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Menstrual toxic shock syndrome: a French nationwide multicenter retrospective study

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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. | Beduneau, G. | Canoui-Poitrine, F. | Boutin, E. | Lina, G. | Dessap, A. M. | Tristant, A. | Prost, N., De

Edité par CCSD ; Oxford University Press (OUP) -

International audience. 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.

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