Sepsis,which is life-threatening organ dysfunction resulting from a dysregulated host response to infection,remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leadin...Sepsis,which is life-threatening organ dysfunction resulting from a dysregulated host response to infection,remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leading causes of maternal morbidity and mortality.The obstetric causes include uterine infection,septic abortion,and wound infection.The non-obstetric causes include pyelonephritis and pneumonia.Maternal sepsis may also be from obstetrical critical illness,such as obstetric severe hemorrhage,obstetric(amniotic fluid/pulmonary)embolism,acute fatty liver of pregnancy,and congestive heart failure,cardiopulmonary arrest,and major trauma.The most commonly reported pathogens in maternal sepsis include Escherichia coli,Streptococcus,Staphylococcus,and other gram-negative bacteria.Maternal sepsis may cause intrauterine infection,which results in(1)preterm premature rupture of membranes or preterm labor or birth,(2)cerebral white matter damage or cerebral palsy or neurodevelopmental delay,(3)stillbirth,(4)early-or late-onset sepsis,and(5)perinatal death.The"Hour-1 bundle"should be initiated within the first hour of the recognition of sepsis.The use of early,appropriate antibiotics is crucial in the management of maternal sepsis.Fetal status should be monitored.Appropriate and early source control should be provided.The decision for delivery is often quite complex and should be individualized to each patient’s clinical scenario while taking into consideration the suspected source of infection,maternal status,fetal well-being,and gestational age.Extracorporeal membrane oxygenation has been increasingly used in refractory sepsis during pregnancy and the puerperium.展开更多
Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidi...Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention,cesarean birth,postpartum uterine atony with hemorrhage,endometritis,peritonitis,sepsis,adult respiratory distress syndrome and,rarely,death.Chorioamnionitis can result from an ascending infection,iatrogenic causes or transplacental passage from maternal blood-borne infections.The clinical findings of chorioamnionitis include maternal fever(≥38°C),maternal(>100 beats per minute)and/or fetal tachycardia(>160 beats per minute),maternal leukocytosis on complete blood count(>15000 cells/mm 3),and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid.The management of chorioamnionitis mainly includes antibiotic therapy and delivery.Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach.The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible,with appropriate neonatal resuscitation available.展开更多
To editor:Clostridium innocuum is a gram-positive spore forming bacillus that normally exists in the oral cavity and gastrointestinal tract.Although it is a rare pathogen for humans,C.innocuum can cause sepsis,especia...To editor:Clostridium innocuum is a gram-positive spore forming bacillus that normally exists in the oral cavity and gastrointestinal tract.Although it is a rare pathogen for humans,C.innocuum can cause sepsis,especially in patients with immunodeficiency,such as those presenting with acquired immunodeficiency syndrome,leukemia,tumors or organ transplants.Since C.innocuum is resistant to several common antibiotics(including vancomycin),it can lead to serious infection.1–5 We report a case of puerperal sepsis caused by C.innocuum in a patient with placenta accreta.The clinical characteristics of C.innocuum infection,as well as its antibiotic susceptibility,were reviewed.A treatment strategy for this rare infection was proposed.This is the first report of Puerperal sepsis caused by C.innocuum in English literature.展开更多
基金This research was supported by the Shenzhen Science and Technology Innovation Commission(JCYJ20180228162311024)
文摘Sepsis,which is life-threatening organ dysfunction resulting from a dysregulated host response to infection,remains a major cause for the admission of pregnant women to the intensive care unit and is one of the leading causes of maternal morbidity and mortality.The obstetric causes include uterine infection,septic abortion,and wound infection.The non-obstetric causes include pyelonephritis and pneumonia.Maternal sepsis may also be from obstetrical critical illness,such as obstetric severe hemorrhage,obstetric(amniotic fluid/pulmonary)embolism,acute fatty liver of pregnancy,and congestive heart failure,cardiopulmonary arrest,and major trauma.The most commonly reported pathogens in maternal sepsis include Escherichia coli,Streptococcus,Staphylococcus,and other gram-negative bacteria.Maternal sepsis may cause intrauterine infection,which results in(1)preterm premature rupture of membranes or preterm labor or birth,(2)cerebral white matter damage or cerebral palsy or neurodevelopmental delay,(3)stillbirth,(4)early-or late-onset sepsis,and(5)perinatal death.The"Hour-1 bundle"should be initiated within the first hour of the recognition of sepsis.The use of early,appropriate antibiotics is crucial in the management of maternal sepsis.Fetal status should be monitored.Appropriate and early source control should be provided.The decision for delivery is often quite complex and should be individualized to each patient’s clinical scenario while taking into consideration the suspected source of infection,maternal status,fetal well-being,and gestational age.Extracorporeal membrane oxygenation has been increasingly used in refractory sepsis during pregnancy and the puerperium.
基金This research was supported by the Shenzhen Science and Technology Innovation Commission(JCYJ20180228162311024)
文摘Intraamniotic infection(IAI)or chorioamnionitis is a common cause of preterm birth and may cause adverse neonatal outcomes,including neonatal pneumonia,respiratory distress,meningitis,sepsis,and death.Maternal morbidities from intraamniotic infection include dysfunctional labor requiring increased intervention,cesarean birth,postpartum uterine atony with hemorrhage,endometritis,peritonitis,sepsis,adult respiratory distress syndrome and,rarely,death.Chorioamnionitis can result from an ascending infection,iatrogenic causes or transplacental passage from maternal blood-borne infections.The clinical findings of chorioamnionitis include maternal fever(≥38°C),maternal(>100 beats per minute)and/or fetal tachycardia(>160 beats per minute),maternal leukocytosis on complete blood count(>15000 cells/mm 3),and uterine tenderness and/or purulent and/or foul-smelling amniotic fluid.The management of chorioamnionitis mainly includes antibiotic therapy and delivery.Women with previable preterm premature rupture of membranes should be offered realistic counseling from a multidisciplinary approach.The separation of the mother and the fetus to preserve the life of the mother should prioritize delivery methods that result in a living fetus if possible,with appropriate neonatal resuscitation available.
基金Funding was provided by the Shenzhen Science and Technology Innovation Commission(JCYJ20160428175005906)
文摘To editor:Clostridium innocuum is a gram-positive spore forming bacillus that normally exists in the oral cavity and gastrointestinal tract.Although it is a rare pathogen for humans,C.innocuum can cause sepsis,especially in patients with immunodeficiency,such as those presenting with acquired immunodeficiency syndrome,leukemia,tumors or organ transplants.Since C.innocuum is resistant to several common antibiotics(including vancomycin),it can lead to serious infection.1–5 We report a case of puerperal sepsis caused by C.innocuum in a patient with placenta accreta.The clinical characteristics of C.innocuum infection,as well as its antibiotic susceptibility,were reviewed.A treatment strategy for this rare infection was proposed.This is the first report of Puerperal sepsis caused by C.innocuum in English literature.
