{
    "abstract": "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.\nValidated 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.\nEighty-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.\nChorioamnionitis 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": [
        {
            "affiliation": "From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.",
            "firstname": "Melissa E",
            "initials": "ME",
            "lastname": "Bauer"
        },
        {
            "affiliation": "From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.",
            "firstname": "Michelle",
            "initials": "M",
            "lastname": "Housey"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan.",
            "firstname": "Samuel T",
            "initials": "ST",
            "lastname": "Bauer"
        },
        {
            "affiliation": "From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.",
            "firstname": "Sydney",
            "initials": "S",
            "lastname": "Behrmann"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.",
            "firstname": "Anthony",
            "initials": "A",
            "lastname": "Chau"
        },
        {
            "affiliation": "Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.",
            "firstname": "Caitlin",
            "initials": "C",
            "lastname": "Clancy"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, Utah.",
            "firstname": "Erin A S",
            "initials": "EAS",
            "lastname": "Clark"
        },
        {
            "affiliation": "Intensive Care Unit, Shaare Zedek Medical Centre, Hebrew University Faculty of Medicine, Jerusalem, Israel.",
            "firstname": "Sharon",
            "initials": "S",
            "lastname": "Einav"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.",
            "firstname": "Elizabeth",
            "initials": "E",
            "lastname": "Langen"
        },
        {
            "affiliation": "Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.",
            "firstname": "Lisa",
            "initials": "L",
            "lastname": "Leffert"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, University of Utah School of Medicine and Intermountain Healthcare, Salt Lake City, Utah.",
            "firstname": "Stephanie",
            "initials": "S",
            "lastname": "Lin"
        },
        {
            "affiliation": "Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.",
            "firstname": "Manokanth",
            "initials": "M",
            "lastname": "Madapu"
        },
        {
            "affiliation": "From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.",
            "firstname": "Michael D",
            "initials": "MD",
            "lastname": "Maile"
        },
        {
            "affiliation": "Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.",
            "firstname": "Emily",
            "initials": "E",
            "lastname": "McQuaid-Hanson"
        },
        {
            "affiliation": "From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.",
            "firstname": "Kristina",
            "initials": "K",
            "lastname": "Priessnitz"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Shaare Zedek Medical Centre, Jerusalem, Israel.",
            "firstname": "Hen Y",
            "initials": "HY",
            "lastname": "Sela"
        },
        {
            "affiliation": "Feinberg School of Medicine, Northwestern University, Evanston, Illinois.",
            "firstname": "Anuj",
            "initials": "A",
            "lastname": "Shah"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Beaumont Health, Royal Oak, Michigan.",
            "firstname": "Paul",
            "initials": "P",
            "lastname": "Sobolewski"
        },
        {
            "affiliation": "Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.\nCenter for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois.",
            "firstname": "Paloma",
            "initials": "P",
            "lastname": "Toledo"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.",
            "firstname": "Lawrence C",
            "initials": "LC",
            "lastname": "Tsen"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.",
            "firstname": "Brian T",
            "initials": "BT",
            "lastname": "Bateman"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1213/ANE.0000000000003709",
    "journal": "Anesthesia and analgesia",
    "keywords": [],
    "methods": null,
    "publication_date": "2019-11-20",
    "pubmed_id": "31743182\n28697109\n25003759\n16319245\n26348189\n11794169\n25162253\n26903338\n1303622\n25198266\n15836892\n29289687\n24613756\n24023020\n28101605\n16625125\n22504241",
    "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.",
    "title": "Risk Factors, Etiologies, and Screening Tools for Sepsis in Pregnant Women: A Multicenter Case-Control Study.",
    "xml": "<Element 'PubmedArticle' at 0x7885054244f0>"
}