Group A streptococcal puerperal sepsis preceded by positive surveillance cultures.
BACKGROUND: Screening of pregnant women for vaginal and rectal carriage of group B streptococci may also identify group A streptococcal carriers. The clinical significance of prenatal group A streptococcal carriage is unknown. CASES: Two women developed group A streptococcal puerperal sepsis after delivery at one hospital 15 months apart. The first patient required hysterectomy and suffered complications including subcapsular hepatic hematoma, pleural effusion, and prolonged ileus. She recovered after a 35-day hospitalization. The second patient had endometritis and recovered. Both had had group A streptococci isolated from vaginal and rectal cultures taken for prenatal group B streptococcal screening. The acute sepsis isolates were both M-type 28, but pulsed-field gel electrophoresis determined that the strains were unrelated. CONCLUSIONS: Finding group A streptococci on prenatal culture may presage serious postpartum infection.