Provider Knowledge, Attitudes, and Practices regarding Obstetric and 
      Postsurgical Gynecologic Infections Due to Group A 
      <i>Streptococcus</i> and Other Infectious Agents

Van Beneden, Chris A.; Hicks, Lauri A.; Riley, Laura E.; Schulkin, Jay

doi:https://doi.org/10.1155/2007/90189

Infectious Diseases in Obstetrics and Gynecology

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Research Article | Open Access

Volume 2007 | Article ID 090189 | https://doi.org/10.1155/2007/90189

Provider Knowledge, Attitudes, and Practices regarding Obstetric and Postsurgical Gynecologic Infections Due to Group A Streptococcus and Other Infectious Agents

Chris A. Van Beneden,¹Lauri A. Hicks,^1,2Laura E. Riley,³and Jay Schulkin⁴

Received05 Sept 2007

Accepted12 Nov 2007

Published16 Jan 2008

Abstract

Background. Knowledge, attitudes, and practices of obstetricians and gynecologists regarding the Centers for Disease Control and Prevention (CDC) recommendations for prevention of healthcare-associated group A streptococcal (GAS) infections as well as general management of pregnancy-related and postpartum infections are unknown. Methods. Questionnaires were sent to 1300 members of the American College of Obstetricians and Gynecologists. Results. Overall, 53% of providers responded. Postpartum and postsurgical infections occurred in 3% and 7% of patients, respectively. Only 14% of clinicians routinely obtain diagnostic specimens for postpartum infections; providers collecting specimens determined the microbial etiology in 28%. Microbiologic diagnoses were confirmed in 20% of postsurgical cases. Approximately 13% and 15% of postpartum and postsurgical infections for which diagnoses were confirmed were attributed to GAS, respectively. Over 70% of clinicians were unaware of CDC recommendations. Conclusions. Postpartum and postsurgical infections are common. Providing empiric treatment without attaining diagnostic cultures represents a missed opportunity for potential prevention of diseases such as severe GAS infections.

References

F. G. Cunningham, J. C. Hauth, K. J. Leveno, L. Gilstrap III, S. L. Bloom, and K. D. Wenstrom, Eds., Williams Obstetrics, McGraw-Hill, New York, NY, USA, 22nd edition, 2005.
R. S. Gibbs and P. Duff, “Progress in pathogenesis and management of clinical intraamniotic infection,” American Journal of Obstetrics & Gynecology, vol. 164, no. 5, part 1, pp. 1317–1326, 1991.
View at: Google Scholar
D. Chelmow, M. P. Aronson, and U. Wosu, “Intraoperative & postoperative complications of gynecologic surgery,” in Current Diagnosis and Treatment Obstetrics and Gynecology, A. H. DeCherney, T. M. Goodwin, and N. Laufer, Eds., McGraw-Hill, New York, NY, USA, 10th edition, 2007.
View at: Google Scholar
E. Y. Anteby, S. Yagel, J. Hanoch, M. Shapiro, and A. E. Moses, “Puerperal and intrapartum group A streptococcal infection,” Infectious Diseases in Obstetrics and Gynecology, vol. 7, no. 6, pp. 276–282, 1999.
View at: Publisher Site | Google Scholar
M. R. D. Barnham and N. C. Weightman, “Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important,” Journal of Infection, vol. 43, no. 3, pp. 173–176, 2001.
View at: Publisher Site | Google Scholar
R. L. Berkelman, D. Martin, D. R. Graham et al., “Streptococcal wound infections caused by a vaginal carrier,” Journal of the American Medical Association, vol. 247, no. 19, pp. 2680–2682, 1982.
View at: Publisher Site | Google Scholar
S. Bygdeman, E. Jacobsson, K. E. Myrback, and G. Wallmark, “Hemolytic streptococci among infants in a maternity department. Report of an outbreak,” Scandinavian Journal of Infectious Diseases, vol. 10, no. 1, pp. 45–49, 1978.
View at: Google Scholar
K. Cartwright, M. Logan, C. McNulty et al., “A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire,” Epidemiology & Infection, vol. 115, no. 3, pp. 387–397, 1995.
View at: Google Scholar
Centers for Disease Control and Prevention, “Hospital outbreak of streptococcal wound infection—Utah,” Morbidity & Mortality Weekly Report, vol. 25, no. 18, p. 141, 1976.
View at: Google Scholar
Centers for Disease Control and Prevention, “Nosocomial group A streptococcal infections associated with asymptomatic health-care workers—Maryland and California, 1977,” Morbidity & Mortality Weekly Report, vol. 48, no. 8, pp. 163–166, 1999.
View at: Google Scholar
B. E. B. Claesson and U. L.-E. Claesson, “An outbreak of endometritis in a maternity unit caused by spread of group A streptococci from a showerhead,” Journal of Hospital Infection, vol. 6, no. 3, pp. 304–311, 1985.
View at: Google Scholar
T. Ejlertsen, J. Prag, E. Pettersson, and A. Holmskov, “A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis,” Scandinavian Journal of Infectious Diseases, vol. 33, no. 10, pp. 734–737, 2001.
View at: Publisher Site | Google Scholar
G. Gordon, B. A. S. Dale, and D. Lochhead, “An outbreak of group A haemolytic streptococcal puerperal sepsis spread by the communal use of bidets,” British Journal of Obstetrics and Gynaecology, vol. 101, no. 5, pp. 447–448, 1994.
View at: Google Scholar
F. B. Jamieson, K. Green, D. E. Low et al., “A cluster of surgical wound infections due to unrelated strains of group A streptococci,” Infection Control and Hospital Epidemiology, vol. 14, no. 5, pp. 265–267, 1993.
View at: Google Scholar
H. J. Kolmos, R. N. Svendsen, and S. V. Nielsen, “The surgical team as a source of postoperative wound infections caused by Streptococcus pyogenes,” Journal of Hospital Infection, vol. 35, no. 3, pp. 207–214, 1997.
View at: Publisher Site | Google Scholar
T. D. Mastro, T. A. Farley, J. A. Elliott et al., “An outbreak of surgical-wound infections due to group A Streptococcus carried on the scalp,” The New England Journal of Medicine, vol. 323, no. 14, pp. 968–972, 1990.
View at: Google Scholar
J. McGregor, A. Ott, and M. Villard, “An epidemic of “childbed fever”,” American Journal of Obstetrics & Gynecology, vol. 150, no. 4, pp. 385–388, 1984.
View at: Google Scholar
E. Ogden and M. S. Amstey, “Puerperal infection due to group A $β$ hemolytic Streptococcus,” Obstetrics & Gynecology, vol. 52, no. 1, pp. 53–55, 1978.
View at: Google Scholar
S. M. Paul, C. Genese, and K. Spitalny, “Postoperative group A $β$ -hemolytic Streptococcus outbreak with the pathogen traced to a member of a healthcare worker's household,” Infection Control & Hospital Epidemiology, vol. 11, no. 12, pp. 643–646, 1990.
View at: Google Scholar
J. Raymond, L. Schlegel, F. Garnier, and A. Bouvet, “Molecular characterization of Streptococcus pyogenes isolates to investigate an outbreak of puerperal sepsis,” Infection Control & Hospital Epidemiology, vol. 26, no. 5, pp. 455–461, 2005.
View at: Publisher Site | Google Scholar
D. D. Richman, S. J. Breton, and D. A. Goldmann, “Scarlet fever and group A streptococcal surgical wound infection traced to an anal carrier,” Journal of Pediatrics, vol. 90, no. 3, pp. 387–390, 1977.
View at: Publisher Site | Google Scholar
W. D. Schrack Jr., G. B. Miller, W. E. Parkin, and D. B. Fontana, “Four streptococcal infections traced to anal carrier,” Pennsylvania Medicine, vol. 82, no. 3, pp. 35–36, 1979.
View at: Google Scholar
W. E. Stamm, J. C. Feeley, and R. R. Facklam, “Wound infections due to group A Streptococcus traced to a vaginal carrier,” Journal of Infectious Diseases, vol. 138, no. 3, pp. 287–292, 1978.
View at: Google Scholar
A. Viglionese, V. F. Nottebart, H. A. Bodman, and R. Platt, “Recurrent group A streptococcal carriage in a health care worker associated with widely separated nosocomial outbreaks,” American Journal of Medicine, vol. 91, no. 3, supplement 2, pp. 329S–333S, 1991.
View at: Publisher Site | Google Scholar
D. J. Weber, W. A. Rutala, and F. W. Denny Jr., “Management of healthcare workers with pharyngitis or suspected streptococcal infections,” Infection Control & Hospital Epidemiology, vol. 17, no. 11, pp. 753–761, 1996.
View at: Google Scholar
A. M. Wiesenthal, “A maternal-neonatal outbreak of infections due to an unusual group A $β$ -hemolytic streptococcus,” Infection Control, vol. 5, no. 6, pp. 271–274, 1984.
View at: Google Scholar
Prevention of Invasive Group A Streptococcal Infections Workshop Participants, “Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention,” Clinical Infectious Diseases, vol. 35, no. 8, pp. 950–959, 2002, erratum in Clinical Infectious Diseases, vol. 36, no. 2, p. 243, 2003.
View at: Google Scholar
P. Duff, “Antibiotic selection for infections in obstetric patients,” Seminars in Perinatology, vol. 17, no. 6, pp. 367–378, 1993.
View at: Google Scholar
L. L. Klein and R. S. Gibbs, “Infection and preterm birth,” Obstetrics & Gynecology Clinics of North America , vol. 32, no. 3, pp. 397–410, 2005.
View at: Publisher Site | Google Scholar
E. R. Newton and P. A. Wallace, “Effects of prophylactic antibiotics on endometrial flora in women with postcesarean endometritis,” Obstetrics & Gynecology, vol. 92, no. 2, pp. 262–268, 1998.
View at: Publisher Site | Google Scholar
D. E. Soper, C. G. Mayhall, and H. P. Dalton, “Risk factors for intraamniotic infection: a prospective epidemiologic study,” American Journal of Obstetrics & Gynecology, vol. 161, no. 3, pp. 562–568, 1989.
View at: Google Scholar
T. J. Yeagley, J. E. Tolosa, and V. K. Bhutani, “Perinatal bacterial infection : an update,” Indian Journal of Pediatrics, vol. 65, no. 6, pp. 841–848, 1998.
View at: Google Scholar
ACOG, “Prophylactic antibiotic in labor and delivery,” International Journal of Gynaecology & Obstetrics, vol. 84, no. 3, pp. 300–307, 2004.
View at: Publisher Site | Google Scholar
S. M. Cox and L. C. Gilstrap, “Postpartum endometritis,” Obstetrics and Gynecology Clinics of North America, vol. 16, no. 2, pp. 363–371, 1989.
View at: Google Scholar
ACOG, “ACOG educational bulletin. Antimicrobial therapy for obstetric patients,” International Journal of Gynaecology & Obstetrics, vol. 61, no. 3, pp. 299–308, 1998, ACOG Technical Bulletin Number 245.
View at: Publisher Site | Google Scholar
S. Faro, “Postpartum endometritis,” Clinics in Perinatology, vol. 32, no. 3, pp. 803–814, 2005.
View at: Publisher Site | Google Scholar
D. Greenberg, E. Leibovitz, E. S. Shinnwell, P. Yagupsky, and R. Dagan, “Neonatal sepsis caused by Streptococcus pyogenes: resurgence of an old etiology?” Pediatric Infectious Disease Journal, vol. 18, no. 5, pp. 479–481, 1999.
View at: Publisher Site | Google Scholar
K. T. Chen, R. C. Huard, P. Della-Latta, and L. Saiman, “Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women,” Obstetrics & Gynecology, vol. 108, no. 3, pp. 482–487, 2006.
View at: Publisher Site | Google Scholar
L. Saiman, M. O'Keefe, P. L. Graham III et al., “Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women,” Clinical Infectious Diseases, vol. 37, no. 10, pp. 1313–1319, 2003.
View at: Publisher Site | Google Scholar
H. Wisplinghoff, T. Bischoff, S. M. Tallent, H. Seifert, R. P. Wenzel, and M. B. Edmond, “Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study,” Clinical Infectious Diseases, vol. 39, no. 3, pp. 309–317, 2004, erratum in Clinical Infectious Diseases, vol. 39, no. 7, p. 1093, 2004.
View at: Publisher Site | Google Scholar
R. S. Gibbs, J. D. Blanco, P. J. St Clair, and Y. S. Castaneda, “Quantitative bacteriology of amniotic fluid from women with clinical intraamniotic infection at term,” Journal of Infectious Diseases, vol. 145, no. 1, pp. 1–8, 1982.
View at: Google Scholar
P. A. Hawrylyshyn, P. Bernstein, and F. R. Papsin, “Risk factors associated with infection following cesarean section,” American Journal of Obstetrics & Gynecology, vol. 139, no. 3, pp. 294–298, 1981.
View at: Google Scholar
E. R. Newton, T. J. Prihoda, and R. S. Gibbs, “A clinical and microbiologic analysis of risk factors for puerperal endometritis,” Obstetrics & Gynecology, vol. 75, no. 3, part 1, pp. 402–406, 1990.
View at: Google Scholar
S. Roberts, M. Maccato, S. Faro, and P. Pinell, “The microbiology of post-cesarean wound morbidity,” Obstetrics & Gynecology, vol. 81, no. 3, pp. 383–386, 1993.
View at: Google Scholar
R. S. Sperling, E. Newton, and R. S. Gibbs, “Intraamniotic infection in low-birth-weight infants,” Journal of Infectious Diseases, vol. 157, no. 1, pp. 113–117, 1988.
View at: Google Scholar
R. E. O'Loughlin, A. Roberson, P. R. Cieslak et al., “The epidemiology of invasive group A Streptococcal infection and potential vaccine implications: United States, 2000–2004,” Clinical Infectious Diseases, vol. 45, no. 7, pp. 853–862, 2007.
View at: Publisher Site | Google Scholar
V. H. Coleman, M. L. Power, S. Zinberg, and J. Schulkin, “Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001–2004: part II,” Obstetrical & Gynecological Survey, vol. 59, no. 11, pp. 787–794, 2004.
View at: Publisher Site | Google Scholar
V. H. Coleman, M. L. Power, S. Zinberg, and J. Schulkin, “Contemporary clinical issues in outpatient obstetrics and gynecology: findings of the Collaborative Ambulatory Research Network, 2001–2004: part I,” Obstetrical & Gynecological Survey, vol. 59, no. 11, pp. 780–786, 2004.
View at: Publisher Site | Google Scholar

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Copyright © 2007 Chris A. Van Beneden et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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