Clinical Epidemiology and Ageing

Menstrual toxic shock syndrome: a French nationwide multicenter retrospective study.

Contou D, Colin G, Travert B, Jochmans S, Conrad M, Lascarrou J-B, Painvin B, Ferré A, Schnell D, La Combe B, Coudroy R, Ehrmann S, Rambaud J, Wiedemann A, Asfar P, Kalfon P, Guérot E, Préau S, Argaud L, Daviet F, Dellamonica J, Dupont A, Fartoukh M, Kamel T, Béduneau G, Canoui-Poitrine F, Boutin E, Lina G, Dessap AMekontso, Tristant A, de Prost N Clin Infect Dis. 2021.

BACKGROUND: Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking.

METHODS: This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between January 1, 2005 and December 31, 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 assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, of critically ill patients with m-TSS.

RESULTS: In total, 102 patients with m-TSS (median age: 18 [16-24] years) were admitted to one of the participating ICUs. All blood cultures (n=102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for super-antigenic toxin gene sequences was performed for 76 of the 92 (83%) vaginal samples positive for Staphylococcus aureus and TSST-1 isolated from 66 (87%) strains. 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 anti-toxin antibiotic therapy and eight (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.

DOI: 10.1093/cid/ciab378