Main findings
This study sought to report the clinical consequences of women diagnosed
with pregnancy-associated GAS. Its main findings were:
- Women who received antibiotic prophylaxis during labor for various
reasons had less severe infectious characteristics, such as STSS. This
observation was supported by a longer interval between delivery to the
first infectious presentation in those who received antibiotics.
- Predictors ICU admission were a tardive empirical antibiotic
administration of more than 24 h after presentation postpartum and
tachycardia.
- In contrast to other reports on a 30% mortality rate, there were no
incidences of maternal death among the women who had sustained SSTS in
the current study.
- Hospital staff transmission was relatively uncommon throughout the
study period. There was a seasonal distribution of GAS infection in a
multi-year analysis, with most cases having been identified between
October and April.
In spite of the advances in medical care, pregnancy-associated GAS
infection contributes significantly to maternal morbidity and mortality
worldwide. Since the recognition of healthcare personnel-related
puerperal sepsis by Semmelweis (13), extensive and costly efforts have
been undertaken to investigate outbreaks of GAS infection from a common
nosocomial source. Contrarily, the current study findings, taken
together with previous data (8,14), reveal that healthcare personnel
test negative in most cases, and that infections are considered as being
community acquired for the most part. The current study results are in
accordance with earlier ones that reported a comparable rate of presumed
staff-related transmission of GAS infection. The overall incidence of
puerperal GAS infection in the current cohort was similar to that of a
previous study from the same institution (14). Of all identified GAS
infections in the current study, 86% occurred postpartum and 14%
occurred antepartum and were followed by septic abortions, similar to
previous (8).