4% of PASS hospitalizations by Bauer et al. . Gram-negative and Gram-positive bacteria were evenly reported (49.5% Selleckchem Fer-1 and 46.1%, respectively). E. coli was the most common isolate.
The TPCA-1 cost investigators did not describe rates of polymicrobial versus monomicrobial PASS events. Infections in the obstetric population are often described as polymicrobial , likely reflecting the predominance of genital tract infection. No data are presently available on site-specific infecting microorganisms in obstetric patients with sepsis versus severe sepsis. Similarly, contemporary trends in antimicrobial resistance of infecting microorganisms among patients with maternal sepsis and specifically PASS have not been systematically examined and require
further study. Management of Pregnancy-Associated Severe Sepsis Early recognition of possible severe sepsis, coupled with timely effective interventions are key elements in the management of PASS, similarly to those in the general population with severe sepsis. Because, as noted earlier, the initial clinical manifestations of PASS may overlap those of pregnancy-related physiological changes [24, 25], while the findings pointing to the source of infection may not be readily apparent, heightened level of suspicion by clinicians is essential to assure timely care. The specific components of care of patients with PASS are commonly based on the periodically revised practice guidelines of the SSC , which include evolving research data on severe sepsis. However, the SSC diagnostic criteria and care elements were never validated KU55933 supplier in the obstetric population and pregnant women were commonly excluded from severe sepsis trials [15, 37]. Early antimicrobial
therapy, prompt circulatory resuscitation in patients with hypotension or elevated lactate, and effective early source control of infection are the main elements of the initial care of PASS, with further organ-specific support in DNA Synthesis inhibitor individual patients. Patients with PASS are commonly managed in an ICU. Empiric broad-spectrum antimicrobial therapy should be initiated within the first 60 min of the clinical manifestations of PASS  (once the patient is in a healthcare setting), adjusted for the suspected site of infection (if apparent) and selected with knowledge of the local antimicrobial resistance patterns of potential pathogens. A recent report by Ferrer et al.  has confirmed the earlier findings by Kumar et al. , demonstrating in a large multinational dataset that each hour of delay in antimicrobial therapy is associated with adjusted linear rise in patient mortality for both severe sepsis and septic shock . The absolute risk of death with antibiotic delay was lower than that reported by Kumar et al. , likely reflecting in part the markedly reduced case fatality in contemporary severely septic patients and increased adherence to other components of the early support of these patients.