Maternal sepsis in Italy: a prospective, population-based cohort and nested case-control study
Open accessAbstract
Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks’ gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80–6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.
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During pregnancy and postpartum period, bloodstream infections - especially sepsis - are commonly caused by Escherichia coli (about 60.26%), coagulase negative Staphylococci (about 6.03%), and Klebsiella pneumoniae.
“During pregnancy and postpartum period, bloodstream infections – especially sepsis – are commonly caused by 3 types of bacteria: Escherichia coli (mainly, about 60.26%),26,27 coagulase negative Staphylococci (about 6.03%,26 Staphylococcus epidermidis accounts for 60% to 70%, hemolytic staphylococci, etc),28 Klebsiella pneumoniae;29”
From Clinical and Pathogenic Characteristics of 45 Cases of Bloodstream Infection in Obstetrics: A Clinical Analysis (2026) · cites this paper as [27]
The Results report E. coli as the most frequent isolate in maternal sepsis cases with positive cultures and list coagulase-negative Staphylococcus among the isolates. They do not report bloodstream-specific proportions of 60.26% or 6.03%; E. coli accounts for 31.1% of positive-culture cases in this study. In the citing sentence, Klebsiella pneumoniae is attached to a different citation. (LLM, conf=0.88)
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- Authors
- Ornaghi, S., Maraschini, A., Buoncristiano, M., Corsi Decenti, E., Colciago, E., Cetin, I., Donati, S., & on behalf of the ItOSS-Regional Working Group
- Affiliations
- Azienda Ospedaliera San Gerardo (IT)
- Istituto Superiore di Sanità (IT)
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità—Italian National Institute of Health, 00161 Rome, Italy
- University of Milano-Bicocca (IT)
- University of Milan (IT)
- Corresponding author
- Ornaghi, Sara
- ORCID
- Venue
- Microorganisms
- Publisher
- MDPI AG
- Published
- 2022-12-31
- Volume
- 11
- Issue
- 1
- Pages
- 105
- ISSN
- 2076-2607 (ISSN-L)
- PMC
- PMC9865500
- OpenAlex
- W4313472362
- Cited by
- 9
- References
- 49
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 6
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Microorganisms (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- BOA (University of Milano-Bicocca) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Italian Ministry of Health
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- maternal sepsis, puerperal fever, incidence, risk factors, indwelling urinary catheter, Escherichia coli, co-infection, genital tract infection, urinary tract infection, respiratory infections, perinatal outcomes, neonatal mortality, maternal mortality, intensive care, language barriers, foreign-born women
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