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.

Prognostic factors for streptococcal toxic shock syndrome: systematic review and meta-analysis

“…Online supplemental file presents the risk of bias assessment of the 41 included studies. The majority of studies were rated as high risk of bias overall owing to residual confounding and lack of adjustment for confounding in statistical analyses (37/41, 90%) 2 5 6 10 35–67. Three studies were rated at moderate risk of bias overall7 14 68 and one at low risk of bias overall 11…”

Next-generation sequencing of 16S rRNA for identification of invasive bacterial pathogens in a formalin-fixed paraffin-embedded placental specimen: a case report of perinatal fulminant Streptococcus pyogenes infection

“…A recent national survey in Japan showed that the number of patients in the group of survivors of perinatal STSS who had received intensive treatment within 1 h of onset of fulminant stage was larger than the number of patients in the mortality group [5]. Furthermore, the percentage of patients who received systematic antibiotic treatment at the first visit in that study was significantly higher in the survivor group than in the mortality group [5]. In our case, we experienced fulminant STSS in mid-pregnancy, and the patient was cured and survived without any complications after starting prompt systemic antibiotic treatment and intensive care.…”

“…The fulminant form of STSS by S. pyogenes is the most popular cause of infectious maternal death [4]. A recent national survey in Japan showed that the number of patients in the group of survivors of perinatal STSS who had received intensive treatment within 1 h of onset of fulminant stage was larger than the number of patients in the mortality group [5]. Furthermore, the percentage of patients who received systematic antibiotic treatment at the first visit in that study was significantly higher in the survivor group than in the mortality group [5].…”