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Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review
Kristin Harris1, Leslie K Proctor2, Shiri Shinar3
1Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Insights
Group A Streptococcus infections pose a significant risk during pregnancy, often leading to severe outcomes like septic shock. Early recognition and aggressive management are crucial for improving survival rates in these critical cases.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Bacteriology
Background:
- Group A Streptococcus (Streptococcus pyogenes) is a lethal pathogen with heightened risks for pregnant individuals, potentially causing septic shock and multiorgan failure.
- Pregnancy and puerperal periods represent critical windows for severe Group A Streptococcus infections, necessitating a comprehensive understanding of outcomes and management.
Approach:
- A systematic review was conducted, analyzing 40 original research articles published from 1990 onwards.
- The review included studies reporting four or more unique cases of Group A Streptococcus infection in pregnant or postpartum women, identified through a comprehensive database search.
Key Points:
- A total of 1160 patients were identified, with the majority of infections occurring postpartum (91.9%).
- Bacteremia (49.0%) and endometritis (45.9%) were common, with 28.2% experiencing puerperal sepsis, and one-third of these progressing to streptococcal toxic shock syndrome.
- The overall case fatality ratio was 2.0%, with a notable proportion of deaths occurring in antenatal cases, including septic abortions.
Conclusions:
- Group A Streptococcus infection significantly contributes to maternal morbidity and mortality.
- Prompt diagnosis and aggressive management are essential for favorable outcomes due to the high risk of sepsis and streptococcal toxic shock syndrome.
Introduction:
Group A streptococcus (Streptococcus pyogenes) is one of the most lethal bacterial pathogens of humans, with increased risk of progression to septic shock and multiorgan failure in the pregnant population. The objective of this study is to systematically review the outcomes and management strategies for pregnancy and puerperal group A streptococcus infections in an effort to provide further guidance for prevention and treatment of a rare but lethal infection worldwide.
Material And Methods:
A comprehensive search using puerperium and streptococcus pyogenes terms was completed across several registered databases. A total of 902 articles investigating pregnancy and puerperal group A streptococcus infection were identified, with 40 studies fulfilling inclusion criteria of original research articles in humans published from 1990 onwards reporting four or more unique cases of group A streptococcus in pregnancy or postpartum. This study was registered in PROSPERO: CRD42020198983.
Results:
A total of 1160 patients with pregnancy and puerperal group A streptococcus infection were identified. Most infections occurred postpartum (91.9%), with 4.7% reported antepartum and 0.6% intrapartum. Bacteremia was present in 49.0% of patients and endometritis in 45.9%. Puerperal sepsis was described in 28.2% of cases and progressed to streptococcal toxic shock syndrome in one-third of such cases. Overall, the case fatality ratio was 2.0%, with one-third of the deaths from antenatal cases including 3/22 (13.6%) cases of septic abortion and 10/46 (21.7%) antenatal cases of group A streptococcus infection.
Conclusions:
Group A streptococcus infection remains an important contributor to pregnancy and puerperal morbidity and mortality. Early recognition, diagnosis and aggressive management are important for favorable outcomes given the serious risk of sepsis and streptococcal toxic shock syndrome.
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