Epidemiology of and Surveillance for Postpartum Infections

Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA.
Emerging infectious diseases (Impact Factor: 6.75). 10/2001; 7(5):837-41. DOI: 10.3201/eid0705.010511
Source: PubMed


We screened automated ambulatory medical records, hospital and emergency room claims, and pharmacy records of 2,826 health maintenance organization (HMO) members who gave birth over a 30-month period. Full-text ambulatory records were reviewed for the 30-day postpartum period to confirm infection status for a weighted sample of cases. The overall postpartum infection rate was 6.0%, with rates of 7.4% following cesarean section and 5.5% following vaginal delivery. Rehospitalization; cesarean delivery; antistaphylococcal antibiotics; diagnosis codes for mastitis, endometritis, and wound infection; and ambulatory blood or wound cultures were important predictors of infection. Use of automated information routinely collected by HMOs and insurers allows efficient identification of postpartum infections not detected by conventional surveillance.

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Available from: Deborah S Yokoe, Sep 24, 2015
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    • "Because the predictors of predischarge infection may not be representative of the predictors of postpartum MRSA as a whole, these findings should not be generalized to the postdischarge period. Recognition of this limitation of generalizability is important, since the majority of postpartum infections are diagnosed after hospital discharge [25]. "
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    ABSTRACT: Background: We sought to characterize the relationship between individual group B streptococcus (GBS) colonization and pre-discharge postpartum methicillin resistant Staphylococcus aureus (MRSA) infection in United States women delivering at term. We also sought to examine the association between hospital GBS colonization prevalence and MRSA infection. Materials and methods: Data was from the Nationwide Inpatient Sample, a representative sample of United States community hospitals. Hierarchical regression models were used to estimate odds ratios adjusted for patient age, race, expected payer, and prepregnancy diabetes and hospital teaching status, urbanicity, ownership, size, and geographic region. We used multiple imputation for missing covariate data. Results: There were 3,136,595 deliveries and 462 cases of MRSA infection included in this study. The odds ratio for individual GBS colonization was 1.2 (95% confidence interval: 0.9 to 1.5). For a five-percent increase in the hospital prevalence of GBS colonization, the odds ratio was 0.9 (95% CI: 0.1 to 5.6). Conclusions: The odds ratio estimate for the association of hospital GBS prevalence with MRSA infection is too imprecise to make conclusions about its magnitude and direction. Barring major bias in our estimates, individual GBS carriage does not appear to be strongly associated with predischarge postpartum MRSA infection.
    Infectious Diseases in Obstetrics and Gynecology 03/2014; 2014:515646. DOI:10.1155/2014/515646
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    • "The diagnose of these wound infections during the follow-up period after the patients discharged might indicate the true incidence of these events. Previous study showed that, up to 80% of infections occur after discharge from the hospital [20-22]. Thus, post- cesarean deliveries infection rates may be underestimated if based on hospital discharge records. "
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    ABSTRACT: BACKGROUND: A prophylactic antibiotic is recommended to reduce infection-related complication following cesarean delivery. There is a current debate on the time of prophylactic antibiotic in cesarean delivery. METHODS: An opened randomized, controlled clinical trial was conducted at Soba hospital, Sudan to investigate the timing (pre-incision or after clamping of the umbilical cord) of ceftizoxime for elective cesarean delivery. The outcome measures were; the incidence of post-cesarean febrile and infection-related morbidity and neonatal outcomes between the two groups. RESULTS: Hundred --eighty women (90 women in each arm of the study) received intravenous injection of 1 g of ceftizoxime as single dose either at pre-incision or after clamping of the umbilical cord. None of the women in either group had endometritis. One woman in the pre-incision group had chest infection. There was no significant difference in the incidence of wound infection between the two groups, 8 (6.7%) vs. 3 (3.3%); P = 0.2. Two babies in the pre-incision group (P = 0.497) had a low Apgar score (< 8) at 1 min. Similar number of neonate (15 in each arm) was admitted to nursery. There were no significant difference in the neonatal jaundice between the two groups, 5 (5.5%) vs. 4 (4.4%), P = 0.2. There was no perinatal death. CONCLUSIONS: There was no difference in the two regimens (pre-incision or post-clamping of the umbilical cord) of ceftizoxime as prophylactic for elective cesarean delivery. Trial registration: NCT01347593.
    BMC Research Notes 02/2013; 6(1):57. DOI:10.1186/1756-0500-6-57
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    • "The published data on the rates of endometritis and surgical site infection (SSI) following CS vary widely, but it is commonly agreed that more complications, particularly infections, arise after CS than after vaginal delivery [2] [3] [4] [5] [6] [7]. Moreover, because of the ever shorter length of stay (LOS) in hospital, an accurate estimate of post-partum infection is difficult to make, since most infections develop after discharge [8] [9]. "
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    ABSTRACT: Despite international recommendations and general agreement on the fact that more complications arise after caesarean section, Italy ranks first in the number of caesarean sections performed each year. Aim of this cohort study was to estimate the incidence of post-partum wound infections following caesarean section in a sample of low-risk women and to examine the main risk factors correlated. 430 mothers were included in the study. A data collection form was completed with woman's obstetric history, details of the operation and of any infection that occurred during hospital staying. A post-discharge telephone call-up surveillance after delivery was also performed A total of 20 (4.7%) SSIs were recorded. Through post-discharge surveillance, 85% of infections were identified. The time between membrane rupture and start of the operation was found to be associated with the development of infection (p = 0.04). No statistically significant association with any of the other risk factors was found. From the comparison of current practices with international guideline recommendations we could identify critical points that will need to be addressed in corrective and training interactions, specifically, choice and timing of administration of antibiotics in antimicrobial prophylaxis and timing of showering and shaving.
    Journal of preventive medicine and hygiene 09/2009; 50(3):159-63.
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