The most common causative bacteria in maternal sepsis-related deaths in Japan were group A Streptococcus: A nationwide survey

Tanaka, Hiroaki; Katsuragi, Shinji; Hasegawa, Junichi; Tanaka, Kayo; Osato, Kazuhiro; Nakata, Masahiko; Murakoshi, Takeshi; Sekizawa, Akihiko; Kanayama, Naohiro; Ishiwata, Isamu; Ikeda, Tomoaki

doi:10.1016/j.jiac.2018.10.004

Cited by 23 publications

(23 citation statements)

References 18 publications

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“…According to a Japanese study that analyzed all maternal deaths that occurred during pregnancy and within ≤ 42 days after childbirth, 13 (4.1%) of the 317 (4.3/100,000) cases of STSS recorded from 2010-2017 were caused by GAS. This causative organism is responsible for the highest maternal mortality rate due to severe infection, as reported by our earlier study of the backgrounds and characteristics of maternal deaths caused by GAS [3,4].…”

Section: Introductionmentioning

confidence: 57%

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

Hayata

Nakata

Hasegawa

et al. 2020

Preprint

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Background Streptococcal toxic shock syndrome is associated with the highest rates of infection-related maternal mortality. We conducted a comparative analysis of background factors and treatment course between patients who survived and those who did not to improve our understanding of the optimal initial treatment approach for this fulminant disease. Methods: A retrospective observational study was conducted based on clinical data collected from two national organizations. Clinical data of patients who died and of those who survived, including background information, clinical course, and treatment administered, were collated. Results: No statistical differences were found between groups for age, parity, season, gestational age, or the patient’s location at the onset of symptoms. After the onset of initial symptoms, survivors were administered antibiotics systematically during their first visit to a clinic (p = 0.006). More survivors had received treatment within 1 hour of onset of fulminant disease (p = 0.069). The number of fetal deaths was significantly higher in the mortality group (p = 0.003), while that of fetal survival was higher in the group of maternal survivors (p = 0.055). Maternal survivors with non-specific initial symptoms received early intervention if there was a family history of group A streptococcal infection or a positive rapid antigen test result. Conclusions Intensive care, including systemic administration of antibiotics, may contribute to maternal survival when administered immediately (within 1 hour) after the onset of fulminant streptococcal toxic shock syndrome. Eliciting a family history of streptococcal infection and conducting a rapid antigen test can identify patients needing early intervention.

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Section: Introductionmentioning

confidence: 57%

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

Hayata

Nakata

Hasegawa

et al. 2020

Preprint

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“…According to a Japanese study that analyzes all maternal deaths occurring during pregnancy and within 42 days after childbirth, 265 (4.9/100 000) cases of death were recorded from 2010 to 2016, of which 13 (4.9%) were caused by STSS 4. This causative organism is responsible for the highest maternal mortality rate due to severe infection, as reported in our earlier study examining the backgrounds and characteristics of maternal deaths caused by GAS 3,5…”

Section: Introductionmentioning

confidence: 68%

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

Hayata

Nakata

Hasegawa

et al. 2020

J of Obstet and Gynaecol

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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.

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“…Only Tanaka et al examined the qSOFA score in maternal death cases. 62 Why was antenatal GAS infection associated with poor maternal outcomes? Compared with postnatal cases, antenatal infections had initial symptoms outside of the hospital and the initiation of treatment might have been delayed.…”

Section: Discussionmentioning

confidence: 99%

How could we suspect life‐threatening perinatal group A streptococcal infection?

Arai

Takai

Samejima

et al. 2020

J of Obstet and Gynaecol

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Aim: Perinatal group A streptococcal infection is a rare but life-threatening condition. Few reports have focused on its clinical characteristics and how to prevent deterioration. We report our experience with two antenatal fatal cases and reviewed 96 cases in the literature to assess the clinical characteristics of group A streptococcal infection. Methods: English-language clinical reports of antenatal and postnatal group A streptococcal infection in 1974-2019 were retrieved and examined. Relationships between clinical characteristics and maternal outcomes were assessed. Results: Univariate analysis revealed that antenatal group A streptococcal infection was significantly associated with an age of ≤19 or ≥ 35 years, cesarean section, sore throat as an initial symptom, positive throat culture, maternal death and fetal death. Multivariate analysis revealed that antenatal onset (odds ratio = 7.922, 95% confidence interval = 1.297-48.374; P = 0.025) and a quick sepsis-related organ-failure assessment score (qSOFA; low blood pressure, high respiratory rate or altered mental status) of ≥2 (odds ratio = 6.166, 95% confidence interval = 1.066-35.670; P = 0.042) were significantly related to maternal death. Conclusion: Per our findings, antenatal group A streptococcal infection was significantly associated with maternal and fetal death. Further, the antenatal infection was revealed as a more critical risk factor. We suggest that the presence of any sign related to the qSOFA is a potential clue suspecting perinatal group A streptococcal infection in primary obstetric facilities.

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The most common causative bacteria in maternal sepsis-related deaths in Japan were group A Streptococcus: A nationwide survey

Cited by 23 publications

References 18 publications

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

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

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

How could we suspect life‐threatening perinatal group A streptococcal infection?

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