Abstract
Objective: To identify the clinical characteristics of
pregnancy associated group A streptococcus (GAS) infection and
predictors for intensive care unit (ICU) admission.
Design: A retrospective cohort study of culture-proven
pregnancy-related GAS infections.Setting and population: a tertiary university-affiliated
hospital between 1/2008-7/2020. Methods: Review patient’s electronic records of patients.Main outcome measures : Incidence and onset time of pregnancy
associated GAS, proportion given prophylaxis and admission to Intensive
care unit.
Results: Of the 143,750 who delivered during the study period,
66 (0.04%) were diagnosed as having a pregnancy associated GAS
infection. Fifty-seven of them (86.3%) presented postpartum, and nine
(13.6%) had septic abortions. The most common presenting signs and
symptoms among puerperal GAS, were postpartum pyrexia (72%), abdominal
pain and/or tenderness (33%), and tachycardia (>100 bpm,
22%). Thirteen women (19.6%) developed streptococcal toxic shock
syndrome (STSS): 10 of them delivered vaginally, two had caesarean
deliveries. Predictors for STSS and ICU admission were: antibiotic
administration >24 hours from presentation postpartum,
tachycardia, and a C-reactive protein level >200 mg/L.
Women that received antibiotic prophylaxis during labour had a
significantly lower rate of STSS (0 vs 10, 22.7%; P = 0.04), as
evidenced by the delayed interval from delivery to the first
presentation of infection among those who received prophylaxis during
labour (8 ± 4.8 vs 4.8 ± 4.2 hours, P = 0.008).
Conclusion: Deferral of medical intervention >24
hours from the first registered abnormal sign had the most important
impact on deterioration of women with invasive puerperal GAS. Antibiotic
prophylaxis during labour in women with GAS may reduce associated
complications.
Keywords: Streptococcus pyogenes, group A Streptococcus,
streptococcal infections, postpartum women.
’Tweetable abstract’:The administration of antibiotic prophylaxis during labour for various
indications is associated with significantly fewer occurrences of
streptococcal toxic shock syndrome (STSS).
Predictors for intensive care unit admission were an empirical
antibiotic administration longer than 24 h from presentation, postpartum
tachycardia, and C-reactive protein >200 mg/L.
A seasonal distribution of group A Streptococcus (GAS) infection
occurred between October and April.
We believe our results may aid in establishing a screening tool for
carriers of group A streptococcal infection in pregnancy in order to
prevent STSS.