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

Autor: Nobuaki Mitsuda, Masahiko Nakata, Tomoaki Ikeda, Junichi Hasegawa, Isamu Ishiwata, Takeshi Murakoshi, Eijiro Hayata, Hiroaki Tanaka, Akihiko Sekizawa
Rok vydání: 2020
Předmět:
Zdroj: Journal of Obstetrics and Gynaecology Research. 47:928-934
ISSN: 1447-0756
1341-8076
DOI: 10.1111/jog.14619
Popis: 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.
Databáze: OpenAIRE
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