Research reveals best approach for detecting maternal sepsis

A new study led by researchers at the University of Limerick in Ireland has revealed the most effective way to diagnose maternal sepsis, a disease with devastating consequences globally.

The new study of microbiology samples used to study maternal sepsis found that placental swabs can provide critical information to guide antimicrobial treatment.

The results, described as “very significant” by the research team, have just been published in PLOS ONE.

The study was carried out by researchers from the University of Limerick (UL) and University Maternity Hospital Limerick (UMHL) and involved the examination of almost 2,000 specimens collected over 5.5 years.

Maternal or perinatal sepsis is a well-recognized risk and a pathology that affects more than 20 million women and causes 17,000 deaths per year.

However, identifying the responsible agents can be difficult. Blood cultures, the gold standard for diagnosis, often have low positivity rates. Other samples, such as vaginal swabs, provide limited clinical value.

This unique new study was led by Professor Colum Dunne, Director of the School and Foundation Chair and Director of Research at the UL School of Medicine and carried out by a team of researchers from UL and of the UMHL.

The team retrospectively analyzed bacterial culture results from a number of different samples that were collected as part of a “septic screen”, which detects bacteria that can cause maternal infections and lead to septicemia. These samples were: blood, urine, throat swabs, vaginal swabs and placental swabs.

“Maternal sepsis can occur during pregnancy or when an incision, tear or other wound caused by a cesarean section becomes infected in the days or weeks after delivery,” Professor Dunne explained.

“This study provides new information on how sepsis can be detected and the organisms involved identified early, so that the best approach for successful treatment can be selected.”

Professor Dunne explained that national, and even international, guidelines are “not consistent” in their recommendations for the diagnosis of maternal infections, and that there is very little information available in the scientific literature regarding the use of swabs. placentals.

“By examining the results of each of these samples from 430 women, they could be compared to determine which detected the greatest number of pathogens and, in this study, the placental samples were found to be the most effective,” she said. explained Professor Dunne.

“These results are very important because these swabs are not always tested in hospitals. As a result, important information that could be used in choosing treatment for these infections could be missed.”

James Powell, Surveillance Scientist at University Hospital Limerick and one of the lead authors, said: “I am delighted to be part of the team that carried out this research, and it was a great honor to be able to present our results at the European Congress of Clinical Microbiology and Infectious Diseases, Copenhagen, Denmark.”

Professor Roy Philip, Consultant Neonatologist and Pediatrician in the Division of Neonatology, Department of Pediatrics, University Maternity Hospital Limerick and Assistant Clinical Professor of Neonatology at UL, explained: “Placental microbial analysis remains a relatively unexplored in the management of perinatal sepsis, and we hope that our research improves clinical awareness.

Professor Nuala O’Connell, consultant microbiologist and clinical assistant professor of microbiology at UL, added: “The value of sending placental swabs for microbiological analysis as part of a septic workup is under-recognized.

“This study will increase the medical literature in the areas of maternal and neonatal sepsis diagnosis and thus contribute to antimicrobial stewardship. »