A Retrospective Study of the Proportion of Women at High and Low Risk of Intrauterine Infection Meeting Sepsis Criteria

The Surviving Sepsis Campaign recently recommended that qSOFA not be used as a single parameter for identification of sepsis. Thus, we evaluated the efficacy of SIRS and qSOFA scores in identifying intrauterine infection. This case-control study evaluates SIRS and qSOFA criteria fulfillment in preterm premature rupture of membranes (n = 453)-at high infection risk-versus elective cesarean-at low infection risk (n = 2004); secondary outcomes included intrauterine infection and positive culture rates. At admission, 14.8% of the study group and 4.6% of control met SIRS criteria (p = 0.001), as did 12.5% and 5.5% on post-operation day (POD) 1 (p = 0.001), with no significant differences on POD 0 or 2. Medical records did not suffice for qSOFA calculation. In the study group, more cultures (29.8% versus 1.9%-cervix; 27.4% versus 1.1%-placenta; 7.5% versus 1.7%-blood; p = 0.001-all differences) and positive cultures (5.5% versus 3.0%-urine-p = 0.008; 4.2% versus 0.2%-cervix-p = 0.001; 7.3% versus 0.0%-placenta-p = 0.001; 0.9% versus 0.1%-blood-p = 0.008) were obtained. Overall, 10.6% of the study group and 0.4% of control met the intrauterine infection criteria (p = 0.001). Though a significant difference was noted in SIRS criteria fulfillment in the study group versus control, there was considerable between-group overlap, questioning the utility of SIRS in intrauterine infection diagnosis. Furthermore, the qSOFA scores could not be assessed.