Infection and Sepsis Trends during United States' Delivery Hospitalizations from 2000 to 2020

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Public Health

Background:

• Infections and sepsis are significant concerns during delivery hospitalizations.
• Understanding trends and risk factors is crucial for improving maternal outcomes.
• Chronic health conditions may influence the risk and severity of infections and sepsis.

Purpose of the Study:

• To evaluate trends in infections and sepsis during US delivery hospitalizations from 2000-2020.
• To identify risk factors, including chronic health conditions, associated with these events.
• To assess the impact of infections and sepsis on maternal outcomes.

Main Methods:

• A repeated cross-sectional analysis of the National Inpatient Sample (2000-2020).
• Identification of delivery hospitalizations with specific infection diagnoses (e.g., chorioamnionitis, endometritis) and sepsis.
• Logistic regression models were used to determine associations with chronic conditions and adverse outcomes.

Main Results:

• Over 80 million delivery hospitalizations were analyzed; 3.5% had infections and 0.04% had sepsis.
• Chorioamnionitis was the most common infection, followed by endometritis and wound infections.
• While endometritis and wound infections decreased, sepsis risk, pyelonephritis, and pneumonia/influenza increased over time. Chronic conditions were associated with higher infection/sepsis rates.
• Infection and sepsis significantly increased the risk of mortality, severe maternal morbidity, and acute renal failure.

Conclusions:

• Sepsis risk during delivery hospitalizations has increased, while endometritis and wound infections have decreased.
• Infections and sepsis are associated with chronic health conditions.
• These events contribute significantly to severe maternal morbidity and other adverse obstetric outcomes.