Antimicrobial stewardship in the management of sepsis in maternity hospitals : a mixed methodology study

• Main Author: Abutheraa, Nouf
• Published: University of Strathclyde 2018
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.759439

Background: Sepsis is one of the leading causes of maternal mortality and morbidity. The absence of a clear diagnostic marker challenges the process of starting antibiotic therapy. Early identification and management of sepsis is essential. Thus, the sepsis six care bundle (SSCB) was introduced in the UK to improve the care of sepsis patients. Aim: To evaluate assessment of sepsis and subsequent management including the antibiotic therapy prescribed, and to use this data as a basis of antimicrobial stewardship programme (AMSP) and quality improvement plan within maternity units. Methods: This study was conducted within three maternity units of NHS Greater Glasgow & Clyde using a mixed methodological approach of an initial quantitative study supplemented by a qualitative study, followed by a quality improvement for further service improvement. Results: Sepsis was diagnosed in 3% (n=89/2690) of women. There was an inconsistent clinical application of SIRS criteria to inform diagnosis. No causative pathogen was isolated from 60% of clinical specimens. Antibiotic therapy was justified in only 31 women with positive culture results. There was a limited application of AMSPs in the maternity units and midwives did not make a positive contribution, and had a low clinical threshold for initiating therapy. Only 37.1% of the 89 women diagnosed with sepsis had the identifiable SSCB sticker prominently displayed on their medical notes. Interview findings indicate that this resulted from the absence of implementation strategies, the challenge of diagnosing sepsis and sub-optimal evaluation and review of patients post-diagnosis. Conclusion: A specialized SSCB specifically for the obstetric population with the full contribution of the multidisciplinary team needs to be developed. Given midwives' central involvement in initial diagnosis, ongoing patient monitoring and antibiotic administration, a more midwife-centred approach to reviewing treatment is a promising way to develop AMSPs in maternity wards.