A multi-centre study in Northern Italy to evaluate the impact of a Sepsis bundle in Obstetric Settings: the SOS study

Background In 2018, Lombardy's “Fight against Sepsis in Obstetrics” group developed a regional sepsis management bundle for obstetric patients. This study aimed to evaluate the impact of this bundle on maternal and neonatal clinical outcomes and on process measures. Methods Multicentre, observational, retrospective study including data from pregnant and puerperal adult patients diagnosed with sepsis according to the Surviving Sepsis Campaign guidelines in two periods: May 2015-May 2018 (pre-bundle) and July 2018-January 2023 (post-bundle). Results Eighty women were included, 24 (30.0%) in the pre-bundle and 56 (70.0%) in the post-bundle period. The primary source of infection was urinary (40.0%), with Escherichia coli being the most common pathogen isolated from blood cultures. Regarding clinical outcomes, no deaths occurred in both pre- and post-bundle periods. For mothers there was no significant difference in median length of stay (LOS) between the two groups, while neonatal intensive care unit (NICU) admissions of neonates significantly decreased from 85.7% to 31.3% (p=0.013). Regarding process measures there was only a significant increase in ID specialist consultations in the post-bundle period (75.0%) compared to the pre-bundle period (50.0%) (p=0.029). Conclusion The implementation of a regional maternal sepsis management bundle did not significantly alter maternal outcomes, but was associated with a reduction in NICU admissions, although uncertainty remains as to what role the bundle implementation had in this change. More ID consultations post-bundle highlight the potential role of the bundle increasing sepsis awareness of physicians dealing with these patients.