Objective This study aimed to evaluate trends, risk factors, and outcomes associated with infections and sepsis during delivery hospitalizations in the United States.

Study Design The 2000–2020 National Inpatient Sample was used for this repeated cross-sectional analysis. Delivery hospitalizations of patients aged 15 to 54 with and without infection and sepsis were identified. Common infection diagnoses during delivery hospitalizations analyzed included (i) pyelonephritis, (ii) pneumonia/influenza, (iii) endometritis, (iv) cholecystitis, (v) chorioamnionitis, and (vi) wound infection. Temporal trends in sepsis and infection during delivery hospitalizations were analyzed. The associations between sepsis and infection and common chronic health conditions including asthma, chronic hypertension, pregestational diabetes, and obesity were analyzed. The associations between clinical, demographic, and hospital characteristics, and infection and sepsis were determined with unadjusted and adjusted logistic regression models with unadjusted odds ratio (OR) and adjusted odds ratios with 95% confidence intervals as measures of association.

Results An estimated 80,158,622 delivery hospitalizations were identified and included in the analysis, of which 2,766,947 (3.5%) had an infection diagnosis and 32,614 had a sepsis diagnosis (4.1 per 10,000). The most common infection diagnosis was chorioamnionitis (2.7% of deliveries) followed by endometritis (0.4%), and wound infections (0.3%). Infection and sepsis were more common in the setting of chronic health conditions. Evaluating trends in individual infection diagnoses, endometritis and wound infection decreased over the study period both for patients with and without chronic conditions, while risk for pyelonephritis and pneumonia/influenza increased. Sepsis increased over the study period for deliveries with and without chronic condition diagnoses. Risks for adverse outcomes including mortality, severe maternal morbidity, the critical care composite, and acute renal failure were all significantly increased in the presence of sepsis and infection.

Conclusion Endometritis and wound infections decreased over the study period while risk for sepsis increased. Infection and sepsis were associated with chronic health conditions and accounted for a significant proportion of adverse obstetric outcomes including severe maternal morbidity.

Key Points

目的 本研究旨在评估美国分娩住院期间与感染和脓毒症相关的趋势、危险因素和结果。

研究设计 2000-2020 年全国住院患者样本用于重复横断面分析。确定了 15 至 54 岁之间有或没有感染和败血症的患者的分娩住院情况。分析的分娩住院期间常见感染诊断包括（i）肾盂肾炎，（ii）肺炎/流感，（iii）子宫内膜炎，（iv）胆囊炎，（v）绒毛膜羊膜炎和（vi）伤口感染。分析了分娩住院期间败血症和感染的时间趋势。分析了脓毒症和感染与常见慢性健康状况（包括哮喘、慢性高血压、妊娠前糖尿病和肥胖）之间的关联。临床、人口统计学和医院特征与感染和败血症之间的关联是通过未调整和调整的逻辑回归模型确定的，其中未调整的比值比（OR）和调整后的比值比（95%置信区间）作为关联的衡量标准。

结果 估计有 80,158,622 例分娩住院病例被识别并纳入分析，其中 2,766,947 例（3.5%）被诊断为感染，32,614 例被诊断为败血症（每 10,000 人中有 4.1 例）。最常见的感染诊断是绒毛膜羊膜炎（占分娩的 2.7%），其次是子宫内膜炎（0.4%）和伤口感染（0.3%）。感染和败血症在慢性健康状况下更为常见。在研究期间，无论是否患有慢性疾病，个体感染诊断、子宫内膜炎和伤口感染的评估趋势均有所下降，而肾盂肾炎和肺炎/流感的风险则有所增加。在研究期间，有或没有慢性病诊断的分娩中败血症的发生率有所增加。在脓毒症和感染存在的情况下，包括死亡率、严重孕产妇发病率、重症监护复合和急性肾衰竭在内的不良结局的风险均显着增加。

结论 研究期间子宫内膜炎和伤口感染减少，而败血症风险增加。感染和败血症与慢性健康状况相关，并且在不良产科结局（包括严重孕产妇发病率）中占很大比例。

关键点