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British Medical Bulletin Sep 2015Streptococci are a genus of Gram-positive bacteria which cause diverse human diseases. Many of these species have the potential to cause invasive infection resulting... (Review)
Review
INTRODUCTION
Streptococci are a genus of Gram-positive bacteria which cause diverse human diseases. Many of these species have the potential to cause invasive infection resulting from the presence of bacteria in a normally sterile site.
SOURCES OF DATA
Original articles, reviews and guidelines.
AREAS OF AGREEMENT
Invasive infection by a streptococcus species usually causes life-threatening illness. When measured in terms of deaths, disability and cost, these infections remain an important threat to health in the UK. Overall they are becoming more frequent among the elderly and those with underlying chronic illness. New observational evidence has become available to support the use of clindamycin and intravenous immunoglobulin in invasive Group A streptococcal disease.
AREAS OF CONTROVERSY
Few interventions for the treatment and prevention of these infections have undergone rigorous evaluation in clinical trials. For example, the role of preventative strategies such as screening of pregnant women to prevent neonatal invasive Group B streptococcal disease needs to be clarified.
FUTURE PROSPECTS
Studies of invasive streptococcal disease are challenging to undertake, not least because individual hospitals treat relatively few confirmed cases. Instead clinicians and scientists must work together to build national and international networks with the aim of developing a more complete evidence base for the treatment and prevention of these devastating infections.
Topics: Evidence-Based Medicine; Humans; Streptococcal Infections; Streptococcal Vaccines; Streptococcus; Streptococcus agalactiae; Streptococcus pyogenes; United Kingdom
PubMed: 26209784
DOI: 10.1093/bmb/ldv027 -
The Veterinary Clinics of North... Dec 2016Endometritis was rated as the third most common medical problem encountered in adult horses in North America. It is the leading cause of subfertility in broodmares and... (Review)
Review
Endometritis was rated as the third most common medical problem encountered in adult horses in North America. It is the leading cause of subfertility in broodmares and is a major contributor to economic loss in the horse breeding industry, with pregnancy rates reported to be as low as 21% in mares with severe endometritis. Endometritis may be categorized as: endometrosis (chronic degenerative endometritis), acute, chronic, active, dormant, subclinical, clinical, and persistent post-breeding. These classifications are not mutually exclusive, and mares may change categories within breeding seasons or estrous cycles or may fit in multiple classifications. This chapter will focus on discussing etiology and management strategies for mares affected by persistent post-breeding endometritis. Overall, these mares are considered subfertile but acceptable pregnancy and foaling rates can be achieved with appropriate breeding management.
Topics: Animals; Breeding; Endometritis; Female; Horse Diseases; Horses; Pregnancy; Puerperal Infection
PubMed: 27810036
DOI: 10.1016/j.cveq.2016.08.004 -
BMC Pregnancy and Childbirth Nov 2023Puerperal infection (PI) is a severe threat to maternal health. The incidence and risk of PI should be accurately quantified and conveyed for prior decision-making. This... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Puerperal infection (PI) is a severe threat to maternal health. The incidence and risk of PI should be accurately quantified and conveyed for prior decision-making. This study aims to assess the quality of the published literature on the epidemiology of PI, and synthesize them to identify the temporal trends and risk factors of PI occurring in Mainland China.
METHODS
This review was registered in PROSPERO (CRD42021267399). Putting a time frame on 2010 to March 2022, we searched Cochrane library, Embase, Google Scholar, MEDLINE, Web of Science, China biology medicine, China national knowledge infrastructure and Chinese medical current contents, and performed a meta-analysis and meta-regression to pool the incidence of PI and the effects of risk factors on PI.
RESULTS
A total of 49 eligible studies with 133,938 participants from 17 provinces were included. The pooled incidence of PI was 4.95% (95%CIs, 4.46-5.43), and there was a statistical association between the incidence of PI following caesarean section and the median year of data collection. Gestational hypertension (OR = 2.14), Gestational diabetes mellitus (OR = 1.82), primipara (OR = 0.81), genital tract inflammation (OR = 2.51), anemia during pregnancy (OR = 2.28), caesarean section (OR = 2.03), episiotomy (OR = 2.64), premature rupture of membrane (OR = 2.54), prolonged labor (OR = 1.32), placenta remnant (OR = 2.59) and postpartum hemorrhage (OR = 2.43) have significant association with PI.
CONCLUSIONS
Maternal infection remains a crucial complication during puerperium in Mainland China, which showed a nationwide temporal rising following caesarean section in the past decade. The opportunity to prevent unnecessary PI exists in several simple but necessary measures and it's urgent for clinicians and policymakers to focus joint efforts on promoting the bundle of evidence-based practices.
Topics: Pregnancy; Female; Humans; Cesarean Section; Incidence; Puerperal Infection; China; Risk Factors; Epidemiologic Studies
PubMed: 37996780
DOI: 10.1186/s12884-023-06135-x -
Maternal complications and cesarean section without indication: systematic review and meta-analysis.Revista de Saude Publica 2017The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The objective of this study was to determine the risks of severe acute maternal complications associated with cesarean section without medical indication.
METHODS
A systematic review was carried out with meta-analysis. The literature search was performed systematically, in multiple stages, in the PubMed, Lilacs, and Web of Science databases using the following descriptors: (postpartum period) and (cesarean section or natural childbirth) and ((morbidity or mortality) or (postpartum hemorrhage) or (puerperal infection) or (surgical infection) or (puerperal disorders)). The protocol of the study was registered at PROSPERO as CRD42016032933. A total of 1,328 articles were found; after selection, eight publications that met the study objective and inclusion criteria were selected, with information on 1,051,543 individuals.
RESULTS
The results obtained in the meta-analyses indicate that women with cesarean section have a higher chance of maternal death (OR = 3.10, 95%CI 1.92-5.00) and postpartum infection (OR = 2.83, 95%CI, 1.585.06), but they have a lower chance of hemorrhage (OR = 0.52, 95%CI 0.48-0.57). For the blood transfusion outcome, the group effect was not associated with the type of delivery (95%CI 0.88-2.81).
CONCLUSIONS
The quality of evidence was considered low for hemorrhage and blood transfusion and moderate for postpartum infection and maternal death. Thus, cesarean sections should be performed with caution and safety, especially when its benefits outweigh the risks of a surgical procedure.
Topics: Blood Transfusion; Cesarean Section; Female; Humans; Maternal Mortality; Natural Childbirth; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Outcome; Puerperal Disorders; Risk Factors
PubMed: 29166440
DOI: 10.11606/S1518-8787.2017051000389 -
The Cochrane Database of Systematic... Aug 2017Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to... (Review)
Review
BACKGROUND
Vacuum and forceps assisted vaginal deliveries are reported to increase the incidence of postpartum infections and maternal readmission to hospital compared to spontaneous vaginal delivery. Prophylactic antibiotics may be prescribed to prevent these infections. However, the benefit of antibiotic prophylaxis for operative vaginal deliveries is still unclear.
OBJECTIVES
To assess the effectiveness and safety of antibiotic prophylaxis in reducing infectious puerperal morbidities in women undergoing operative vaginal deliveries including vacuum or forceps deliveries, or both.
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (12 July 2017), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (12 July 2017) and reference lists of retrieved studies.
SELECTION CRITERIA
All randomised trials comparing any prophylactic antibiotic regimens with placebo or no treatment in women undergoing vacuum or forceps deliveries were eligible. Participants were all pregnant women without evidence of infections or other indications for antibiotics of any gestational age undergoing vacuum or forceps delivery for any indications. Interventions were any antibiotic prophylaxis (any dosage regimen, any route of administration or at any time during delivery or the puerperium) compared with either placebo or no treatment.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial eligibility and methodological quality. Two review authors extracted the data independently using prepared data extraction forms. Any discrepancies were resolved by discussion and a consensus reached through discussion with all review authors. We assessed methodological quality of the one included trial using the GRADE approach.
MAIN RESULTS
One trial, involving 393 women undergoing either vacuum or forceps deliveries, was included. The trial compared the antibiotic intravenous cefotetan after cord clamping compared with no treatment. This trial reported only two out of the nine outcomes specified in this review. Seven women in the group given no antibiotics had endomyometritis and none in prophylactic antibiotic group, the risk reduction was 93% (risk ratio (RR) 0.07; 95% confidence interval (CI) 0.00 to 1.21; low-quality evidence). There was no difference in the length of hospital stay between the two groups (mean difference (MD) 0.09 days; 95% CI -0.23 to 0.41; low-quality evidence). Overall, the risk of bias was judged to be unclear. The quality of the evidence using GRADE was low for both endometritis and maternal length of stay.
AUTHORS' CONCLUSIONS
One small trial was identified reporting only two outcomes. Evidence from this single trial suggests that antibiotic prophylaxis may lead to little or no difference in endometritis or maternal length of stay. There were no data on any other outcomes to evaluate the impact of antibiotic prophylaxis after operative vaginal delivery. Future research on antibiotic prophylaxis for operative vaginal delivery is needed to conclude whether it is useful for reducing postpartum morbidity.
Topics: Antibiotic Prophylaxis; Endometritis; Extraction, Obstetrical; Female; Humans; Obstetrical Forceps; Pregnancy; Puerperal Infection; Randomized Controlled Trials as Topic; Vacuum Extraction, Obstetrical; Vaginal Diseases
PubMed: 28779515
DOI: 10.1002/14651858.CD004455.pub4 -
Nederlands Tijdschrift Voor Geneeskunde Mar 2023Group A streptococcal (GAS) infections are caused by the Gram-positive bacterium Streptococcus pyogenes. Infection can occur via droplet infection from the throat and...
Group A streptococcal (GAS) infections are caused by the Gram-positive bacterium Streptococcus pyogenes. Infection can occur via droplet infection from the throat and via (in)direct contact with infected people. GAS can cause a wide variety of diseases, ranging from superficial skin infections, pharyngitis and scarlet fever, to serious invasive diseases such as puerperal sepsis, pneumonia, necrotising soft tissue infections (NSTI) (also known as necrotising fasciitis/myositis), meningitis and streptococcal toxic shock syndrome (STSS). In invasive GAS infections, the bacteria has penetrated into a sterile body compartment (such as the bloodstream, deep tissues, or the central nervous system). Invasive GAS infections are rare but serious, with high morbidity and mortality. Since March 2022, the National Institute for Public Health and the Environment (RIVM) reported a national increase in notifiable invasive GAS infections (NSTI, STSS and puerperal fever). Particularly NSTI has increased compared to the years before the SARS-CoV-2 pandemic. Remarkably, the proportion of children aged 0 to 5 years with invasive GAS-infections is higher in 2022 than in the previous years (12% compared to 4%). While seasonal peaks occur, the current elevation exceeds this variation. To promote early recognition and diagnosis of invasive GAS infections different clinical cases are presented.
Topics: Child; Female; Pregnancy; Humans; Netherlands; COVID-19; SARS-CoV-2; Streptococcal Infections; Streptococcus pyogenes; Fasciitis, Necrotizing; Soft Tissue Infections; Shock, Septic; Puerperal Infection
PubMed: 36928399
DOI: No ID Found -
AIDS Care Aug 2018HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality...
HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be higher in HIV-infected than HIV-uninfected women. We performed a prospective cohort study of 4231 women presenting to a regional referral hospital in 2015 for delivery or postpartum care. All febrile or hypothermic women, and a subset of randomly selected normothermic women were followed during hospitalization and with 6-week postpartum phone interviews. The primary outcome was in-hospital postpartum infection. Secondary outcomes included in-hospital complications (mortality, re-operation, intensive care unit transfer, need for imaging or blood transfusion) and 6-week mortality. We performed multivariable regression analyses to estimate adjusted differences in each outcome by HIV serostatus. Mean age was 25.2 years and 481 participants (11%) were HIV-infected. Median CD4+ count was 487 (IQR 325, 696) cells/mm, and 90% of HIV-infected women (193/215 selected for in-depth survey) were on antiretroviral therapy. Overall, 5% (205/4231) of women developed fever or hypothermia. Cumulative in-hospital postpartum infection incidence was 2.0% and did not differ by HIV status (aOR 1.4, 95% CI 0.6-3.3, P = 0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P = 0.001). In-hospital mortality was rare (2/1768, 0.1%), and remained so at 6 weeks (4/1526, 0.3%), without differences by HIV serostatus (P = 1.0 and 0.31, respectively). For women in rural Uganda with high rates of antiretroviral therapy coverage, HIV infection did not predict postpartum infection or mortality, but was associated with increased risk of postpartum complications.
Topics: Adult; CD4 Lymphocyte Count; Female; HIV Infections; Hospitalization; Humans; Incidence; Maternal Mortality; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Prospective Studies; Rural Population; Uganda; Young Adult
PubMed: 29451005
DOI: 10.1080/09540121.2018.1434119 -
Gynecologie, Obstetrique, Fertilite &... Feb 2023Sepsis is a severe affection, that requires an urgent and specific treatment sequence. Physiological changes occurring during pregnancy make the diagnosis of sepsis more... (Review)
Review
Sepsis is a severe affection, that requires an urgent and specific treatment sequence. Physiological changes occurring during pregnancy make the diagnosis of sepsis more challenging in this setting, with possible delay in treatment initiation, that in turn is responsible for poorer maternal and fetal outcome. This review aims to summarize current knowledge on the diagnosis and treatment of maternal sepsis, as well as persistent knowledge gaps in the field.
Topics: Pregnancy; Female; Humans; Pregnancy Complications, Infectious; Sepsis; Prenatal Care
PubMed: 36436821
DOI: 10.1016/j.gofs.2022.11.007 -
BMJ Case Reports Oct 2014
Topics: Female; Humans; Pericarditis; Puerperal Infection; Streptococcal Infections; Young Adult
PubMed: 25274560
DOI: 10.1136/bcr-2014-205513 -
What can the early infection preventing pioneers teach infection prevention and control teams today?Infection, Disease & Health May 2022Puerperal fever and erysipelas were common Streptococcal infections of the 18th and 19th centuries which caused extensive nosocomial outbreaks. With dramatic clinical...
BACKGROUND
Puerperal fever and erysipelas were common Streptococcal infections of the 18th and 19th centuries which caused extensive nosocomial outbreaks. With dramatic clinical presentations and high-mortality, physicians struggled to understand and prevent them. Three infection prevention and control (IPC) pioneers (Gordon, Holmes and Semmelweis) in the pre-antibiotic and pre-epidemiology era made significant discoveries. Although much has been written of their breakthroughs, this has been selective and at times misinterpreted.
METHODS
The primary sources of the three IPC pioneers (1 translation) were reviewed to present 3 narratives of their discoveries. An interpretation of the pioneers' discoveries in the current context is provided.
RESULTS
The IPC pioneers' achievements are much wider than acknowledged in extant hand hygiene guidance - in relation to the role of indirect contact transmission (environment and equipment), e.g. Semmelweis considered the primary measure to prevent infection to be the avoidance of contamination - not hand hygiene.
CONCLUSIONS
The pioneers provided strong evidence of both direct and indirect transmission to significant 18th -19th century infections. They make a strong case for environment and equipment decontamination and cleanliness alongside decontaminating hands.
Topics: Disease Outbreaks; Female; Hand Hygiene; Hospitals; Humans; Infection Control; Pregnancy; Puerperal Infection
PubMed: 34862150
DOI: 10.1016/j.idh.2021.10.003