Data analysis
The data were retrieved from electronic medical files and included
demographics, medical history, risk factors for infection, recent self
or family member illness, the absence of medical insurance and the
presence of major clinical comorbidities, such as diabetes and an
immunocompromised state. The presenting signs and symptoms included
inflammatory markers upon admission [white blood cell (WBC) and
C-reactive protein (CRP) levels] and positive results of bacteriologic
cultures (from the cervix and blood). The obstetric history included the
course of delivery, gestational age at delivery, screening for group B
streptococci (GBS), duration of membrane rupture, and presence of
intrapartum fever, defined as a single oral temperature measurement
>38°C.
The bacterial identification tests from the clinical specimens were
performed at the local microbiology laboratory using the Vitek MS and
Vitek2 systems (bioMerieux, St. Louis, MO) according to the Clinical and
Laboratory Standards Institute criteria. The characteristics of the GAS
infections were also retrieved from medical files, including time to
symptom onset, initial symptoms or signs of illness, maximal body
temperature, laboratory workup, and time from first presentation of
symptoms to antibiotic treatment. The complications, including adult
respiratory distress syndrome, renal and hepatic failure, disseminated
intravascular coagulation, transfer to the ICU, and mechanical
ventilation, were also documented. Lastly, the data on the medical and
surgical treatments (antibiotics, intravenous immunoglobulin
administration, laparoscopy, and hysterectomy) were collected and
reviewed.