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.