Clinical Report: Impact of a Sepsis Management Bundle in Obstetric Care in Northern Italy
Overview
This multicenter retrospective study evaluated the implementation of a regional sepsis management bundle in obstetric patients in Lombardy, Italy. While maternal outcomes such as mortality and length of stay remained unchanged, neonatal intensive care unit admissions significantly decreased postbundle implementation. Infectious disease specialist consultations increased, suggesting improved sepsis awareness among clinicians.
Background
Sepsis is a leading cause of maternal mortality worldwide, accounting for approximately 11% of maternal deaths. Early identification and management in pregnancy are challenging due to physiological changes and lack of pregnancy-specific sepsis definitions until recently. The Surviving Sepsis Campaign has promoted sepsis bundles to standardize care, but evidence for their efficacy in pregnant populations remains limited. In 2018, Lombardy developed a regional obstetric sepsis bundle to improve outcomes and standardize management.
Data Highlights
Measure
Prebundle (n=24)
Postbundle (n=56)
P value
Neonatal ICU Admissions
85.7%
31.3%
0.013
Infectious Disease Consultations
50.0%
75.0%
0.029
Maternal Deaths
0
0
NS
Median Maternal Length of Stay
Not significantly different
Not significantly different
NS
Key Findings
Implementation of the sepsis bundle did not result in maternal deaths in either period.
Neonatal ICU admissions significantly decreased from 85.7% prebundle to 31.3% postbundle (P = .013).
Infectious disease specialist consultations increased significantly postbundle (75.0% vs 50.0%, P = .029).
No significant difference was observed in maternal median length of hospital stay between pre- and postbundle periods.
The primary infection source was urinary tract infections (40%), with Escherichia coli as the most common pathogen.
Clinical Implications
The regional sepsis management bundle may enhance neonatal outcomes by reducing ICU admissions, potentially through earlier recognition and management of maternal sepsis. Increased infectious disease consultations post-implementation highlight improved clinician awareness and multidisciplinary involvement. However, maternal outcomes such as mortality and length of stay were unchanged, indicating the need for further strategies to impact maternal morbidity.
Conclusion
The introduction of a regional obstetric sepsis bundle in Lombardy was associated with reduced neonatal ICU admissions and increased infectious disease consultations, though maternal outcomes remained stable. These findings support the role of standardized bundles in improving neonatal health and sepsis awareness in obstetric care.
References
Lombardy Fight Against Sepsis in Obstetrics Group, 2023 -- Evaluation of a Sepsis Management Bundle in Obstetric Care: Findings from a Multicenter Study in Northern Italy
