Twenty-four hours post-surgery, her symptoms became more severe, and she became dyspneic and hypotensive. Additional laboratory testing showed a significant drop in hemoglobin (10.2 g/dl), and blood cultures taken upon admission revealed gram-positive cocci that were confirmed to be GAS. The patient’s condition continued to deteriorate, with progressive signs and symptoms of multiorgan impairment. Her condition necessitated an emergency diagnostic

laparotomy, which was conducted in a different operating room. Diffuse ischemia of all intra-abdominal organs, with fluid throughout the abdominal cavity, see more was apparent. Peritoneal fluid samples that were taken intraoperatively also grew GAS. A diagnosis of TSS was made, and treatment with intravenous meropenem and vancomycin was started. Despite intensive care management and adequate resuscitative efforts, the patient expired on the third day following surgery. Case 2: After the first case of TSS, a 31-year-old female, para 6 + 1, presented to the gynecological clinic for an elective tubal ligation. Nineteen hours following BMS387032 the surgery of the 1st case, the second patient underwent laparoscopic bilateral tubal ligation in the same operating room in which the surgery on the index patient had been performed.

The second patient did not receive any preoperative antibiotic prophylaxis and was discharged in very good condition on the same day. Less than 24 h later, she was readmitted with severe abdominal pain and nausea. The physical examination revealed generalized abdominal tenderness and absent bowel sounds. The laboratory tests were insignificant, and the abdominal X-ray showed free gas under the diaphragm. She was started on intravenous meropenam and vancomycin. The patient’s condition continued to deteriorate, and signs and symptoms of multiorgan failure were observed. A bedside ultrasound revealed a moderate to large amount of free fluid in the peritoneal cavity. A laparotomy was performed to rule out bowel perforation. Megestrol Acetate A bilateral salpingectomy was performed,

and the drained peritoneal fluid grew GAS. A diagnosis of TSS was made, and clindamycin was added to the treatment regime. With continued intensive care treatment, the patient exhibited signs of improvement, and two weeks later, she was discharged in very good condition. Following the identification of the two GAS cases, infection prevention and control precautions were implemented as follows: • Both patients were promptly isolated using contact and standard precautions. All specimens were cultured on 5% sheep blood agar plates and were anaerobically incubated for 48 h. All beta-hemolytic Streptococci colonies were typed as GAS using a latex test (Remel Streptex, Remel Europe Ltd. Dartford, Kent, UK).