Estimating predictors of severity of group A Streptococcus infection in pregnancy

Figures & data

Table 1. Characteristics of group A Streptococcus infection in pregnancy and postpartum (n = 57).

No deaths occurred among this cohort.

Variable	Women n = 57 (%)
Detection of an infection
Postpartum (<72 h)	26 (46.6)
Late postpartum	27 (47.3)
Wound infection	4 (7.0)
Age, year	32.7
GA at delivery, weeks	39 ± 2
Mode of delivery
NVD	42 (73.6)
VE	5 (8.7)
CS	10 (17.5)
Positive GBS screening	4 (7.0)
Antibiotic treatment during labor	15 (26.3)
Presenting sign/symptom
Fever	48 (84.2)
Abdominal pain	22 (38.5)
Tachycardia	15 (0.38)
Culture site
Uterus	44 (77.1)
Urine	9 (15.3)
Blood	24 (42.1)
Wound	4 (7.0)
Positive from 2 sites	28 (49.1)
Time from sign/symptom to antibiotic treatment
<24 h	48 (84.3)
>24 h	9 (15.7)
Epidemiology
Hospital-acquired	7 (1.2)
Community-acquired	50 (87.1)
Season
May–September	12 (21.0)
October–April	45 (78.9)

GA: gestational age; NVD: normal vaginal delivery; VE: vaccume extraction; CS: cesarean section.

Table 2. Complications and treatment for group A Streptococcus infections in women with streptococcal toxic shock syndrome admitted to an intensive care unit (n = 12).

Variable	n (%)
Complication
ARDS	8 (66.6)
Acute liver failure	5 (41.6)
Acute kidney failure	2 (16.2)
DIC	4 (33.3)
Treatment
Antibiotics only	6 (50)
Intubation	4 (33.3)
IVIG	6 (66.6)
Laparotomy/laparoscopy	6 (66.6)
Uterine curettage	2 (16.2)
Hysterectomy	4 (33.3)

Table 3. Characteristics of women admitted to an intensive care unit (n = 12).

Variable	ICU (n = 12)	Non-ICU (n = 45)	p-Value
Timing of infection
Post-partum (<72 h)	9 (75)	17 (37.7)	.12
Late post-partum	3 (25)	24 (53.3)
Wound infection	0	4 (7.5)
Age (years)	32.4 ± 5.5	32.8 ± 4.5	.83
BMI >30	2 (15.4)	4 (7.5)	.35
GDM	2 (16.6)	5 (11. 1)	.61
PROM (hours)	5.93 (3.3)	3.88 (1.8)	.005
Mode of delivery
NVD	10 (83.3)	32 (71.1)	.48
CS	2 (16.6)	8 (17.7)	.7
Positive GBS screening	0	4 (8.8)	.51
Presenting sign/symptom
Fever	9 (75)	39 (86.6)	.37
Abdominal pain	3 (25)	19 (42.2)	.33
Tachycardia (>100 bpm)	6 (50)	8 (17.7)	.04
C-reactive protein (CRP) (mg/L)	261.0 (97.0)	190.0 (125.0)	.25
Time to sign/symptom to first antibiotic treatment
<48 h	8 (66.6)	7 (15.5)	.02
2–7 days	3 (25)	27 (60)	.05
>7 days	1 (8.3)	11 (24.4)	.67
Time from sign/symptom to antibiotics treatment
<24 h	5 (41.6.4)	42 (93.3)	<.001

Cases of pregnancy associated GAS were not included in this analysis. This have now been clearly stated in the table.

Figure 1. A multi-year description of pregnancy associated GAS infection and the results of the epidemiologic investigation. Eis: epidemiologic investigation status, Ca: community acquired, Ha: hospital-staff acquired, LpHa: low probability of hospital staff acquired.

Table 4. Characteristics of women who received antibiotics during labor.

	Antibiotics during labor (n = 15)	No antibiotics during labor (n = 42)	p-Value
Admitted to ICU	1 (6.6%)	12 (27.3%)	.12
Time from delivery to presentation (hours)	8 (± 4.8)	4.8 (± 4.2)	.008
Laparotomy/explorative laparoscopy	0	9 (20.4%)	.09
Hysterectomy	0	4 (9.0%)	.51
Streptococcal toxic shock syndrome	0	10 (22.7%)	.04