Defining Physiological Predictors of Peripartum Maternal Bacteremia.
OBJECTIVE
This study aims to examine physiological and laboratory parameters associated with peripartum maternal bacteremia.


METHODS
This case-control study matched 115 cases (women with fever and bacteremia during the peripartum period) to 285 controls (defined as the next two febrile women with negative blood cultures at the same institution) from two academic medical centers from 2009 to 2013. Conditional logistic regression models were used to evaluate the association of physiological and laboratory parameters with maternal bacteremia at the time of initial and maximum fever.


RESULTS
At the time of initial fever, temperature > 103°F (adjusted odds ratio [aOR]: 5.58, 95% confidence interval [CI]: 2.05-15.19) and respiratory rate (RR) > 20 respirations per minute (aOR: 5.27, 95% CI: 2.32-11.96) were associated with bacteremia. At the time of maximum fever, temperature (> 102°F, aOR: 3.37, 95% CI: 1.61-7.06; > 103°F, aOR: 7.96, 95% CI: 3.56-17.82), heart rate > 110 beats per minute (aOR: 2.20, 95% CI: 1.21-3.99), and RR > 20 (aOR: 3.65, 95% CI: 1.65-8.08) were associated with bacteremia. Bandemia > 10% (aOR: 2.44, 95% CI: 1.07-5.54) was associated with bacteremia.


CONCLUSIONS
Physiological and laboratory parameters associated with maternal bacteremia differed from those reported with sepsis in the adult critical care population. Further studies of objective markers are needed to improve detection and treatment of peripartum bacteremia.
Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts.
Rose L
RL
Molina
Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts.
Sarah Rae
SR
Easter
Department of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts.
Kartik K
KK
Venkatesh
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
David E
DE
Cantonwine
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Anjali J
AJ
Kaimal
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts.
Ruth E
RE
Tuomala
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts.
Laura E
LE
Riley
D000328:Adult; D019540:Area Under Curve; D016470:Bacteremia / Q000175:diagnosis / Q000503:physiopathology*; D001772:Blood Cell Count; D016022:Case-Control Studies; D005260:Female; D005334:Fever / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D009504:Neutrophils; D058725:Peripartum Period / Q000502:physiology; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000503:physiopathology*; D012372:ROC Curve; D056152:Respiratory Rate; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult