Vaginal carriage rate of streptococcal pyogenes in 1600 pregnant women

Saab, Jawad; Bell, Sydney M.; Lahra, Monica M

doi:10.1097/pat.0b013e3283582983

Cited by 13 publications

(8 citation statements)

References 5 publications

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“…The inclusion of genital culture specimens, and thus isolates from nonsterile sites, could represent another limitation. Given the very low rate of genital colonization with GAS (only 0.03% to 0.06%) and the well-recognized nature of puerperal sepsis as an invasive form of streptococcal disease, we would argue that this is justified, as the isolation of GAS is unlikely to be due to chance alone in a female patient with a compatible clinical presentation [ 35 – 36 ]. For GCS and GGS, colonization rates may be higher (1–3%), but out of 9 cases with GCGS endometritis, 5 had a positive blood culture and exclusion of the remaining 4 would not impact our results, as the treatment effect of clindamycin was limited to the subset of patients with iGAS disease.…”

Section: Discussionmentioning

confidence: 99%

Secular trends in incidence of invasive beta-hemolytic streptococci and efficacy of adjunctive therapy in Quebec, Canada, 1996-2016

et al. 2018

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ObjectivesTo examine secular changes in the incidence of invasive beta-hemolytic streptococcal infections, and to assess the efficacy of immunoglobulins and clindamycin as adjunctive therapies in the management of Streptococcus pyogenes infections.MethodsRetrospective cohort study of all cases of invasive group A (GAS), B (GBS), C or G (GCGS) streptococcal infections managed in a Canadian tertiary center from 1996–2016. Population incidence was measured for diabetics and non-diabetics. Adjusted odds ratios (AOR) and their 95% confidence intervals (CI) were calculated by logistic regression.Results741 cases were identified (GAS: 249; GBS: 304; GCGS: 188). While the incidence of invasive GAS infections fluctuated with no clear trend, incidence of invasive GBS and GCGS increased over time and were 8.4 and 6.3 times higher in diabetics. Mortality of invasive GAS infections decreased from 16% (6/37) in 1996–2001 to 4% (4/97) in 2011–15. Among patients with GAS infections, clindamycin administered concomitantly with a beta-lactam within 24 hours of admission decreased mortality (AOR: 0.04, 95%CI: 0.003–0.55, P = 0.02. Immunoglobulins had no such effect (AOR: 1.66, 95%CI: 0.16–17.36, P = 0.67). The protective effect of clindamycin was similar in patients with pneumonia/empyema compared to all others.ConclusionIncidence of GBS and GCGS infections increased due to an expansion of the high-risk population (elderly diabetics), but also rose in non-diabetics. No such secular change was seen for invasive GAS infections. The decrease in mortality in patients with invasive GAS infections presumably reflects better case-management. Adjunctive clindamycin reduced mortality in invasive GAS infections; immunoglobulins did not, but power was limited. The highest mortality was seen in patients with GAS pneumonia/empyema, for whom clindamycin was protective but underused.

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Section: Discussionmentioning

confidence: 99%

Secular trends in incidence of invasive beta-hemolytic streptococci and efficacy of adjunctive therapy in Quebec, Canada, 1996-2016

et al. 2018

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“…4 GAS is not always symptomatic, and the genital and rectal tracts were found to be colonized by GAS in 0.03% of 6944 women at 35-37 weeks of pregnancy in 2000. 5 In a recent study conducted among 1600 pregnant women in the UK by Saab et al 6 , only one patient (0.06%) was found to be positive for GAS. Concerning the prevalence of asymptomatic pharyngeal GAS carriage, it is quite high in children (around 10%), but is generally lower in adults: in a Danish study conducted by Hoffman et al 7 , it was found to be 2.2% in the general population aged >14 years, while it was 10.4% below this age.…”

Section: Discussionmentioning

confidence: 96%

Recurrent Streptococcus pyogenes genital infection in a woman: test and treat the partner!

Verkaeren

Epelboin

et al. 2014

International Journal of Infectious Diseases

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Group A Streptococcus (GAS) is a well-known cause of vulvovaginitis in prepubescent girls, but it is rarely described in adult women. We describe the case of a 64-year-old woman who presented with endometritis revealed by GAS bacteraemia, followed by recurrent vulvovaginitis due to a wild-type strain of GAS. She relapsed twice despite amoxicillin treatment. Her husband was found to be an asymptomatic carrier after GAS was identified in nasal and rectal swabs. She was cured after eradication of carriage in both herself and her husband with amoxicillin and rifampin. When recurrent Streptococcus pyogenes genital infections occur, test and treat the partner.

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“…RD2 encodes several surface proteins, which may play a role in the tissue tropism by attaching to endometrial epithelial cells [32,33]. However, vaginal GAS colonization during pregnancy is known be to very low, less than 1% [34,35], and most likely it does not explain the prevalence of postpartum emm28 GAS infections. Asymptomatic carriage of GAS on skin or throat are more common (5e30% of the population), and community carriage might predispose to postpartum infections [29].…”

Section: Discussionmentioning

confidence: 99%

Genetic evolution of invasive emm28 Streptococcus pyogenes strains and significant association with puerperal infections in young women in Finland

Gröndahl-Yli-Hannuksela

Beres

Hyyryläinen

et al. 2021

Clinical Microbiology and Infection

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Objectives: Streptococcus pyogenes or group A streptococcus (GAS) is a human specific pathogen that annually infects over 700 million individuals. GAS strains of type emm28 are an abundant cause of invasive infections in Europe and North America. Methods: We conducted a population-based study on bacteraemic emm28 GAS cases in Finland, from 1995 to 2015. Whole-genome sequencing (WGS) was used to genetically characterize the bacterial isolates. Bayesian analysis of the population structure was used to define genetic clades. Register-linkage analysis was performed to test for association of emm28 GAS with delivery-or postpartum-related infections. A genome-wide association study was used to search for DNA sequences associated with delivery or puerperal infections. Results: Among 3060 bacteraemic cases reported during the study period, 714 were caused by emm28. Women comprised a majority of cases (59 %, 422/714), and were significantly over-represented (84.4 %, 162/192, p < 0.0001) among cases in the childbearing age group (20e40 years). Register-linkage analysis revealed strong association (p < 0.0001) of emm28 bacteraemias with delivery and puerperium. In this register-linkage analysis, 120 women with GAS bacteraemia were identified and linked to delivery, infections during delivery or puerperium time. Among these the proportion of cases caused by emm28 was significantly higher than any other emm type (55.8%, 67/120, p < 0.0001). Among the four genetic subclades identified, SC1B has dominated among the bacteraemic cases since 2000. Altogether 620 of 653 (94.9%) isolates belonged to SC1B. No specific sequence or genetic clade was found nonrandomly associated with delivery or puerperal infections. Conclusions: Women of childbearing age were significantly overrepresented among bacteraemic emm28 GAS cases, and in particular were strongly associated with delivery and puerperium cases over the 21 years studied. The molecular mechanisms behind these associations are unclear and warrant further investigation.

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Vaginal carriage rate of streptococcal pyogenes in 1600 pregnant women

Cited by 13 publications

References 5 publications

Secular trends in incidence of invasive beta-hemolytic streptococci and efficacy of adjunctive therapy in Quebec, Canada, 1996-2016

Secular trends in incidence of invasive beta-hemolytic streptococci and efficacy of adjunctive therapy in Quebec, Canada, 1996-2016

Recurrent Streptococcus pyogenes genital infection in a woman: test and treat the partner!

Genetic evolution of invasive emm28 Streptococcus pyogenes strains and significant association with puerperal infections in young women in Finland

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