(1142) Intrapartum Maternal Bacteremia: an Important Predictor of Puerperal Adverse Outcomes

We aimed to assess the risk factors, pathogens, and outcomes in Individuals with intrapartum fever with and without proven bacteremia bacteremia.

Study Design:

We conducted a retrospective study at a single tertiary center (October 2011 to February 2024). Included in the study were individuals with singleton pregnancies in labor beyond 24 weeks who experienced intrapartum fever (defined as > 38 degrees Celsius). We excluded those with unavailable blood cultures for review. Baseline demographic and delivery characteristics were compared between those with positive cultures and those with negative or non-pathogenic blood cultures (contaminants). The primary outcome was a composite adverse maternal outcome (CAMO), which included any of the following: length of stay > 4 days, ICU admission, CT-guided drainage, fever-related surgery, and death. A multivariable regression analysis was performed for the primary outcome, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported.

Results:

Out of 86,904 deliveries, 3,603 (4.1%) had intrapartum fever, and 3,047 (85%) met inclusion criteria.  Among these, 117 (3.8%) had positive blood cultures, with the most common blood-borne pathogens being non-hemolytic Streptococci, Enterobacterales, and GBS (Figure). Those with bacteremia differed from those without in terms of age, rate of nulliparity, rate of spontaneous labor onset, preterm delivery, and neuraxial analgesia. Furthermore, patients with bacteremia had a higher maximal temperature and WBC count, had a higher rate of cesarean delivery, and required additional broad-spectrum second-line antibiotics. Following multi-variable regression, those with bacteremia had a higher rate of CAMO (85.5% vs. 38.6%, aOR 16.0, CI 7.2-35.8, Table) compared to those without bacteremia.

Conclusion:

Intrapartum fever accompanied by bacteremia is associated with an increased need for second-line antibiotic use and poorer maternal outcomes. This study underscores the importance of blood culture among individuals at risk in guiding treatment and identifying individuals at higher risk of adverse maternal complications.