Early vs. standard reversal ileostomy: a systematic review and meta-analysis.

BACKGROUND: Formation of a defunctioning loop ileostomy is common after mid and low rectal resection. Historically, they were reversed between 3 and 6 months after initial resection. Recently, earlier closure (< 14 days) has been suggested by some current randomised controlled trials. The aim of this study was to investigate the effect of early stoma closure on surgical and patient outcomes. METHODS: A systematic review of the current randomised controlled trial literature comparing early and standard ileostomy closure after rectal surgery was performed. Specifically, we examined surgical outcomes including; morbidity, mortality and quality of life. RESULTS: Six studies met the predefined criteria and were included in our analysis. 275 patients underwent early stoma closure compared with 259 patients having standard closure. Overall morbidity was similar between both groups (25.5% vs. 21.6%) (OR, 1.47; 95% CI 0.75-2.87). However, there tended to be more reoperations (8.4 vs. 4.2%) (OR, 2.02, 95% CI 0.99-4.14) and small bowel obstructions/postoperative ileus (9.3% vs. 4.4%) (OR 0.44, 95% CI 0.22-0.90) in the early closure group, but no difference across the other domains. CONCLUSIONS: Early closure appears to be a feasible in highly selective cases after good perioperative counselling and shared decision-making. Further research on quality of life outcomes and long term benefits is necessary to help define which patients are suitable candidates for early closure.

The Prevalence of Pseudomonas Aeruginosa Infection Over a Ten-Year Period in Children with Cystic Fibrosis

Background Pseudomonas aeruginosa (PA) infection is associated with an increased morbidity and adverse prognosis in children with Cystic Fibrosis(CF). The aim of the study was to evaluate the prevalence and characteristics of PA over a ten year period at a single paediatric tertiary referral centre in Ireland. Methods This was a retrospective cross-sectional study. Patient's case notes, microbiology laboratory results and CF Registry of Ireland(CFRI) data were used to collect the data. Results The overall chronic PA infection prevalence was 28.1%(45/160) in 2004 and 21.3%(35/164) in 2014. In 2004, 54/160(33.8%) patients were never infected with PA, 27/160(16.9%) were free for 12 months and 34/160(21.3%) were intermittently infected. In 2014; 80/164(49%) patients, 38/164(23.2%) and 11/164(6.7%) were never infected, free for 12 months and intermittently infected respectively. Conclusion There has been a decline in the overall prevalence of PA infection and a change in the pattern of prevalence over the last decade at our Centre.

Prevention of healthcare-associated invasive aspergillosis during hospital construction/renovation works.

The association between healthcare-associated invasive aspergillosis and hospital construction/building works is well recognized. This infection can cause significant morbidity and mortality and imposes a substantial burden on the healthcare system. The population of patients at risk for this opportunistic infection has expanded and multi-triazole drug resistance has emerged globally. Hence the need for a multi-faceted approach to prevent acquisition of invasive aspergillosis in acute care settings. This article is a summary of the Irish National Guidelines for the prevention of healthcare-associated aspergillosis which is based on published reports, international clinical guidelines, official engineering standards, and technical guidelines. We discuss the key recommendations and strategies for the prevention of invasive aspergillosis from the planning/pre-construction, construction, and post-construction phases. The importance of multi-disciplinary team involvement, education, and communication is emphasized.

Establishment of Hy-Line commercial laying hen whole blood gas and biochemistry reference intervals utilizing portable i-STAT1 clinical analyzer.

Blood gas and biochemistry reference intervals were established for 3 genetically distinct commercial varieties (CVs) of Hy-Line laying hens: 2 brown-egg layers (Hy-Line Brown, Hy-Line Silver Brown) and a tint-egg layer (Hy-Line Sonia) utilizing the i-STAT1 analyzer. Each respective variety of laying hen was sampled on a replicate cycle of 2 wk for a total of 6 replicates (35 to 46 wk of age). Blood samples were obtained in the production house from the brachial vein, and subsequently analyzed by the i-STAT1 portable device. i-STAT1 clinical analyzer reports blood gas and biochemistry values for the following parameters: pH, partial pressure of carbon dioxide (pvCO2, mm Hg), partial pressure of oxygen (pvO2, mm Hg), bicarbonate (HCO3, mmol/L), base excess (BE, mmol/L), saturation of oxygen on hemoglobin (sO2%), glucose (Glu, mg/dL), sodium (Na, mmol/L), potassium (K, mmol/L), total concentration of carbon dioxide (TCO2, mmol/L), ionized calcium (iCa, mmol/L), hematocrit (Hct % packed cell volume [PCV]), hemoglobin (Hb, g/dL). A total of 1,800 individual hen i-STAT1 records were utilized in the establishment of reference interval values for the 13 parameters between the 3 CVs. Statistical analysis via ANOVA and Tukey's test revealed significant line differences for all 13 blood gas and chemistry parameters measured, with particularly interesting results in iCa. The blood gas and chemistry parameters collected in this study will serve as reference intervals to set the framework for potential future correlations to genetic markers, physiological abnormalities, and production performance.

Investigating the genetic determination of clutch traits in laying hens.

Clutch traits were proposed as a more detailed description of egg-laying patterns than simple total egg production. In this study, egg production of 23,809 Rhode Island Red (RIR) and 22,210 White Leghorn (WL) hens was described in terms of number of clutches, average and maximum clutch size, age at first egg, total saleable egg production, and percentage of egg defects. Genetic parameters were estimated using a six-trait animal model. Of the phenotyped birds, 1433 RIR hens and 1515 WL hens were genotyped with line specific 50K Affymetrix Axiom single nucleotide polymorphism chips to perform genome-wide association analyses. Moderate heritabilities were estimated for clutch traits of 0.20 to 0.42 in the RIR line and 0.29 to 0.41 in the WL line. Average and maximum clutch size was positively genetically correlated with total saleable egg number in both lines. Genome-wide association analysis identified seven regions that were associated with egg production in the RIR line and 12 regions in the WL line. The regions identified were line and trait specific, except for one region on chromosome 6 from 28 to 29 Mb that influenced number of clutches and maximum and average clutch size in WL hens. Regions associated with egg production identified here overlapped with 260 genes, with some strong positional candidates based on gene ontology including WASH1, which is involved in oocyte maturation, NPVF, involved in regulation of follicle-stimulating hormone secretion, and FOXO3, involved in oocyte maturation and ovulation from the ovarian follicle. Confirmation of the role of these genes in regulation of egg production pattern will require further studies.

Genome wide association study for heat stress induced mortality in a white egg layer line.

High environmental temperature is a serious stress affecting economic and biological efficiency of poultry production in tropical and subtropical countries that is expected to become more prominent with global climate change. Iowa experienced 3 acute heat waves of 11, 3, and 4 d of heat index above 38°C in the summer of 2012, which led to production losses and increased bird mortality. For the current study, the proportion of daughters that died from heat stress during this period was calculated for 118 sire families of an elite White Leghorn layer line. The number of daughters per sire ranged from 25 to 111 and averaged 68. Average mortality due to heat stress was 8.2%, ranging from 0 to 24.6%. All sires were genotyped using a 600 K Affymetrix chip. After stringent quality filtering (clustering quality, parentage, missing genotypes, MAF) 113,344 SNPs were retained for the analysis. Method BayesB with π equal to 0.999, for the number of markers fitted not to exceed the number of observations, was applied. Markers explained 8% of the phenotypic variance. One 1-Mb window on chromosome 5 explained 1.2% of genetic variance. When the number of daughters was fitted as a weight in the analysis, the proportion of variance explained by markers dropped to 1%, but 9 1-Mb windows explained more than 1% of genetic variance on chromosomes 1, 3, 5 (the same top window as in the unweighted analysis), 9, 17, and 18. Although the support of the genomic regions associated with heat stress resistance identified in this study was not very strong, they overlapped with previously reported quantitative trait loci regions for immune response and physiological traits in chickens and contained genes that have been associated with response to heat stress in other studies. Further research is needed to validate the results.

Identifying the genetic basis for resistance to avian influenza in commercial egg layer chickens.

Two highly pathogenic avian influenza (HPAI) outbreaks have affected commercial egg production flocks in the American continent in recent years; a H7N3 outbreak in Mexico in 2012 that caused 70% to 85% mortality and a H5N2 outbreak in the United States in 2015 with over 99% mortality. Blood samples were obtained from survivors of each outbreak and from age and genetics matched non-affected controls. A total of 485 individuals (survivors and controls) were genotyped with a 600 k single nucleotide polymorphism (SNP) array to detect genomic regions that influenced the outcome of highly pathogenic influenza infection in the two outbreaks. A total of 420458 high quality, segregating SNPs were identified across all samples. Genetic differences between survivors and controls were analyzed using a logistic model, mixed models and a Bayesian variable selection approach. Several genomic regions potentially associated with resistance to HPAI were identified, after performing multidimensional scaling and adjustment for multiple testing. Analysis conducted within each outbreak identified different genomic regions for resistance to the two virus strains. The strongest signals for the Iowa H5N2 survivor samples were detected on chromosomes 1, 7, 9 and 15. Positional candidate genes were mainly coding for plasma membrane proteins with receptor activity and were also involved in immune response. Three regions with the strongest signal for the Mexico H7N3 samples were located on chromosomes 1 and 5. Neuronal cell surface, signal transduction and immune response proteins coding genes were located in the close proximity of these regions.

Group B streptococcal PCR testing in comparison to culture for diagnosis of late onset bacteraemia and meningitis in infants aged 7-90 days: a multi-centre diagnostic accuracy study.

The aim of this study was to compare an in-house real-time PCR assay, with bacterial culture as the reference, for the diagnosis of late onset group B Streptococcal (GBS) disease. This was a retrospective review. All children aged 7-90 days presenting to four paediatric centres that had a blood or CSF sample tested by GBS PCR were included. Of 7,686 blood and 2,495 cerebrospinal fluid (CSF) samples from patients of all ages received for PCR testing, 893 and 859 samples were eligible for the study, respectively. When compared to culture, the sensitivity of blood PCR was 65% (13/20) in comparison to the CSF PCR test which was 100% (5/5). Ten of 23 PCR-positive blood samples and 17 of 22 PCR-positive CSF samples were culture negative. The median threshold Ct values for culture-positive/PCR-positive CSF samples was lower than that of culture-negative/PCR-positive CSF samples (p = 0.08). Clinical details of 17 available cases that were culture negative/PCR positive were reviewed; seven were deemed to be definite cases, eight were probable and two were possible. The results showed that detection of GBS by PCR is useful for CSF samples from infants aged 7-90 days with suspected meningitis; however, analysis of blood samples by PCR is of limited value as a routine screening test for late onset GBS sepsis and should not replace bacterial culture.

Repeatability vs. multiple-trait models to evaluate shell dynamic stiffness for layer chickens.

Shell quality is one of the most important traits for improvement in layer chickens. Proper consideration of repeated records can increase the accuracy of estimated breeding values and thus genetic improvement of shell quality. The objective of this study was to compare different models for genetic evaluation of the collected data. For this study, 81,646 dynamic stiffness records on 21,321 brown egg layers and 93,748 records on 24,678 white egg layers from 4 generations were analyzed. Across generations, data were collected at 2 to 4 ages (at approximately 26, 42, 65, and 86 wk), with repeated records at each age. Seven models were compared, including 5 repeatability models with increasing complexity, a random regression model, and a multitrait model. The models were compared using Akaike Information Criteria with significance testing of nested models with a Log Likelihood Ratio test. Estimates of heritability were 0.31-0.36 for the brown line and 0.23-0.26 for the white line, but repeatability was higher for the model with age-specific permanent environment effects (0.59 for both lines) than for the model with an overall permanent environmental effects (0.47 for the brown and 0.41 for the white line). The model that allowed for permanent environmental effect within age and heterogeneous residual variance between ages resulted in improved fit compared to the traditional model that fits single permanent environment and residual effects, but was inferior in fit and predictive ability to the full multiple-trait model. The random regression model had better fit to the data than repeatability models but slightly worse than the multiple-trait model. For traits with repeated records at different ages, repeatability within and across ages as well as genetic correlations should be considered while choosing the number of records collected per individual as well as the model for genetic evaluation.

Model comparison to evaluate a shell quality bio-complex in layer hens.

Reducing the incidence of egg shell breakage is an important selection goal in egg layer hens breeding. Breaking strength provides an indicator of static shell resistance correlated with shell thickness. Acoustic egg tests combine shell's resonance profile with egg mass to calculate dynamic stiffness (KDyn) a quantitative indicator of integral shell resistance, and a novel direct detection of both cracks and micro-cracks (MCr) making it possible for use in selection programs aiming improvement of shell quality. A shell quality bio-complex was defined to improve overall shell quality, including: breaking strength at equator (BSe) and poles (BSp), KDyn, and MCr, on multiple eggs/hen-age. A total of 81,667; 101,113; and 72,462 records from 4 generations of three pure lines were evaluated. Two models were tested in the brown-egg line: I) four-trait linear repeatability model and II) three-trait linear (BS, KDyn)-threshold (MCr) in the three lines. Models were implemented with AIREMLF90 and THRGIBBS1F90. Heritability and repeatability (Model I) estimates were: h2 = 0.14, 0.18, 0.33, and 0.02; r = 0.16, 0.28, 0.43, and 0.03 for BSe, BSp, KDyn, and MCr, respectively. Corresponding values in White Plymouth Rock were h2 = 0.14, 0.17, 0.33, and 0.02; r = 0.21, 0.33, 0.44, and 0.04, and in White Leghorn were h2 = 0.14, 0.23, 0.36, and 0.02; r = 0.24, 0.38, 0.52, and 0.02. Genetic correlations between BSe and BSp were between 0.51 and 0.68. The BS traits were moderately correlated with KDyn (+0.23 to +0.51), and tended to be negatively correlated with MCr. KDyn, and MCr (-0.46 to -0.62). Model II had similar results; except for increased h2 = 0.06 and r = 0.09 for MCr. Results indicate that BSe and BSp are different traits; while incidence of MCr is low in heritable but showed negative genetic correlations with the other traits. This makes MCr unsuitable for direct selection; but favors indirect selection against MCr via BSe, BSp, and KDyn for a holistic selection to improve shell quality, in particular to achieve the ultimate goal, reduction of egg breakage.

Impact of fitting dominance and additive effects on accuracy of genomic prediction of breeding values in layers.

Most genomic prediction studies fit only additive effects in models to estimate genomic breeding values (GEBV). However, if dominance genetic effects are an important source of variation for complex traits, accounting for them may improve the accuracy of GEBV. We investigated the effect of fitting dominance and additive effects on the accuracy of GEBV for eight egg production and quality traits in a purebred line of brown layers using pedigree or genomic information (42K single-nucleotide polymorphism (SNP) panel). Phenotypes were corrected for the effect of hatch date. Additive and dominance genetic variances were estimated using genomic-based [genomic best linear unbiased prediction (GBLUP)-REML and BayesC] and pedigree-based (PBLUP-REML) methods. Breeding values were predicted using a model that included both additive and dominance effects and a model that included only additive effects. The reference population consisted of approximately 1800 animals hatched between 2004 and 2009, while approximately 300 young animals hatched in 2010 were used for validation. Accuracy of prediction was computed as the correlation between phenotypes and estimated breeding values of the validation animals divided by the square root of the estimate of heritability in the whole population. The proportion of dominance variance to total phenotypic variance ranged from 0.03 to 0.22 with PBLUP-REML across traits, from 0 to 0.03 with GBLUP-REML and from 0.01 to 0.05 with BayesC. Accuracies of GEBV ranged from 0.28 to 0.60 across traits. Inclusion of dominance effects did not improve the accuracy of GEBV, and differences in their accuracies between genomic-based methods were small (0.01-0.05), with GBLUP-REML yielding higher prediction accuracies than BayesC for egg production, egg colour and yolk weight, while BayesC yielded higher accuracies than GBLUP-REML for the other traits. In conclusion, fitting dominance effects did not impact accuracy of genomic prediction of breeding values in this population.

British Dietetic Association systematic review and evidence-based practice guidelines for the dietary management of irritable bowel syndrome in adults (2016 update).

BACKGROUND: The first British Dietetic Association (BDA) guidelines for the dietary management of irritable bowel syndrome (IBS) in adults were published in 2012. Subsequently, there has been a wealth of new research. The aim of this work was to systematically review the evidence for the role of diet in the management of IBS and to update the guidelines. METHODS: Twelve questions relating to diet and IBS were defined based on review of the previous guideline questions, current evidence and clinical practice. Chosen topics were on healthy eating and lifestyle (alcohol, caffeine, spicy food, elimination diets, fat and fluid intakes and dietary habits), milk and dairy, dietary fibre, fermentable carbohydrates, gluten, probiotics and elimination diets/food hypersensitivity. Data sources were CINAHL, Cochrane Register of Controlled Trials, Embase, Medline, Scopus and Web of Science up to October 2015. Studies were assessed independently in duplicate using risk of bias tools specific to each included study based on inclusion and exclusion criteria for each question. National Health and Medical Research Council grading evidence levels were used to develop evidence statements and recommendations, in accordance with Practice-based Evidence in Nutrition Global protocol used by the BDA. RESULTS: Eighty-six studies were critically appraised to generate 46 evidence statements, 15 clinical recommendations and four research recommendations. The IBS dietary algorithm was simplified to first-line (healthy eating, provided by any healthcare professional) and second-line [low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) to be provided by dietitian] dietary advice. CONCLUSIONS: These guidelines provide updated comprehensive evidence-based details to achieve the successful dietary management of IBS in adults.

Commercial Hy-Line W-36 pullet and laying hen venous blood gas and chemistry profiles utilizing the portable i-STAT®1 analyzer.

Venous blood gas and chemistry reference ranges were determined for commercial Hy-Line W-36 pullets and laying hens utilizing the portable i-STAT®1 analyzer and CG8+ cartridges. A total of 632 samples were analyzed from birds between 4 and 110 wk of age. Reference ranges were established for pullets (4 to 15 wk), first cycle laying hens (20 to 68 wk), and second cycle (post molt) laying hens (70 to 110 wk) for the following traits: sodium (Na mmol/L), potassium (K mmol/L), ionized calcium (iCa mmol/L), glucose (Glu mg/dl), hematocrit (Hct% Packed Cell Volume [PCV]), pH, partial pressure carbon dioxide (PCO2 mm Hg), partial pressure oxygen (PO2 mm Hg), total concentration carbon dioxide (TCO2 mmol/L), bicarbonate (HCO3 mmol/L), base excess (BE mmol/L), oxygen saturation (sO2%), and hemoglobin (Hb g/dl). Data were analyzed using ANOVA to investigate the effect of production status as categorized by bird age. Trait relationships were evaluated by linear correlation and their spectral decomposition. All traits differed significantly among pullets and mature laying hens in both first and second lay cycles. Levels for K, iCa, Hct, pH, TCO2, HCO3, BE, sO2, and Hb differed significantly between first cycle and second cycle laying hens. Many venous blood gas and chemistry parameters were significantly correlated. The first 3 eigenvalues explained ∼2/3 of total variation. The first 2 principal components (PC) explained 51% of the total variation and indicated acid-balance and relationship between blood O2 and CO2. The third PC explained 16% of variation and seems to be related to blood iCa. Establishing reference ranges for pullet and laying hen blood gas and chemistry with the i-STAT®1 handheld unit provides a mechanism to further investigate pullet and layer physiology, evaluate metabolic disturbances, and may potentially serve as a means to select breeder candidates with optimal blood gas or chemistry levels on-farm.

Real-time polymerase chain reaction and culture in the diagnosis of invasive group B streptococcal disease in infants: a retrospective study.

Group B streptococcus (GBS) is a leading cause of invasive disease in infants. Accurate and rapid diagnosis is crucial to reduce morbidity and mortality. Real-time polymerase chain reaction (PCR) targeting the dltR gene was utilised for the direct detection of GBS DNA in blood and cerebrospinal fluid (CSF) from infants at an Irish maternity hospital. A retrospective review of laboratory and patient records during the period 2011-2013 was performed in order to evaluate PCR and culture for the diagnosis of invasive GBS disease. A total of 3570 blood and 189 CSF samples from 3510 infants had corresponding culture and PCR results. Culture and PCR exhibited concordance in 3526 GBS-negative samples and 13 (25%) GBS-positive samples (n = 53). Six (11%) and 34 (64%) GBS-positive samples were positive only in culture or PCR, respectively. Culture and PCR identified more GBS-positive infants (n = 47) than PCR (n = 43) or culture (n = 16) alone. Using culture as the reference standard, the sensitivity, specificity, and positive and negative predictive values for PCR on blood samples were 71.4%, 99.2%, 25% and 99.9%, and for CSF samples, they were 60%, 97.8%, 42.9% and 98.9%, respectively. The sensitivity and positive predictive values were improved (blood: 84.6% and 55%; CSF: 77.8% and 100%, respectively) when maternal risk factors and other laboratory test results were considered. The findings in this study recommend the use of direct GBS real-time PCR for the diagnosis of GBS infection in infants with a clinical suspicion of invasive disease and as a complement to culture, but should be interpreted in the light of other laboratory and clinical findings.

Effects of feeding diets varying in energy and nutrient density to Hy-Line W-36 laying hens on production performance and economics.

The objectives of this study were to evaluate the effects of feeding 5 different energy and nutrient dense diets to Hy-Line W-36 hens on long-term performance and economics. A total of 480 19 wk old Hy-Line W-36 Single Comb White Leghorn hens were weighed and randomly allocated to 6 replicate groups of 16 hens each (2 adjacent cages containing 8 hens per cage, 60.9×58.4 cm) per dietary treatment in a randomized complete block design. The hens were fed 5 treatment diets formulated to contain 85, 90, 95, 100, and 105% of the energy and nutrient recommendations stated in the 2009 Hy-Line Variety W-36 Commercial Management Guide. Production performance was measured for 52 wk from 19 to 70 wk age. Over the course of the trial, a significant increasing linear response to increasing energy and nutrient density was seen for hen-day egg production, egg weight, egg mass, feed efficiency, energy intake, and body weight (BW). Feed intake showed no significant linear level response to increasing energy and nutrient density except during the early production cycle. No consistent responses were noted for egg quality, percent yolk, and percent egg solids throughout the study. Significant linear responses due to energy and nutrient density were seen for egg income, feed cost, and income minus feed cost. In general, as energy and nutrient density increased, egg income and feed cost per hen increased, but income minus feed cost decreased. Overall, these results indicate that feeding Hy-Line W-36 hens increasing energy and nutrient-dense diets will increase egg production, egg weight, egg mass, feed efficiency, energy intake, BW, egg income, and feed cost, but decrease egg income minus feed cost. However, these benefits do not take effect in early production and seem to be most effective in later stages of the production cycle, perhaps "priming" the birds for better egg-production persistency with age.

Calpain inhibition mediates autophagy-dependent protection against polyglutamine toxicity.

Over recent years, accumulated evidence suggests that autophagy induction is protective in animal models of a number of neurodegenerative diseases. Intense research in the field has elucidated different pathways through which autophagy can be upregulated and it is important to establish how modulation of these pathways impacts upon disease progression in vivo and therefore which, if any, may have further therapeutic relevance. In addition, it is important to understand how alterations in these target pathways may affect normal physiology when constitutively modulated over a long time period, as would be required for treatment of neurodegenerative diseases. Here we evaluate the potential protective effect of downregulation of calpains. We demonstrate, in Drosophila, that calpain knockdown protects against the aggregation and toxicity of proteins, like mutant huntingtin, in an autophagy-dependent fashion. Furthermore, we demonstrate that, overexpression of the calpain inhibitor, calpastatin, increases autophagosome levels and is protective in a mouse model of Huntington's disease, improving motor signs and delaying the onset of tremors. Importantly, long-term inhibition of calpains did not result in any overt deleterious phenotypes in mice. Thus, calpain inhibition, or activation of autophagy pathways downstream of calpains, may be suitable therapeutic targets for diseases like Huntington's disease.

Maternal sepsis incidence, aetiology and outcome for mother and fetus: a prospective study.

OBJECTIVE: To determine the incidence of maternal bacteraemia during pregnancy and for 6 weeks postpartum, describe the gestation/stage at which sepsis occurs, the causative microorganisms, antibiotic resistance and review maternal, fetal and neonatal outcome. DESIGN: Prospective review. SETTING: Two tertiary referral, maternity hospitals in Dublin, Ireland. POPULATION: During 2005-2012 inclusive, 150 043 pregnant women attended and 24.4% of infants born in Ireland were delivered at the hospitals. METHODS: Demographic, clinical, microbiological and outcome data was collected from women with sepsis and compared with controls. MAIN OUTCOME MEASURES: Incidence, bacterial aetiology, gestation/stage at delivery, mode of delivery, antibiotic resistance, admission to augmented care, maternal, fetal and neonatal outcome. RESULTS: The sepsis rate was 1.81 per 1000 pregnant women. Escherichia coli was the predominant pathogen, followed by Group B Streptococcus. Sepsis was more frequent among nulliparous women (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.07-1.79) and multiple births (OR 2.04; 95% CI 0.98-4.08). Seventeen percent of sepsis episodes occurred antenatally, 36% intrapartum and 47% postpartum. The source of infection was the genital tract in 61% (95% CI 55.1-66.6) of patients and the urinary tract in 25% (95% CI 20.2-30.5). Sepsis was associated with preterm delivery (OR 2.81; 95% CI 1.99-3.96) and a high perinatal mortality rate (OR =5.78; 95% CI 2.89-11.21). Almost 14% of women required admission to augmented care. The most virulent organisms were Group A Streptococcus linked to postpartum sepsis at term and preterm Escherichia coli sepsis. CONCLUSIONS: Maternal sepsis is associated with preterm birth, a high perinatal mortality rate and nulliparous women.