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“Introduction Pregnancy is associated with an increased risk of infection, in part due to various pregnancy-related mechanical and physiological changes [1]. In addition, recent

evidence suggests that pregnancy is associated with an immunological CP673451 supplier shift away from inflammatory processes and inflammatory cytokines and toward a more anti-inflammatory immunologic state [2]. These changes may also play a role in the maternal response to overwhelming infection and subsequent sepsis [2]. Despite improvements in medical care and preventive measures, infectious complications remain a SGC-CBP30 manufacturer major source of pregnancy-related mortality in both developing and developed countries worldwide [3], reported to be the 5th most common cause of maternal death [1]. A recent review conducted by the World Health Organization has estimated the global burden of maternal sepsis to be more than 6,900,000 cases per year [4]. Necrotizing fasciitis (NF) is a soft tissue infection ON-01910 datasheet manifesting as necrosis of subcutaneous tissues and fascia. Although rare, NF commonly

results in severe and often fatal illness with high resource utilization. Case fatality associated with NF has been reported to exceed 40% in Tolmetin single-center studies [5], while reports on larger cohorts described case fatality around 5–12% [6, 7]. Pregnancy-associated NF (PANF) has been described in multiple reports. However, because of its rarity, descriptions of NF in the obstetric population to date were limited to case reports [8–10] or small case series [11, 12], and was absent in a population study of invasive streptococcal infections in the postpartum period [13]. Thus, the epidemiology of PANF is presently unknown, with limited data on its clinical characteristics,

resource utilization and outcomes. The aim of this first population-level study to date, to the authors’ knowledge, was to examine the epidemiological, clinical, resource utilization, outcome characteristics, and secular trends of pregnancy-associated NF. Materials and Methods Data Sources Data were obtained from the Texas Inpatient Public Use Data File (TIPUDF), a longitudinal data set maintained by the Texas Department of State Health Services [14]. The data set includes detailed de-identified inpatient discharge data from all state-licensed hospitals, with the exception of those exempt by state statute from reporting to the Texas Health Care Information Collection. Exempt hospitals include (a) those that do not seek insurance payment or government reimbursement and (b) Selected rural providers, based on bed number and local county population [14]. The facilities included in the mandated report account for 93–97% of all hospital discharges.