TY - JOUR
T1 - The golden hour of sepsis
T2 - An in-depth analysis of sepsis-related maternal mortality in middle-income country Suriname
AU - Kodan, Lachmi R
AU - Verschueren, Kim J C
AU - Kanhai, Humphrey H H
AU - van Roosmalen, Jos J M
AU - Bloemenkamp, Kitty W M
AU - Rijken, Marcus J
N1 - Funding Information:
The authors received no specific funding for this work. The authors wish to thank the Ministry of Health of Suriname, the Bureau of Public Health and the Central Bureau of Civil Registration for their support, as well as the hospital boards of all hospitals in Suriname, Regional Health Services and Medical Mission for making this study possible. We are also thankful to the members of the expert committee who carefully analysed every case.
Publisher Copyright:
© 2018 Kodan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/7/10
Y1 - 2018/7/10
N2 - BACKGROUND: Sepsis was the main cause of maternal mortality in Suriname, a middle-income country. Objective of this study was to perform a qualitative analysis of the clinical and management aspects of sepsis-related maternal deaths with a focus on the 'golden hour' principle of antibiotic therapy.METHODS: A nationwide reproductive age mortality survey was performed from 2010 to 2014 to identify and audit all maternal deaths in Suriname. All sepsis-related deaths were reviewed by a local expert committee to assess socio-demographic characteristics, clinical aspects and substandard care.RESULTS: Of all 65 maternal deaths in Suriname 29 (45%) were sepsis-related. These women were mostly of low socio-economic class (n = 23, 82%), of Maroon ethnicity (n = 14, 48%) and most deaths occurred postpartum (n = 21, 72%). Underlying causes were pneumonia (n = 14, 48%), wound infections (n = 3, 10%) and endometritis (n = 3, 10%). Bacterial growth was detected in 10 (50%) of the 20 available blood cultures. None of the women with sepsis as underlying cause of death received antibiotic treatment within the first hour, although most women fulfilled the diagnostic criteria of sepsis upon admission. In 27 (93%) of the 29 women from which sufficient information was available, substandard care factors were identified: delay in monitoring in 16 (59%) women, in diagnosis in 17 (63%) and in treatment in 21 (78%).CONCLUSION: In Suriname, a middle-income country, maternal mortality could be reduced by improving early recognition and timely diagnosis of sepsis, vital signs monitoring and immediate antibiotic infusion (within the golden hour).
AB - BACKGROUND: Sepsis was the main cause of maternal mortality in Suriname, a middle-income country. Objective of this study was to perform a qualitative analysis of the clinical and management aspects of sepsis-related maternal deaths with a focus on the 'golden hour' principle of antibiotic therapy.METHODS: A nationwide reproductive age mortality survey was performed from 2010 to 2014 to identify and audit all maternal deaths in Suriname. All sepsis-related deaths were reviewed by a local expert committee to assess socio-demographic characteristics, clinical aspects and substandard care.RESULTS: Of all 65 maternal deaths in Suriname 29 (45%) were sepsis-related. These women were mostly of low socio-economic class (n = 23, 82%), of Maroon ethnicity (n = 14, 48%) and most deaths occurred postpartum (n = 21, 72%). Underlying causes were pneumonia (n = 14, 48%), wound infections (n = 3, 10%) and endometritis (n = 3, 10%). Bacterial growth was detected in 10 (50%) of the 20 available blood cultures. None of the women with sepsis as underlying cause of death received antibiotic treatment within the first hour, although most women fulfilled the diagnostic criteria of sepsis upon admission. In 27 (93%) of the 29 women from which sufficient information was available, substandard care factors were identified: delay in monitoring in 16 (59%) women, in diagnosis in 17 (63%) and in treatment in 21 (78%).CONCLUSION: In Suriname, a middle-income country, maternal mortality could be reduced by improving early recognition and timely diagnosis of sepsis, vital signs monitoring and immediate antibiotic infusion (within the golden hour).
UR - http://www.scopus.com/inward/record.url?scp=85049619264&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0200281
DO - 10.1371/journal.pone.0200281
M3 - Article
C2 - 29990331
SN - 1932-6203
VL - 13
SP - 1
EP - 14
JO - PLoS ONE [E]
JF - PLoS ONE [E]
IS - 7
M1 - e0200281
ER -