Estimating possibility of applying the modified cumulative illness rating scale (CIRS-Obs) for predicting postpartum infections and antimicrobial resistance

BACKGROUND: In obstetrics, there are no systems or scales for assessing somatic burden, predicting and choosing empirical antibiotic therapy in postpartum (postoperative) pyoinflammatory complications. AIM: The given research aims to assess the reliability and validity of the Cumulative Illness Rating Scale for Obstetrics (CIRS-Obs), which has been firstly modified for obstetric patients. The study is based on the inclusion of additional variables that may be used as highly informative predictors of the development of infectious complications resistant to antibiotics following caesarean section to assess the prognosis. MATERIALS AND METHODS: A retrospective study of 406 clinical records of obstetric patients suffering endometritis following caesarean section and admitted to the Gynecology department of the Mariinskaya Municipal Hospital has been carried out during the period from September 2008 to September 2020. Multivariate regression analysis allowed to establish a number of indicators characterized by a high predictive value in relation to the unfavorable course of postpartum infections and the isolation of multidrug-resistant pathogens in patients with aggravated somatic status. The most significant factors have been included in the variant of the cumulative comorbidity index (CIRS-Obs), which was firstly modified by the authors for obstetric patients. RESULTS: The most significant predictors associated with a high risk of isolating resistant and multidrug-resistant pathogens in the examined patients suffering endometritis include CIRS score 4 points, an emergency caesarean section in combination with a prolonged labor and a period without amniotic fluid, antibiotic therapy in the third trimester of pregnancy, as well as previous hospitalizations during pregnancy/invasive procedures or operations. CONCLUSIONS: The CIRS-Obs scale modified for obstetric patients by including highly informative predictors and developed to assess the risk of isolating resistant and multi-resistant pathogens in obstetric patients suffering endometritis following cesarean section in terms of a patients somatic status, antibiotic therapy, the category of urgency and conditions of the operation allows to increase the reliability of the prognosis to make efficient therapeutic decisions.