Search

Objective This study aims to estimate postcesarean infectious morbidity in women receiving perioperative β-lactam versus non-β-lactam antibiotics. Methods We conducted a retrospective cohort analysis of the Maternal-Fetal Medicine Unit Cesarean Registry. The exposure was β-lactam perioperative antibiotics versus non-β-lactam regimens at cesarean delivery (CD). We stratified by labored versus unlabored CD. The primary composite outcome included wound infection, seroma, hematoma, endometritis, readmission due to wound complication, or debridement. Multivariable logistic regression estimated odds of wound complication by antibiotic regimen after adjusting for relevant confounders. Results Our analysis included 43,735 women who delivered via CD, 48% following labor. In both groups, 95% of women received β-lactam antibiotics. In the labored CD group (n = 20,860), there was no significant difference in primary outcome by β-lactam versus non-β-lactam antibiotics (10.5 vs. 9.9%, p = 0.53). In the unlabored CD group (n = 22,875), women receiving non-β-lactam antibiotics were more likely to experience a wound complication compared with those in the β-lactam group (6.2 vs. 4.7%, p = 0.02, adjusted odds ratio: 1.39, 95% confidence interval: 1.08-1.80) after adjustment for clinical confounders. Conclusion In unlabored CD, non-β-lactam antibiotics have a higher risk of wound complications compared with β-lactam regimens. Further study to optimize antibiotic prophylaxis for β-lactam allergic women undergoing unlabored CD is warranted. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to identify risk factors associated with the development of septic pelvic thrombophlebitis (SPT). Study Design This is a secondary case-control study of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Unit Network Cesarean Registry. SPT was defined as suspected infectious thrombosis of the pelvic veins, often persistent febrile illness in the setting of antibiotic therapy for endometritis. Women with SPT were compared with those without SPT using descriptive statistics. Logistic regression models estimated the association between selected risk factors and SPT. Results Of 73,087 women in the cohort, 89 (0.1%) developed SPT. Women with SPT were more likely to be < 20 years old (33.7 vs. 10.6%, p < 0.001), black race (58.4 vs. 29.1%, p < 0.001), and nulliparous (51.1 vs. 23.3%, p < 0.001). Hypertensive disorders of pregnancy (32.6 vs. 11.8%, p < 0.001) and multiple gestation (12.5 vs. 7.4%, p = 0.03) were also more common in women with SPT. In the multivariable regression model, maternal age < 20, black race, multiple gestation, and preeclampsia were all significantly associated with increased odds of SPT (adjusted odds ratio [aOR]: 1.96, 95% confidence interval [CI]: 1.22,3.14; aOR: 2.6, 95% CI: 1.68,4.02; aOR: 2.10,95% CI: 1.13, 3.88; aOR: 2.91, 95% CI: 1.86, 4.57). Conclusion SPT is a rare pregnancy complication. Our analysis confirmed known risk factors (e.g., infections, cesarean delivery), and identified novel ones, including black race, young age, preeclampsia, and multiple gestation. [ABSTRACT FROM AUTHOR]

Objective:  This study aims to determine if pregnant patients with both pyelonephritis and anemia are at an increased risk of adverse maternal outcomes compared with those with pyelonephritis without anemia., Study Design:  We conducted a retrospective cohort study utilizing the Nationwide Readmissions Database (NRD). Patients with antepartum pyelonephritis-associated hospitalizations from October 2015 to December 2018 were included. International Classification of Diseases codes were used to identify pyelonephritis, anemia, maternal comorbidities, and severe maternal morbidities. The primary outcome was a composite of severe maternal morbidity, as defined by the Centers for Disease Control criteria. Univariate statistical methods, weighted to account for complex survey methods in the NRD, were used to assess for associations between anemia, baseline characteristics, and patient outcomes. Weighted logistic and Poisson regressions were used to assess for associations between anemia and outcomes, adjusting for clinical comorbidities and other confounding factors., Results:  In total, 29,296 pyelonephritis admissions were identified, corresponding to a weighted national estimate of 55,135 admissions. Of these, 11,798 (21.3%) were anemic. The rate of severe maternal morbidity was higher among anemic patients than nonanemic patients (27.8 vs. 8.9%, respectively, p  < 0.001), and remained higher after adjustment (adjusted relative risk [aRR] 2.86 [95% confidence interval [CI]: 2.67, 3.06]). Rates of individual components of severe maternal morbidities, including acute respiratory distress syndrome (4.0 vs. 0.6%, aRR 3.97 [95% CI: 3.10, 5.08]), sepsis (22.5 vs. 7.9%, aRR 2.64 [95% CI: 2.45, 2.85]), shock (4.5 vs. 0.6%, aRR 5.48 [95% CI: 4.32, 6.95]), and acute renal failure (2.9 vs. 0.8%, aRR 1.99 [95% CI: 1.55, 2.55]) were all higher for anemic pyelonephritis. The mean length of stay was also longer (25% average increase, 95% CI: 22, 28%)., Conclusion:  Among pregnant patients with pyelonephritis, those with anemia are at greater risk of severe maternal morbidity and longer hospital stay., Key Points: · Anemia is associated with longer stays for pyelo.. · Anemic pyelo patients have increased morbidity.. · Anemic pyelo patients have increased sepsis risk.., Competing Interests: None declared., (Thieme. All rights reserved.)