title: Creatine kinase as an indicator for hysterectomy in postpartum endomyometritis due to group A streptococci: a hypothesis illustrated by a case report.
abstract: BACKGROUND
  Puerperal group A streptococcus (GAS) infection, once the leading cause of postpartum sepsis, has been increasing again since the 1980s. Streptococcal toxic shock syndrome (STSS) is a serious complication characterized by rapidly spreading GAS infection, shock, and multiple organ failure. Immediate recognition and implementation of therapy is crucial for survival. Making informed decisions regarding surgical debridement, namely hysterectomy, based on clinical indicators is difficult for practitioners.
  
  
  OBJECTIVE
  This article discusses the potential role of creatine kinase in the decision-making process for treatment of STSS, particularly with regard to hysterectomy.
  
  
  METHODS
  A case report is presented. The literature was searched using the key words 'group A streptococcus', 'postpartum hysterectomy', 'creatine kinase', 'endomyometritis', and 'streptococcal toxic shock syndrome' in PubMed and the UptoDate database. Relevant articles published between 1991 and 2011 were evaluated.
  
  
  CONCLUSIONS
  Decisions regarding hysterectomy in STSS management are difficult. A rise in CK levels in the serum may indicate involvement of the myometrium and may be an important parameter in the difficult decision of hysterectomy when treating STSS.
authors.affiliation: Department of Obstetrics and Gynaecology, AZ Sint Jan, Brugge-Oostende, Belgium. isabelle.dehaene@ugent.be
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dehaene
authors.forename: Anne
authors.initials: A
authors.lastname: Loccufier
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
authors.forename: Bart
authors.initials: B
authors.lastname: De Keersmaecker
authors.forename: Luc
authors.initials: L
authors.lastname: De Baene
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D003402:Creatine Kinase / Q000097:blood*; D003657:Decision Making; D004716:Endometritis / Q000201:enzymology / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000201:enzymology / Q000382:microbiology; D010535:Laparoscopy; D008297:Male; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012121:Respiration, Artificial; D012772:Shock, Septic / Q000201:enzymology / Q000382:microbiology / Q000601:surgery*; D013290:Streptococcal Infections / Q000201:enzymology / Q000382:microbiology / Q000601:surgery*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; D003402:Creatine Kinase