Abstract
Background: Maternal urosepsis is a major cause of maternal morbidity, mortality, and intensive care unit (ICU) admission. Urinary tract infection is the most frequent bacterial infection during pregnancy and a leading source of severe maternal sepsis. Although inflammatory biomarkers are widely used in sepsis management, evidence on their serial changes in severe obstetric urosepsis is limited. Procalcitonin may better reflect therapeutic response than conventional hematological parameters.
Objective: This study aimed to characterize the clinical course, microbiological profile, intensive care management, and longitudinal inflammatory biomarker kinetics in pregnant women with severe urosepsis requiring ICU admission.
Methods: A retrospective observational case series was conducted, including eight consecutive pregnant women directly admitted to the ICU of a tertiary referral hospital with severe urosepsis. Demographic, clinical, microbiological, laboratory, therapeutic, and outcome data were extracted from medical records. Serial inflammatory biomarkers measured at ICU admission and hospital discharge were compared to evaluate longitudinal changes during hospitalization.
Results: Eight pregnant women with severe urosepsis were included. The median maternal age was 19.5 years (interquartile range [IQR] 18.0–23.0), and the mean gestational age at ICU admission was 27.6±6.1 weeks. Septic shock was present in five patients (62.5%), and extended-spectrum β-lactamase (ESBL)-producing pathogens were identified in two of the six patients with positive urine cultures (33.3%). All patients received prompt broad-spectrum antimicrobial therapy, and maternal survival was 100%. Serum procalcitonin demonstrated a significant decline during hospitalization (28.62±27.07 vs. 2.16±1.92 ng/ml; p=0.016), whereas leukocyte and platelet counts showed no significant changes. Individual paired analyses revealed a remarkably consistent decline in procalcitonin across nearly all patients, while conventional hematological parameters exhibited substantially greater interindividual variability. Overall, serial procalcitonin measurements more closely paralleled clinical recovery than leukocyte or platelet counts.
Conclusions: Pregnant women with severe urosepsis admitted to the ICU had favorable maternal outcomes with early multidisciplinary management and prompt broad-spectrum antimicrobial therapy. Serial procalcitonin showed the most consistent recovery kinetics, suggesting its potential as a complementary biomarker for monitoring treatment response, although further prospective multicenter studies are needed to confirm these findings.
Miroslava Avila-Valdivia, Francisco Javier Castro-Apodaca, Eli Teran-Cabanillas, Heysel Murillo, Isaac Misael Beltrán Corona, Nayeli Nohemi Cabrera-Diaz, Maria Estefania Ramirez-Arellano, Jorge Bravo-Rubio, Nancy Godoy-Rodríguez, Alberto Ballesteros-Manzo, Luis Diego Barrgan-Loera, Diana Marcela Enriquez-Cadena, Dalia Magaña-Ordorica, Joel Murillo-Llanes, Jorge Iván Urbina Ruiz, Talia Gierut, Debra Gierut, Ellen Pege, Jonh M Heusinkveld
