Infections/Sepsis in Pregnancy - including GBS GT36, Bacterial Sepsis in/following pregnancy GT64a, b Flashcards
(44 cards)
What is the incidence of Early Onset GBS disease in the UK?
0.5/1000 Births
If GBS was detected in a previous pregnancy what is the likelihood of carriage in a subsequent pregnancy?
50%
If GBS was detected in a previous pregnancy - what is the risk estimate of disease (EOGBS) in this pregnancy?
1/700-1/800
If has third trimester screening and swab is positive for GBS then risk is 1/400
If swab negative then risk is 1/5000
If a woman has pyrexia in labour, and an unknown GBS carrier status, what is the risk of EOGBS?
5.3/1000
What is the risk of EOGBS in preterm deliveries?
What is the mortality rate?
2-3/1000
Mortality rate is 20-30%
What is the antibiotic recommendation for intrapartum antibiotics to prevent EOGBS?
Benzylpenicillin 3g then 1.5g 4 hourly
If penicillin allergic then cefuroxime (1.5g loading dose followed by 750mg 8hourly)
OR Vancomycin 1g every 12hours
(Clindamycin no longer recommended due to resistance rate in UK of 16%).
What % of EOGBS were identified on day 1?
89-94%
How do babies with EOGBS present?
80% sepsis
12% meningitis
8% pneumonia
1% focal
How should well babies at risk of EOGBS whose mothers did not receive adequate IAP be observed?
Assessed for clinical indicators of neonatal infection and have vital signs checked @ 0,2,4,6,8,10,12 hours
In which triennium was sepsis the leading cause of direct maternal deaths in the UK? And which microbe was responsible for death in 13 women?
2006-8
GAS
What is the mortality rate of severe sepsis with acute organ dysfunction?
And if septic shock develops?
Severe sepsis - 20-40%
Septic shock - 60%
What is the definition of sepsis?
Infection plus systemic manifestations of infection
What is the definition of severe sepsis?
Sepsis + sepsis-induced organ dysfunction or tissue hypoperfusion
What is the definition of septic shock?
Persistence of hypoperfusion despite adequate fluid replacement therapy
What are the risk factors for maternal sepsis in pregnancy?
Obesity DM/impaired glucose tolerance Impaired immunity/medication Anaemia Vaginal discharge History of pelvic infection History of group B streptococcal infection Amniocentesis and other invasive procedures Cervical cerclage Prolonged SROM GAS in close contacts Black/minority ethnic
When should lactate be measured in suspicion of severe sepsis and at what level is indicative of tissue hypoperfusion?
Within 6 hours
Lactate >=4
Within what time scale should IVAbx be administered when there is recognition of severe sepsis?
1 hour
What are the parameters for fluid resuscitation in severe sepsis/septic shock if lactate =>4 or there is hypotension?
Crystalloid 20ml/kg initially
If does not respond vasopressors to maintain MAP >65mmHg
If septic shock: CVP >8mmHg
Central venous SpO2 >=70%
Mixed venous SpO2 >= 65%
What are the indications for transfer to ICU?
CV - Hypotension or raised lactate despite fluid resus (ie
need vasopressors)
Resp - Pulmonary oedema, ventilation, airway support
Renal - Dialysis
Neuro - Decreased GCS
Other - Multiorgan failure, uncorrected acidosis,
hypothermia
What are the most commonly identified organisms implicated in maternal death?
- Lancefield group A beta-haemolytic Streptococcus
- E Coli (esp urosepsis, PPROM, cerclage)
Less commonly anaerobes -
- Peptostreptococcus
- Bacteroides spp
(Clostridium perfringens)
What are the limitations of co-amoxiclav when treating sepsis in pregnancy?
No MRSA or Pseudomonas cover
Risk of NEC to neonates
What are the limitations of metronidazole when treating sepsis in pregnancy?
Only covers anaerobes
What are the actions of clindamycin?
Covers most strep and staph including many MRSA
Switches off exotoxin production
Not nephrotoxic/renally excreted
What are the limitations of Tazocin/carbapenems when treating sepsis in pregnancy?
Covers all except MRSA
Renal sparing compared to aminoglycosides
