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Streptococcal infections in pregnancy. A study of 48 bacteremias
Abstract:
During a 4-year period, 48 obstetric patients with aerobic streptococcal bacteremia were identified. The isolates were group B (31); group D, enterococci (5); group A (4); group D, not enterococci (3); Streptococcus pneumoniae (3); and viridans streptococci (2). The most common diagnoses were endometritis (36) and chorioamnionitis (8). For all streptococcal genital infections, the clinical presentation included early-onset fever, often with few localizing signs. Only one patient had a chronic debilitating disease. There was an excellent correlation between genital and bloodstream isolates (36 of 42). Maternal response to therapy was good, with no deaths nor episodes of septic shock. Possible infectious complications developed in two fetuses and four neonates. The microbiologic and clinical features of aerobic streptococci were reviewed, and the outcome in obstetric patients and that in other adults were compared.
Insights
This study found aerobic streptococcal bacteremia in 48 obstetric patients, primarily linked to endometritis and chorioamnionitis. Prompt treatment led to good maternal outcomes, with minimal fetal or neonatal complications.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Microbiology
Background:
- Aerobic streptococcal bacteremia can occur in obstetric patients.
- Understanding the causative agents and clinical presentations is crucial for effective management.
Purpose of the Study:
- To identify the microbiologic and clinical features of aerobic streptococcal bacteremia in obstetric patients.
- To compare outcomes in obstetric patients with those in other adult populations.
Main Methods:
- Retrospective analysis of 48 obstetric patients with aerobic streptococcal bacteremia over a 4-year period.
- Identification of streptococcal species and correlation with diagnoses like endometritis and chorioamnionitis.
- Review of clinical presentations, treatment responses, and maternal/neonatal outcomes.
Main Results:
- Group B Streptococcus was the most common isolate (31 patients).
- Endometritis (36) and chorioamnionitis (8) were the most frequent diagnoses.
- Excellent correlation between genital and bloodstream isolates was observed (36/42).
- Maternal outcomes were favorable, with no deaths or septic shock.
- Two fetuses and four neonates experienced possible infectious complications.
Conclusions:
- Aerobic streptococcal bacteremia in obstetric patients typically presents with early-onset fever and few localizing signs.
- Prompt therapeutic intervention leads to good maternal outcomes.
- While rare, neonatal complications can occur, necessitating careful monitoring.