450 Obstetrically related group a streptococcal infection and predictors for severity - retrospective 12-year cohort study

Abstract

To identify the clinical characteristics related with invasive puerperal group A streptococcus (GAS) infection and to discover novel predictors for admissions to the intensive care unit (ICU) A retrospective cohort study of culture-proven pregnancy-related GAS infection was performed at a tertiary university hospital between January 2008 and July 2020 1. Of 66 women diagnosed with GAS infection, 57 presented postpartum and 9 had septic abortions. 2. The most common presenting signs and symptoms were postpartum pyrexia (72%), abdominal pain and or tenderness (33%) and tachycardia (22%). 3. 11% of infections were proven to be acquired via hospital staff involved in patient admission or delivery. 4.The prevalence of strep-agalactia carriers, in which antibiotic prophylaxis was uniformly provided, in the study group was remarkably low (0.6%) in compere to its rate in the overall pregnant population (12%). Suggesting antibiotic prophylaxis as a protective factor against puerperal GAS infection. 5.13 women (19.6%) developed streptococcal toxic shock syndrome (STSS) and transferred to the intensive care unit (ICU), 10 of whom delivered vaginally, 2 had cesarean delivery and one of whom had a septic abortion. 6.Predictors for STSS and ICU admission were as following: antibiotics administration more than 24 hours from presentation (OR 5.5, CI 1.90-41) Postpartum, tachycardia (OR 4.19, CI 1.12-15.84) and CRP measurement above 202 (OR 3.25, CI 0.57-26.18). 7.The most common Emm-type isolated were: 14.3 (3), 22 (3), 75 (4) and 11 (3, all recovered from women admitted to ICU). 8.During the study period, no cases of maternal deaths occurred. Pregnancy related GAS infection is associated with a significant morbidity. Deferral in medical intervention of more than 24 hours from first abnormal signs registered, had the most important impact on maternal deterioration. Since vital signs have been demonstrated to be of utmost clinical importance with regard infection prediction in cases with delay, the implementation of wearable technology and continuous monitoring should be considered.View Large Image Figure ViewerDownload Hi-res image Download (PPT)