# A Multicenter Study in Northern Italy to Evaluate the Impact of a Sepsis Bundle in Obstetric Settings: The SOS Study

## TL;DR

A study in Italy evaluated a sepsis management bundle for pregnant women and found it reduced neonatal ICU admissions but had no significant effect on maternal outcomes.

## Contribution

The study introduces a regional sepsis management bundle tailored for obstetric patients and evaluates its real-world impact.

## Key findings

- Neonatal ICU admissions decreased significantly after bundle implementation.
- There was no significant change in maternal ICU admissions or hospital stay length.
- Infectious disease specialist consultations increased postbundle.

## Abstract

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.

This multicenter, observational, retrospective study included data from pregnant and puerperal adult patients diagnosed with sepsis according to the Surviving Sepsis Campaign guidelines in 2 periods: May 2015 to May 2018 (prebundle) and July 2018 to January 2023 (postbundle).

Eighty women were included: 24 (30.0%) in the prebundle period and 56 (70.0%) in the postbundle 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 pre- and postbundle periods. For mothers, there was no significant difference in median length of stay between the groups, while neonatal intensive care unit admissions of neonates significantly decreased from 85.7% to 31.3% (P = .013). Regarding process measures, the only significant increase occurred in infectious disease specialist consultations in the postbundle period (75.0%) as compared with the prebundle period (50.0%, P = .029).

The implementation of a regional maternal sepsis management bundle did not significantly alter maternal outcomes but was associated with a reduction in neonatal intensive care unit admissions, although what role bundle implementation had in this change remains uncertain. More infectious disease consultations postbundle highlight the potential role of the bundle increasing sepsis awareness among physicians dealing with these patients.

Sepsis is a significant cause of maternal deaths, but early identification and management remain challenging due to the unique physiologic changes in pregnancy. A sepsis management bundle specific to obstetrics was implemented in Lombardy, Italy, aiming to improve sepsis outcomes in pregnant and postpartum women. The study assessed the bundle's impact across 7 hospitals, finding no reduction in maternal intensive care unit admissions or length of hospital stay. The bundle did lead to a significant decrease in neonatal intensive care unit admissions and miscarriage rates, indicating improved clinician awareness of sepsis in this patient population. Despite the mixed results, the study suggests that improved guidelines and education could enhance sepsis management in this population.