Nationwide study of mortality and survival in pregnancy-related streptococcal toxic shock syndrome.

Abstract

AIM:

Streptococcal toxic shock syndrome is associated with the highest infection-related maternal mortality rates. We conducted a comparative analysis of the background factors and treatment course between survivors and nonsurvivors to improve our understanding concerning the optimal initial treatment approach for this fulminant disease.

METHODS:

This retrospective observational study was conducted based on clinical data collected from two national organizations. Clinical data of patients who died or survived (i.e. background information, clinical course and treatment administered) were collected.

RESULTS:

Records of 13 dead and 15 surviving patients were collected and analyzed. No statistically significant differences were found between the groups regarding age, parity, season, gestational age or the patients' location at the onset of symptoms. After the initial symptom onset, the survivors received antibiotics more systematically during their first visit to a clinic (P = 0.006). More survivors had received treatment within 1 h of onset of fulminant disease (P = 0.069). The number of fetal deaths was significantly higher in the mortality group (P = 0.003), while the fetal survival number was higher in the group of maternal survivors (P = 0.055). Maternal survivors with nonspecific initial symptoms received early intervention when there was a family history of group A streptococcal infection or a positive rapid antigen test result.

CONCLUSION:

Intensive care, including systemic antibiotic administration, may contribute to maternal survival when administered immediately (within 1 h) after the fulminant streptococcal toxic shock syndrome onset. Eliciting a family history of streptococcal infection and conducting a rapid antigen test can identify the patients needing early intervention.

• Authors: Eijiro Hayata, Masahiko Nakata, Junichi Hasegawa, Hiroaki Tanaka, Takeshi Murakoshi, Nobuaki Mitsuda, Akihiko Sekizawa, Tomoaki Ikeda, Isamu Ishiwata
• Journal: The journal of obstetrics and gynaecology research (J Obstet Gynaecol Res) Vol. 47 Issue 3 Pg. 928-934 (Mar 2021) ISSN: 1447-0756 [Electronic] Australia
• PMID: 33350021 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2020 Japan Society of Obstetrics and Gynecology.

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Female
• Humans
• Pregnancy
• Prenatal Care
• Retrospective Studies
• Shock, Septic
• Streptococcal Infections (diagnosis, drug therapy)