Predicting peripartum infection in laboring patients at high risk in Cameroon, Africa.

Autor: Cozzi GD; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: gabriellacozzi@uabmc.edu., Ye Y; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA., Mbah R; Cameroon Baptist Convention Health Services, Cameroon, Africa., Mbunwe DM; Cameroon Baptist Convention Health Services, Cameroon, Africa., Pekwarake S; Cameroon Baptist Convention Health Services, Cameroon, Africa., Yui Bunwi E; Cameroon Baptist Convention Health Services, Cameroon, Africa., Fondzeyuf A; Cameroon Baptist Convention Health Services, Cameroon, Africa., Ngong MG; Cameroon Baptist Convention Health Services, Cameroon, Africa., Dionne JA; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA., Harper LM; Department of Women's Health, Division of Maternal Fetal Medicine, University of Texas at Austin, Dell School of Medicine, Austin, TX, USA., Jauk VC; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA., Carlo WA; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA., Halle-Ekane G; Cameroon Baptist Convention Health Services, Cameroon, Africa; University of Buea, Cameroon, Africa., Tih PM; Cameroon Baptist Convention Health Services, Cameroon, Africa., Szychowski JM; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA., Tita AT; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA., Subramaniam A; Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2024 Feb; Vol. 293, pp. 9-14. Date of Electronic Publication: 2023 Dec 06.
DOI: 10.1016/j.ejogrb.2023.12.003
Abstrakt: Objective: To develop a predictive model for peripartum infection among high risk laboring patients in Cameroon, Africa.
Study Design: We conducted a secondary analysis of the Cameroon Antibiotic Prophylaxis Trial (NCT03248297), a multicenter 3-arm double-blind randomized controlled trial of oral azithromycin ± amoxicillin among term pregnancies with prolonged labor or rupture of membranes in Cameroon 1/2018-5/2020. Patients with chorioamnionitis prior to randomization, study drug contraindications, or planned cesarean were excluded. The outcome of interest was a composite of maternal peripartum infection (chorioamnionitis, endometritis, sepsis by World Health Organization criteria, wound infection/abscess) diagnosed up to 6 weeks postpartum. Potential predictors were compared between patients with and without the composite outcome, and evaluated at a 0.05 alpha level. Statistically significant exposures were analyzed using multivariable regression (to generate adjusted odds ratios and 95 % confidence intervals) with backwards selection to generate a parsimonious model. Receiver operating characteristic curves with associated area under the curve assessed the model's predictive ability. A nomogram based on the final best fit multivariable model was constructed.
Results: Of 756 patients in the parent trial, 652 were analyzed: 45 (7 %) had peripartum infection. Those with infection were more likely to be nulliparous, lower education level, higher gestational age, receive antibiotics per hospital protocols, and undergo cesarean. In our best-fit multivariable model, none/primary education (vs university), cesarean birth, and antibiotic receipt per physician discretion (vs for cesarean prophylaxis) were significantly associated with increased infection risk. This model was moderately predictive (AUC = 0.75, 95 % CI 0.67-0.82). When using this 3 factor model, for a patient with a cesarean birth, receipt of antibiotics per physician discretion, and university education, the probability of peripartum infection was 35 % (95 % CI 0.11-0.73).
Conclusions: While several variables such as parity are associated with infectious morbidity within 6 weeks among high risk laboring patients in Cameroon, only education level, antibiotic indication, and cesarean birth were independently associated, and a model including these 3 factors was moderately predictive. Validation of our findings in a larger population is warranted.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)
Databáze: MEDLINE
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