Menstrual Toxic Shock Syndrome: A French Nationwide Multicenter Retrospective Study
Damien Contou, Gwenhaël Colin, Brendan Travert, Sébastien Jochmans, Marie Conrad, Jean-Baptiste Lascarrou, Benoît Painvin, Alexis Ferré, David Schnell, Béatrice La Combe, Rémi Coudroy, Stéphan Ehrmann, Jérôme Rambaud, Arnaud Wiedemann, Pierre Asfar, Pierre Kalfon, Emmanuel Guérot, Sébastien Préau, Laurent Argaud, Florence Daviet, Jean Dellamonica, Audrey Dupont, Muriel Fartoukh, Toufik Kamel, G. Béduneau, Florence Canouï‐Poitrine, Emmanuelle Boutin, Gérard Lina, Armand Mekontso Dessap, Anne Tristan, Nicolas de Prost, French m-TSS Study Group, Gwenhaël Colin, Brendan Travert, Sébastien Jochmans, Marie Conrad, Jean-Baptiste Lascarrou, Nicolas de Prost, Benoît Painvin, Alexis Ferré, David Schnell, Béatrice La Combe, Rémi Coudroy, Stéphan Ehrmann, Jérôme Rambaud, Arnaud Wiedemann, Pierre Asfar, Damien Contou, Pierre Kalfon, Florence Daviet, Sébastien Préau, Laurent Argaud, Jean Dellamonica, Toufik Kamel, G. Béduneau, Muriel Fartoukh, Anthony Dupont, Fabrice Sinnah, Zakaria Ait Hamou, Jean‐Pierre Quenot, Pierre Moine, Jérémy Bourenne, Emmanuel Guérot, Bruno Mégarbane, Danielle Reuter, Arnaud Galbois, Pascal Beuret, Cédric Bruel, M. Isnard, Agathe Delbove, Benjamin Sztrymf, Martial Thyrault, Mike Recher, Guillaume Mortamet
Abstract
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 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.