious morbidity rate between parturient women with uncomplicated vaginal birth received either prophylactic course of oral antibiotics post-episiotomy in addition to routine local care and who received routine local care only.Patient and method: A randomized trial conducted in the labour room of Alzhraa University Hospital, Cairo, Egypt within a 15 months duration. We recruited 630 pregnant ladies admitted for a non-complicated vaginal birth and indicated for episiotomy. Cases randomly assigned after delivery and at discharge into two groups. Group A: prescribed on discharge oral antibiotics twice daily for 5 days after the delivery and routine episiotomy care, Group B: received routine episiotomy care only. Primary outcomes: Episiotomy wound infection and endometritis, and secondry outcomes: Episiotomy wound dehiscence or gapping, Puerperal infection or adverse effects of antibiotics.Results: We reported a 7.5 % prevalence of wound infection in total study participants. Episiotomy overall wound complications were 7.8 %-6.7% in antibiotic and non antibiotic group respectively with no statistical difference. On the second visit, no cases reported with abnormal lochia or maternal fever.Conclusion: It is concluded that administration of prophylactic systemic antibiotic post episiotomy is not effective to prevent wound infection.

17 Postoperative infectious morbidity after hysterectomy: A propensity-matched analysis comparing vaginal preparation with povidone iodine versus chlorhexidine

To compare rates of infectious morbidity and hospital utilization with preoperative vaginal preparation using povidone iodine (PI) or chlorhexidine (CHX) prior to hysterectomy. This was a retrospective analysis of women who underwent hysterectomy for gynecologic indications at 70 hospitals in a statewide surgical collaborative between January 2017 and December 2019. The primary outcome was post-operative infectious morbidity which included urinary tract infection and surgical site infection (SSI) involving superficial, deep, or organ space tissues within 30 days of surgery. To adjust for confounding, propensity score matching, 1:1 without replacement and with a caliper of 0.005 was performed to create cohorts that had vaginal preparation with either PI or CHX and did not differ in observable characteristics. We compared rates of infectious morbidity as well as hospital utilization (reoperation, readmission, and ED visits) in the matched cohorts. In the statewide collaborative, there were 18,184 patients who received PI and 3,018 who received CHX. After propensity score matching of 2935 pairs, the PI and CHX groups did not differ in demographics, comorbidities, choice of preoperative antibiotics, benign vs malignant surgical indication, and surgical approach (Table 1). PI was associated with a lower rate of infectious morbidity when compared to the CHX group (3.0% vs 4.3%, P = 0.008; Figure 1). There were significantly lower rates of urinary tract infection (1.1% vs 1.7%, P = 0.034) and emergency department visits (7.9% vs 9.7%, P = 0.013) in the PI group when compared with CHX. There were non-significant trends of lower rates of SSI (2.0% vs 2.7%, P = 0.071) and reoperation (1.6% vs 2.1%, P = 0.174) in the PI group when compared with CHX. This propensity score-matched analysis provides evidence that povidone iodine is preferable to chlorhexidine for vaginal preparation prior to hysterectomy due to lower rates of infectious morbidity and fewer emergency department visits. However, the absolute differences in infectious morbidity rates were relatively small, and in the event of an iodine allergy, chlorhexidine appears to be a reasonable alternative.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effectiveness of antimicrobial prophylaxis at 30 versus 60\xa0min before cesarean delivery

This study aimed to examine the effect of antibiotic prophylaxis (AP) given within 30 compared to 30–60 min before skin incision on the incidence of infectious morbidity after cesarean delivery (CD). A retrospective cohort study was conducted at a single institution on data between 2014 and 2018. Women who delivered by CD were divided into two groups according to AP timing before skin incision: group 1 within 30 min, and group 2 from 30 to 60 min. The primary outcome was the incidence of any infectious morbidity. Overall, 2989 women were eligible: 2791 in group 1 and 198 in group 2. The primary composite outcome occurred in 125 women (4.48%) in group 1 and 8 women (4.04%) in group 2 (OR, 1.11; 95% CI 0.54–2.31; P = 0.77). The rate of surgical site infection only, was 1.08% in group 1 and 0.51% in group 2 (OR, 2.13; 95% CI 0.29–15.70; P = 0.72). The incidence was comparable between the groups in a separate sub-analysis restricted to laboring CDs and obese women. The rate of infectious morbidity was similar among women who received AP within 30 min and from 30 to 60 min before skin incision.

Association between Maternal Obesity Class, Adherence to Labor Guidelines, and Perinatal Outcomes.

Background Data are limited concerning rates of perinatal complications in women with a body mass index (BMI) ≥40 kg/m2 compared to women with other BMI classes when guidelines for the safe prevention of the primary cesarean delivery are applied. Objective The aim of the study is to evaluate labor guideline adherence by BMI class and to compare perinatal outcomes across BMI classes with guideline adherent management. Study Design This retrospective study included low-risk women admitted for delivery between April 2014 and April 2017 after the labor guidelines were implemented. BMI closest to delivery was used for analysis. Women with cesarean for nonreassuring fetal status were excluded. Results Guideline adherence decreased with increasing BMI, with 93% adherence among women of normal weight compared to 81% for class III obese women ( p < 0.0001). Among women who had guideline-adherent management, there was increased rates of cesarean among class III versus other obesity classes; however, there were no differences in rates of infectious morbidity ( p = 0.98) or hemorrhage ( p = 0.93). Although newborns of women with class III obesity had higher rates of meconium at birth, neonatal outcomes were not different with increasing maternal BMI ( p = 0.65). Conclusion There were no differences in adverse perinatal outcomes with increasing BMI.