An Observational Cohort Study Evaluating Antimicrobial Use in Peripartum Sepsis: A Tendency towards Overdiagnosis?

Nouf Abutheraa* (Corresponding Author), June Grant, Alexander B. Mullen

*Corresponding author for this work

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(1) Background: Sepsis is the leading cause of maternal death in 11–15% of women worldwide. This emphasises the importance of administrating timely and appropriate antibiotic therapy to women with sepsis. We aimed to evaluate the appropriateness of antimicrobial prescribing in women diagnosed with peripartum sepsis. (2) Method: A prospective observational cohort study in a single Scottish health region with 12,233 annual live births. Data were collected on women diagnosed with sepsis in the peripartum period using physical and electronic medical records, drug Kardex® (medication administration) and ward handover records. (3) Results: A sepsis diagnosis was concluded in 89 of the 2690 pregnancy cases reviewed, with a median hospital stay of four days. Good overall adherence to the local guidelines for the empiric antimicrobial treatment of sepsis was observed. Group B Streptococcus was associated with 20.8% of maternal sepsis cases, whilst in 60% of clinical specimens tested no causative pathogen was isolated. (4) Conclusion: The lack of specific and sensitive clinical markers for sepsis, coupled with their inconsistent clinical application to inform diagnosis, hindered effective antimicrobial stewardship. This was further exacerbated by the lack of positive culture isolates from clinical specimens, which meant that patients were often continued on broader-spectrum empiric treatment.
Original languageEnglish
Article number211
Number of pages10
Issue number4
Publication statusPublished - 11 Nov 2020

Bibliographical note

Funding: This research received no external funding. This study was sponsored by the University of Strathclyde. Nouf Abutheraa received a financial scholarship from the government of the Kingdom of Saudi Arabia as part of her PhD studentship. The funding source had no involvement or influence on study design, data collection, analysis and interpretation or writing the report.
Acknowledgments: The authors thank the healthcare staff who provided general support throughout the study.


  • antimicrobial
  • antimicrobial stewardship
  • maternity
  • permpartum
  • pregnancy and labour
  • sepsis


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