Genital Tract GAS Infection ISIDOG Guidelines

Donders, Gilbert; Greenhouse, Peter; Donders, Francesca; Engel, Ulrike; Paavonen, Jorma; Mendling, Werner

doi:10.3390/jcm10092043

Cited by 17 publications

(21 citation statements)

References 110 publications

(135 reference statements)

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“…In the past 30 years, most investigators have focused only on the relationship between S. pyogenes and postpartum infections, while the relationship with neonatal infections and vaginitis in girls has not received sufficient attention. Recent research on S. pyogenes shows that the pathogenicity of S. pyogenes in the vulva and vaginal mucosa of girls has become a concern ( Donders et al, 2021 ; Hu et al, 2021 ). Although the amount of relevant information in this study is limited, the results provide insight into the relationship between emm type and vulvitis and vaginitis.…”

Section: Discussionmentioning

confidence: 99%

Molecular Characteristics of Streptococcus pyogenes Isolated From Chinese Children With Different Diseases

Liang

et al. 2021

Front. Microbiol.

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Streptococcus pyogenes is a bacterial pathogen that causes a wide spectrum of clinical diseases exclusively in humans. The distribution of emm type, antibiotic resistance and virulence gene expression for S. pyogenes varies temporally and geographically, resulting in distinct disease spectra. In this study, we analyzed antibiotic resistance and resistance gene expression patterns among S. pyogenes isolates from pediatric patients in China and investigated the relationship between virulence gene expression, emm type, and disease categories. Forty-two representative emm1.0 and emm12.0 strains (n = 20 and n = 22, respectively) isolated from patients with scarlet fever or obstructive sleep apnea-hypopnea syndrome were subjected to whole-genome sequencing and phylogenetic analysis. These strains were further analyzed for susceptibility to vancomycin. We found a high rate and degree of resistance to macrolides and tetracycline in these strains, which mainly expressed ermB and tetM. The disease category correlated with emm type but not superantigens. The distribution of vanuG and virulence genes were associated with emm type. Previously reported important prophages, such as φHKU16.vir, φHKU488.vir, Φ5005.1, Φ5005.2, and Φ5005.3 encoding streptococcal toxin, and integrative conjugative elements (ICEs) such as ICE-emm12 and ICE-HKU397 encoding macrolide and tetracycline resistance were found present amongst emm1 or emm12 clones from Shenzhen, China.

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Section: Discussionmentioning

confidence: 99%

Molecular Characteristics of Streptococcus pyogenes Isolated From Chinese Children With Different Diseases

Liang

et al. 2021

Front. Microbiol.

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“…People presenting with postpartum fever and/or abdominal pain deserve a high level of suspicion for GAS. and investigation with blood and vaginal cultures should be strongly considered and is recommended per the most recent International Society for Infectious Disease in Obstetrics and Gynecology (ISIDOG) 56 . Given the potential for severe disease and rapid deterioration, the development of rapid assays for detection of GAS from vaginal specimens could allow for timely diagnosis and appropriate antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…Penicillin and first‐generation cephalosporins are used routinely in pregnancy for prophylaxis in preterm premature rupture of membranes, group B streptococcus carriage, as well as surgical and instrumental births. However, a prophylactic course of antibiotics for group B streptococcus is insufficient for eradication of GAS (a 10‐day course of amoxicillin plus clavulanic acid or a first‐generation oral cephalosporin is recommended) and spontaneous clearance occurs in only half of patients 56 . Therefore, this practice is unlikely to change GAS prevalence rates, but it should be considered in future population surveillance studies.…”

Section: Discussionmentioning

confidence: 99%

“…55 At this time, screening for asymptomatic women in pregnancy is not recommended; however, given the excessive risk during this period, further studies on necessity, modality and cost analysis of screening are needed. 56 The optimal management strategy for puerperal GAS infection remains unclear. Most patients in this review received antibiotics; however, the timing, type and duration were not often reported and cannot be linked to outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review

Harris

Proctor

Shinar

et al. 2023

Acta Obstet Gynecol Scand

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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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“…They are one of the top five causes of maternal deaths worldwide and account for 10–15% of deaths in the postpartum period. Puerperal sepsis causes more than 75,000 maternal deaths annually [ 22 ]. Abnormal vaginal microbiota forms an important reservoir for causative agents of these infections.…”

Section: Discussionmentioning

confidence: 99%

Aerobic vaginitis in the third trimester and its impact on pregnancy outcomes

Nguyen

Hoang

et al. 2022

BMC Pregnancy Childbirth

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Background Aerobic vaginitis (AV) is a vaginal inflammation characterized by disruption of the lactobacillus microbiota and increased counts of different aerobic bacteria. AV may result in severe complications, especially during pregnancy, including preterm delivery, neonatal and maternal infections. This study aimed to determine the prevalence of AV in the third trimester of pregnancy, and the relationship between AV and pregnancy outcomes. Methods A cross-sectional descriptive study included 323 pregnant women attending for routine antenatal care in the Hue University Hospital. Vaginal samples collected at the third trimester of pregnancy were evaluated for AV according to the scoring system of Donders and cultured for identification of predominant bacteria. Pregnancy was followed to its end, and pregnancy outcomes were recorded for both mothers and infants. Results The proportion of pregnant women diagnosed with AV in the third trimester was found to be 15.5%, with the vast majority of the cases (84%) displaying the light AV and 16% the moderate AV. The vaginal cultures in the women with AV revealed most frequently Streptococcus agalactiae (6%), followed by Enterococcus spp (4%), Staphylococcus aureus (4%), and Acinetobacter baumannii (2%). In addition, AV during the last trimester of pregnancy was associated with an increased risk of puerperal sepsis (OR 8.65, 95% CI: 1.41—53.16, p = 0.020) and there was a slightly increased risk for neonatal infections, which was statistically insignificant. Conclusions The proportion of AV is relatively high in Vietnamese pregnant women. Since it is associated with an increased risk of puerperal sepsis, it needs to be diagnosed and treated before delivery.

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Genital Tract GAS Infection ISIDOG Guidelines

Cited by 17 publications

References 110 publications

Molecular Characteristics of Streptococcus pyogenes Isolated From Chinese Children With Different Diseases

Molecular Characteristics of Streptococcus pyogenes Isolated From Chinese Children With Different Diseases

Outcomes and management of pregnancy and puerperal group A streptococcal infections: A systematic review

Aerobic vaginitis in the third trimester and its impact on pregnancy outcomes

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