Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study.
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Contou Damien, Colin Gwenhaël, Travert Brendan, Jochmans Sébastien, Conrad Marie, Lascarrou Jean-Baptiste, Painvin Benoit, Ferré Alexis, Schnell David, La Combe Beatrice, Coudroy Rémi, Ehrmann Stephan, Rambaud Jérôme, Wiedemann Arnaud, Asfar Pierre, Kalfon Pierre, Guérot Emmanuel, Préau Sébastien, Argaud Laurent, Daviet Florence, Dellamonica Jean, Dupont Audrey, Fartoukh Muriel, Kamel Toufik, Béduneau Gaëtan, Canouï-Poitrine Florence, Boutin Emmanuelle, Lina Gérard, Mekontso Dessap Armand, Tristan Anne, de Prost Nicolas, French m-TSS Study Group
Аннотация
METHODS: This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between 1 January 2005 and 31 December 2020 in 43 French pediatric (n = 7) or adult (n = 36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as to assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, in critically ill patients with m-TSS.
RESULTS: In total, 102 patients with m-TSS (median age, 18 years; interquartile range, 16-24 years) were admitted to 1 of the participating ICUs. All blood cultures (n = 102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for superantigenic toxin gene sequences was performed for 76 of the 92 vaginal samples positive for S. aureus (83%), and toxic shock syndrome toxin 1 was isolated from 66 strains (87%). At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS, and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with antitoxin antibiotic therapy, and 8 (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors, and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU.
CONCLUSIONS: In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.