TY - JOUR
T1 - Creatine kinase as an indicator for hysterectomy in postpartum endomyometritis due to group a streptococci
T2 - A hypothesis illustrated by a case report
AU - Dehaene, Isabelle
AU - Loccufier, Anne
AU - Temmerman, Marleen
AU - De Keersmaecker, Bart
AU - De Baene, Luc
PY - 2012/1
Y1 - 2012/1
N2 - Background: Puerperal group A streptococcus (GAS) infection, once the leading cause of postpartum sepsis, has been increasing again since the 1980s. Streptococcal toxic shock syndrome (STSS) is a serious complication characterized by rapidly spreading GAS infection, shock, and multiple organ failure. Immediate recognition and implementation of therapy is crucial for survival. Making informed decisions regarding surgical debridement, namely hysterectomy, based on clinical indicators is difficult for practitioners. Objectives: This article discusses the potential role of creatine kinase in the decision-making process for treatment of STSS, particularly with regard to hysterectomy. Material and Methods: A case report is presented. The literature was searched using the key words 'group A streptococcus', 'postpartum hysterectomy', 'creatine kinase', 'endomyometritis', and 'streptococcal toxic shock syndrome' in PubMed and the UptoDate database. Relevant articles published between 1991 and 2011 were evaluated. Conclusion: Decisions regarding hysterectomy in STSS management are difficult. A rise in CK levels in the serum may indicate involvement of the myometrium and may be an important parameter in the difficult decision of hysterectomy when treating STSS.
AB - Background: Puerperal group A streptococcus (GAS) infection, once the leading cause of postpartum sepsis, has been increasing again since the 1980s. Streptococcal toxic shock syndrome (STSS) is a serious complication characterized by rapidly spreading GAS infection, shock, and multiple organ failure. Immediate recognition and implementation of therapy is crucial for survival. Making informed decisions regarding surgical debridement, namely hysterectomy, based on clinical indicators is difficult for practitioners. Objectives: This article discusses the potential role of creatine kinase in the decision-making process for treatment of STSS, particularly with regard to hysterectomy. Material and Methods: A case report is presented. The literature was searched using the key words 'group A streptococcus', 'postpartum hysterectomy', 'creatine kinase', 'endomyometritis', and 'streptococcal toxic shock syndrome' in PubMed and the UptoDate database. Relevant articles published between 1991 and 2011 were evaluated. Conclusion: Decisions regarding hysterectomy in STSS management are difficult. A rise in CK levels in the serum may indicate involvement of the myometrium and may be an important parameter in the difficult decision of hysterectomy when treating STSS.
KW - Creatine kinase
KW - Group A streptococcus
KW - Postpartum hysterectomy
KW - Postpartum toxic shock syndrome
KW - Streptococcus pyogenes
UR - http://www.scopus.com/inward/record.url?scp=84856103348&partnerID=8YFLogxK
U2 - 10.1159/000333233
DO - 10.1159/000333233
M3 - Article
C2 - 22178984
AN - SCOPUS:84856103348
SN - 0378-7346
VL - 73
SP - 82
EP - 88
JO - Gynecologic and Obstetric Investigation
JF - Gynecologic and Obstetric Investigation
IS - 1
ER -