Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California.
Am J Perinatol. 2024 Oct;41(13):1767-1778. doi: 10.1055/s-0044-1780538. Epub 2024 Feb 26.
This study aimed to evaluate trends, risk factors, and outcomes associated with infections and sepsis during delivery hospitalizations in the United States.
The 2000-2020 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with and without infection and sepsis were identified. Common infection diagnoses during delivery hospitalizations analyzed included (i) pyelonephritis, (ii) pneumonia/influenza, (iii) endometritis, (iv) cholecystitis, (v) chorioamnionitis, and (vi) wound infection. Temporal trends in sepsis and infection during delivery hospitalizations were analyzed. The associations between sepsis and infection and common chronic health conditions including asthma, chronic hypertension, pregestational diabetes, and obesity were analyzed. The associations between clinical, demographic, and hospital characteristics, and infection and sepsis were determined with unadjusted and adjusted logistic regression models with unadjusted odds ratio (OR) and adjusted odds ratios with 95% confidence intervals as measures of association.
An estimated 80,158,622 delivery hospitalizations were identified and included in the analysis, of which 2,766,947 (3.5%) had an infection diagnosis and 32,614 had a sepsis diagnosis (4.1 per 10,000). The most common infection diagnosis was chorioamnionitis (2.7% of deliveries) followed by endometritis (0.4%), and wound infections (0.3%). Infection and sepsis were more common in the setting of chronic health conditions. Evaluating trends in individual infection diagnoses, endometritis and wound infection decreased over the study period both for patients with and without chronic conditions, while risk for pyelonephritis and pneumonia/influenza increased. Sepsis increased over the study period for deliveries with and without chronic condition diagnoses. Risks for adverse outcomes including mortality, severe maternal morbidity, the critical care composite, and acute renal failure were all significantly increased in the presence of sepsis and infection.
Endometritis and wound infections decreased over the study period while risk for sepsis increased. Infection and sepsis were associated with chronic health conditions and accounted for a significant proportion of adverse obstetric outcomes including severe maternal morbidity.
· Sepsis increased over the study period for deliveries with and without chronic condition diagnoses.. · Endometritis and wound infection decreased over the study period.. · Infection and sepsis accounted for a significant proportion of adverse obstetric outcomes..
本研究旨在评估美国分娩住院期间与感染和败血症相关的趋势、风险因素和结局。
本重复横断面分析使用了 2000 年至 2020 年的国家住院患者样本。确定了患有和不患有感染和败血症的 15 至 54 岁患者的分娩住院感染病例。分析了分娩住院期间常见的感染诊断，包括（i）肾盂肾炎，（ii）肺炎/流感，（iii）子宫内膜炎，（iv）胆囊炎，（v）绒毛膜羊膜炎和（vi）伤口感染。分析了分娩住院期间败血症和感染的时间趋势。分析了败血症和感染与哮喘、慢性高血压、孕前糖尿病和肥胖等常见慢性健康状况之间的关联。使用未调整和调整后的逻辑回归模型，以未调整比值比（OR）和调整后的比值比及其 95%置信区间作为关联的衡量指标，确定了临床、人口统计学和医院特征与感染和败血症之间的关联。
估计有 80158622 例分娩住院，其中 2766947 例（3.5%）有感染诊断，32614 例有败血症诊断（每 10000 例 4.1 例）。最常见的感染诊断是绒毛膜羊膜炎（占分娩的 2.7%），其次是子宫内膜炎（0.4%）和伤口感染（0.3%）。感染和败血症在慢性健康状况下更为常见。评估个别感染诊断的趋势，子宫内膜炎和伤口感染在有或没有慢性疾病的情况下均呈下降趋势，而肾盂肾炎和肺炎/流感的风险增加。有或没有慢性疾病诊断的分娩患者中，败血症的风险在研究期间呈上升趋势。包括死亡率、严重产妇发病率、重症监护综合指数和急性肾功能衰竭在内的不良结局风险在败血症和感染的存在下均显著增加。
在研究期间，子宫内膜炎和伤口感染减少，而败血症的风险增加。感染和败血症与慢性健康状况有关，并导致包括严重产妇发病率在内的不良产科结局的显著比例。
· 有或没有慢性疾病诊断的分娩患者中，败血症的风险在研究期间呈上升趋势。· 在研究期间，子宫内膜炎和伤口感染减少。· 感染和败血症导致了显著比例的不良产科结局。
