Peripartum Bacteremia in the Era of Group B Streptococcus Prophylaxis

Harvard University, Cambridge, Massachusetts, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 04/2013; 121(4):812-8. DOI: 10.1097/AOG.0b013e3182888032
Source: PubMed


: To define the microbial epidemiology and clinical risk factorms associated with peripartum bacteremia in the era of group B streptococcus prophylaxis.
: We identified all cases of maternal bacteremia occurring during the peripartum time period (defined as from 7 days before delivery until 30 days after delivery) in a large maternity center from 2000 to 2008. Chart review was performed to determine the clinical factors associated with bacteremia.
: During the study period, blood cultures were obtained from 1,295 febrile peripartum women (1.6% of all parturients); 172 of 1,295 febrile peripartum women (13.3%) had bacteremia (2.2 cases per 1,000 deliveries) with 194 microbial isolates and 1 yeast. The most frequent bacterial isolates were Escherichia coli (35.9%), enterococci (23.6%), and anaerobic species (9.2%); group B streptococcus was isolated in only eight cases (4.1%). Clinical diagnoses among infected women included endometritis (56%), chorioamnionitis (21%), and urosepsis (8%). Among women with endometritis, 77% underwent cesarean delivery (compared with vaginal delivery; relative risk [RR] 10.85, 95% confidence interval [CI] 6.75-17.45) and 39% delivered at less than 37 weeks of gestation (compared with37 weeks or more; RR 3.21, 95% CI 2.42-4.25). Severe maternal complications of bacteremia were noted; six women required intensive care unit admission, five women had development of ileus, and one death occurred because of urosepsis.
: In the era of group B streptococcus prophylaxis, E coli and enterococci are the most frequent bacteria isolated in peripartum bacteremia. Group B streptococcus accounted for only 4% of cases.
: III.

8 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To determine if genital tract colonization with GBS at the time of preterm premature rupture of membranes (PPROM) affects the latency period. Study Design: A retrospective cohort study was performed of all gravidas admitted with PPROM between 23 and 34 weeks of gestation from January 1, 2005 through February 29, 2012. Vaginal/rectal specimens for GBS were performed on admission. The latency period and infectious complications were evaluated in GBS positive and GBS negative groups. Results: 189 women were identified with PPROM, 177 meet the inclusion criteria. 60 patients were GBS positive on admission, 117 were GBS negative. Median latency period in GBS positive and GBS negative groups did not differ (6.8 vs. 7.3 days, P = 0.384). Risk of intra-amniotic, wound infection, maternal and neonatal sepsis, and composite infectious morbidity did not differ between GBS positive and GBS negative group. Among patients who undergone cesarean delivery GBS negative group had a higher risk of endomyometritis (25%) compared to the GBS positive group (6%), P = 0.05. Conclusion: GBS genital tract colonization on admission does not appear to affect the latency period or increase the risk of intra-amniotic infection in patients with PPROM.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 06/2013; 27(4). DOI:10.3109/14767058.2013.816279 · 1.37 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: 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.DesignProspective review.SettingTwo tertiary referral, maternity hospitals in Dublin, Ireland.PopulationDuring 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 measuresIncidence, bacterial aetiology, gestation/stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome.ResultsThe 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.
    BJOG An International Journal of Obstetrics & Gynaecology 05/2014; 122(5). DOI:10.1111/1471-0528.12892 · 3.45 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In order to improve the knowledge on Escherichia coli bacteremia during pregnancy, we studied clinical data and performed molecular characterization of strains in 29 E. coli bacteremia occurring in pregnant women. Bacteremia mostly occurred in the third trimester of pregnancy (45%) and were community-acquired (79%). Portals of entry were urinary (55%) and genital (45%). E. coli strains belonged mainly to phylogroups B2 (72%) and D (17%). Four clonal lineages, i.e. sequence type complex (STc) 73, STc95, STc12 and STc69 represented 65% of the strains. The strains exhibited a high number of virulence factor coding genes at 10 (3-16) over 18 screened. Six fetuses died (27%), 5 of them during bacteremia with bacteremia of genital origin (83%). Fetal deaths occurred despite adequate antibiotic regimen. Strains associated with fetal mortality had less virulence factors (8 (6-10)) than strains involved in no fetal mortality bacteremia (11 (4-12)) (p=0.02). When comparing E. coli strains involved in bacteremia with urinary portal of entry in non-immunocompromised pregnant versus non-immunocompromised non-pregnant women from the COLIBAFI study, there was no significant difference of phylogroups and virulence factors coding genes. These results show that E. coli bacteremia in pregnant women involve few highly virulent clones but that severity, represented by fetal death, is mainly related to bacteremia of genital origin.This article is protected by copyright. All rights reserved.
    Clinical Microbiology and Infection 06/2014; 20(12). DOI:10.1111/1469-0691.12742 · 5.77 Impact Factor
Show more