Postpartum Streptococcus pyogenes Outbreak in the Labor and Delivery Unit of a Quaternary Referral Center: a Case Series and Review of the Literature

Historically, childbirth was associated with morbidity and mortality, often due to endometritis or puerperal fever. Streptococcus pyogenes was first identified as the cause of puerperal fever by Louis Pasteur, and it remains a virulent and lethal pathogen with a case fatality rate of 15 to 20% [1]. The pathogenesis of postpartum endometritis is believed to be associated with disruption of the woman's mucosal barriers from childbirth and invasion of bacteria either from vaginal flora or from a health care worker's hands [2]. Despite the implementation of hand sanitizing and barrier precautions (gloves), outbreaks of S. pyogenes still occur today [1]. This article provides an overview of the role of S. pyogenes in postpartum infections and describes an outbreak of postpartum endometritis due to S. pyogenes. The case report involved three patients who were admitted to a quaternary care medical center on the same day and, following discharge, were all readmitted with sepsis and endometritis. The bacteria were isolated, and pulsed-field gel electrophoresis revealed that the three S. pyogenes strains were genetically identical.