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Charfi R, Guyonnet C, Untrau M, Giacometti G, Paper T, Poyart C, Plainvert C, Tazi A. Performances of two rapid LAMP-based techniques for the intrapartum detection of Group B Streptococcus vaginal colonization. Ann Clin Microbiol Antimicrob 2024; 23:37. [PMID: 38664821 PMCID: PMC11046945 DOI: 10.1186/s12941-024-00695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE Group B Streptococcus (GBS) is the leading cause of invasive infections in newborns. The prevention of GBS neonatal disease relies on the administration of an intrapartum antibiotic prophylaxis to GBS-colonized women. In recent years, rapid intrapartum detection of GBS vaginal colonization using real-time nucleic acid amplification tests (NAATs) emerged as an alternative to antenatal culture screening methods. METHODS We compared the performances of two loop-mediated isothermal amplification (LAMP) tests, the Ampliflash® GBS and the PlusLife® GBS tests, to standard culture for GBS detection in vaginal specimens from pregnant women. The study was conducted from April to July 2023 in a French hospital of the Paris area. RESULTS A total of 303 samples were analyzed, including 85 culture-positive samples (28.1%). The Ampliflash® GBS test and the PlusLife® GBS tests gave a result for 100% and 96.3% tests, respectively. The performances of the tests were as follows: sensitivity 87.1% (95% confidence interval (CI) 78.3-92.6) and 98.7% (95% CI 93.0-99.8), specificity 99.1% (95% CI 96.7-99.8), and 91.9% (95% CI 87.3-95.0), respectively. False negative results of the Ampliflash® GBS test correlated with low-density GBS cultures. Time-to-results correlated with GBS culture density only for the PlusLife® GBS test (p < 0.001). CONCLUSION Both techniques provide excellent analytical performances with high sensitivity and specificity together with a short turnaround time and results available in 10 to 35 min. Their potential to further reduce the burden of GBS neonatal disease compared with antenatal culture screening needs to be assessed in future clinical studies.
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Affiliation(s)
- Rym Charfi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Cécile Guyonnet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | | | | | | | - Claire Poyart
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | - Céline Plainvert
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | - Asmaa Tazi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France.
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France.
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France.
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Leante-Castellanos JL, Pizarro-Ruiz AM, Olmo-Sánchez MP, Martínez-Martínez MJ, Doval-Calvo D. Results of a strategy based on clinical observation of newborns at risk of early-onset neonatal sepsis. Early Hum Dev 2023; 176:105714. [PMID: 36701928 DOI: 10.1016/j.earlhumdev.2023.105714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Serial clinical observation of asymptomatic newborns at risk of early-onset sepsis is an alternative option for which there is limited scientific evidence. AIMS To evaluate the rate of protocol compliance, the impact on blood tests, percentage of hospitalizations and subsequent procedures, and course of diagnosed early-onset sepsis cases of a protocol based on serial clinical observation. METHODS Retrospective observational study comparing an 18-month period under this protocol against a previous protocol based on laboratory tests. SUBJECTS 6895 asymptomatic newborns with over 35 weeks of gestation. OUTCOME MEASURES number of evaluations performed on each subject at risk, percentage of patients undergoing blood draws and hospitalization rates. RESULTS Some of the evaluations included in the protocol were omitted in 51.6 % of the newborns undergoing the physical examinations. The implementation of this new approach was associated with a decrease in the percentage of patients undergoing blood draws from 16.8 % to 0.7 % (p < 0.001) with no differences in the progression of the five cases of sepsis studied in each period. The serial clinical observation protocol was associated with a significant increase in hospitalizations for suspected infection, although with no difference in the rate of lumbar punctures performed or antibiotic treatments administered. CONCLUSION Compliance with the serial clinical observation protocol can be difficult. This approach often detects newborns with abnormal clinical data that are not explained by early-onset sepsis. Clinical observation is a safe option that minimizes the rate of blood draws.
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Affiliation(s)
- José L Leante-Castellanos
- Saint Anthony Catholic University, Murcia, Spain; Neonatology Department, Hospital Santa Lucía, Cartagena, Murcia, Spain.
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Rosa-Fraile M, Alós JI. Group B Streptococcus neonatal infections, the ongoing history. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:349-352. [PMID: 35906029 DOI: 10.1016/j.eimce.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Manuel Rosa-Fraile
- Emeritus, Servicio de Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Juan-Ignacio Alós
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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4
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Efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por Streptococcus agalactiae. Estudio GALL. Aten Primaria 2022; 54:102366. [PMID: 35569427 PMCID: PMC9112094 DOI: 10.1016/j.aprim.2022.102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 04/03/2022] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
Abstract
Objetivo Evaluar la efectividad de la autotoma del exudado vaginorrectal para el cribado prenatal de la infección por EGB e identificar barreras y facilitadores que encuentra la gestante para esta intervención. Diseño Estudio transversal de pruebas diagnósticas. Participantes y emplazamiento Participaron 213 gestantes que acudieron a la consulta de la matrona de atención primaria en 6 centros de salud del Servicio Vasco de Salud/Osakidetza en Bizkaia, que cumplían los criterios de inclusión y aceptaban participar en el estudio. Mediciones principales Se comparó el resultado del cultivo vaginorrectal obtenido por la gestante con el resultado del cultivo vaginorrectal tomado por la matrona en consulta el mismo día, y se recogieron barreras y facilitadores encontrados por las mujeres en la autotoma. Resultados Se ha observado que la autotoma como prueba para detectar el EGB tiene una sensibilidad del 93,3% (IC 95%, 78,7-98,2), una especificidad del 99,4% (IC 95%, 96,5-99,9), un valor predictivo positivo del 96% (IC 95% 82,8-99,4) y un valor predictivo negativo del 98,8% (IC 95%, 95,6-99,7). El 27,3% de los encuestadas encontraron alguna dificultad en la recogida, solo el 4,8% no se vieron capacitadas, el 84,2% se sintieron cómodas, el 99,5% consideraron la información proporcionada adecuada y completa, al 94,7% no le resultaron complicados los pasos a seguir, y el 96% están satisfechas con el estudio. Conclusiones La autotoma del exudado vaginorrectal para la detección del EGB ha resultado ser válida y fiable, lo que permitiría ofrecer esta opción a las gestantes en el cribado sistemático de la infección por EGB.
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Rosa-Fraile M, Alós JI. Group B Streptococcus neonatal infections, the ongoing history. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spencer RN, Hecher K, Norman G, Marsal K, Deprest J, Flake A, Figueras F, Lees C, Thornton S, Beach K, Powell M, Crispi F, Diemert A, Marlow N, Peebles DM, Westgren M, Gardiner H, Gratacos E, Brodszki J, Batista A, Turier H, Patel M, Power B, Power J, Yaz G, David AL. Development of standard definitions and grading for Maternal and Fetal Adverse Event Terminology. Prenat Diagn 2021; 42:15-26. [PMID: 34550624 DOI: 10.1002/pd.6047] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Adverse event (AE) monitoring is central to assessing therapeutic safety. The lack of a comprehensive framework to define and grade maternal and fetal AEs in pregnancy trials severely limits understanding risks in pregnant women. We created AE terminology to improve safety monitoring for developing pregnancy drugs, devices and interventions. METHOD Existing severity grading for pregnant AEs and definitions/indicators of 'severe' and 'life-threatening' conditions relevant to maternal and fetal clinical trials were identified through a literature search. An international multidisciplinary group identified and filled gaps in definitions and severity grading using Medical Dictionary for Regulatory Activities (MedDRA) terms and severity grading criteria based on Common Terminology Criteria for Adverse Event (CTCAE) generic structure. The draft criteria underwent two rounds of a modified Delphi process with international fetal therapy, obstetric, neonatal, industry experts, patients and patient representatives. RESULTS Fetal AEs were defined as being diagnosable in utero with potential to harm the fetus, and were integrated into MedDRA. AE severity was graded independently for the pregnant woman and her fetus. Maternal (n = 12) and fetal (n = 19) AE definitions and severity grading criteria were developed and ratified by consensus. CONCLUSIONS This Maternal and Fetal AE Terminology version 1.0 allows systematic consistent AE assessment in pregnancy trials to improve safety.
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Affiliation(s)
- Rebecca N Spencer
- School of Medicine, University of Leeds, Leeds, UK.,Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gill Norman
- Division of Nursing, Midwifery & Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK.,Antenatal Results and Choices Charity, UK
| | | | - Jan Deprest
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Alan Flake
- Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesc Figueras
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain
| | - Christoph Lees
- Queen Charlottes and Chelsea Hospital, Imperial College London, London, UK
| | | | - Kathleen Beach
- Global Health Unit, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Marcy Powell
- Safety and Medical Governance, GlaxoSmithKline, Research Triangle Park, North Carolina, USA
| | - Fatima Crispi
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain.,BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain
| | - Anke Diemert
- Clinic for Obstetrics and Prenatal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - Donald M Peebles
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
| | | | - Helena Gardiner
- The Fetal Center, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Eduard Gratacos
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Ciínic and Hospital Sant Joan de Deu), University of Barcelona, Spain.,Center for Biomedical Research on rare Diseases (CIBERER), Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Universitat de Barcelona, Barcelona, Spain
| | | | - Albert Batista
- Institut D'Investigacions Biomèdiques August Pi ì Sunyer, Barcelona, Spain
| | | | - Mehali Patel
- Bliss Charity, London, UK.,Sands Charity, London, UK
| | - Beverley Power
- CDH UK: The Congenital Diaphragmatic Hernia Support Charity, King's Lynn, UK
| | - James Power
- CDH UK: The Congenital Diaphragmatic Hernia Support Charity, King's Lynn, UK
| | - Gillian Yaz
- SHINE: Spina bifida, Hydrocephalus, Information, Networking, Equality Charity, Peterborough, UK
| | - Anna L David
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.,NIHR UCLH Biomedical Research Centre, London, UK
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Streptococcus agalactiae in childbearing age immigrant women in Comunitat Valenciana (Spain). Sci Rep 2020; 10:9904. [PMID: 32555315 PMCID: PMC7303196 DOI: 10.1038/s41598-020-66811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 05/13/2020] [Indexed: 11/08/2022] Open
Abstract
Streptococcus agalactiae (GBS) remains the leading cause of meningitis and neonatal sepsis in the world, and causes disease in pregnant and puerperal women. This is a retrospective study of GBS infections on women of childbearing age living in Comunitat Valenciana, Spain (years 2009-2014) and GBS colonization rate on pregnant women attending Hospital La Fe (years 2013-2015) according to their origin. An aggregated total of 6,641,960 women exposed during the study period had an average GBS isolation rate of 5.19‰ (5.14-5.25‰), geographical group rates being: Western Europe (2.2‰), North America (2.1‰), Australia (3.7‰), Spain (4.6‰), Latin America II (4.5‰), Eastern Europe (5.3‰), Asia (6.7‰), Latin America I (7.7‰), Middle East (7.9‰), Indian Subcontinent (17.2‰), North Africa (17.8‰), Sub-Saharan Africa (22.7‰). The 4532 pregnant women studied had an average GBS colonization rate of 12.47% (11.51-13.43) and geographical group rates varied similar to geographical isolation rates. Low GDP and high temperatures of the birth country were associated with higher colonization rates. Thus, differences in GBS colonization depend on the country of origin; Africa and the Indian subcontinent presented the highest, while Western Europe and North America had the lowest. This variability portrays a geographical pattern influenced by temperature and GDP.
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Jaqueti J, Molina L, García-Arata I, Prieto-Menchero S. Evaluación de una pauta de detección de colonización vaginorrectal por Streptococcus agalactiae usando medio de cultivo GBS modified. Enferm Infecc Microbiol Clin 2019; 37:682. [DOI: 10.1016/j.eimc.2018.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/09/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022]
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Vagino-rectal colonization prevalence by Streptococcus agalactiae and its susceptibility profile in pregnant women attending a third-level hospital. ACTA ACUST UNITED AC 2019; 39:689-698. [PMID: 31860180 PMCID: PMC7363344 DOI: 10.7705/biomedica.4514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 01/06/2023]
Abstract
Introducción. Streptococcus agalactiae es el principal agente etiológico causante de infección invasiva del recién nacido con cuadros clínicos que pueden cursar con septicemia, neumonía o meningitis con prevalencias hasta del 50 % a nivel mundial, donde se viene presentando un incremento en su resistencia antibiótica. Objetivo. Estimar la prevalencia de colonización vaginorrectal por S. agalactiae y su perfil de sensibilidad, en mujeres embarazadas atendidas en un hospital de tercer nivel. Materiales y métodos. Se muestrearon 121 mujeres gestantes mediante hisopado vaginal y rectal. Los cultivos se desarrollaron siguiendo la metodología recomendada por los Centers for Disease Control and Prevention (CDC) y se agregó el agar chromID Strepto B. Las colonias sugestivas se identificaron bioquímicamente y se determinaron los perfiles de sensibilidad según el Clinical and Laboratory Standards Institute (CLSI). Resultados. La prevalencia de colonización por S. agalactiae en las mujeres gestantes fue del 20,66 %. Se obtuvieron 40 aislamientos del total de muestras analizadas, de los cuales, el 12,5 % no presentó sensibilidad a la penicilina. La sensibilidad a la levofloxacina, la clindamicina y la eritromicina fue de 100 %, 92,5 % y 87,5 %, respectivamente; no se encontró sensibilidad a la tetraciclina. El fenotipo iMLSB se encontró en tres y, el M, en dos de los 40 aislamientos. Conclusiones. La prevalencia de colonización vaginorrectal por S. agalactiae en la población de estudio, fue de 20,66 %. Se obtuvieron aislamientos no sensibles a la penicilina, y con resistencia a los macrólidos y las lincosamidas mediante el método de Kirby-Bauer. Por ello, es importante la búsqueda activa en las mujeres gestantes colonizadas por estreptococos del grupo B y la vigilancia epidemiológica constante para detectar cambios en los perfiles de sensibilidad de los aislamientos.
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Prevalence of colonisation by group B streptococcus in pregnant patients in Taguatinga, Federal District, Brazil: a cross-sectional study. Arch Gynecol Obstet 2019; 299:703-711. [PMID: 30656444 DOI: 10.1007/s00404-019-05040-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 01/04/2019] [Indexed: 01/19/2023]
Abstract
PROPOSE Group B streptococcus is responsible for severe infections in neonates resulting from vertical transmission from pregnant women colonized in the anal, perineal or vaginal regions. The identification of colonized patients and use of intrapartum prophylaxis may reduce the risk of neonatal infection. METHODS A cross-sectional study of pregnant women of gestational age between 35 and 37 weeks was conducted. Material was collected from patients for laboratory identification of group B streptococcus. Epidemiological data, including weight, height, body mass index, antibiotic use during pregnancy, pathologies during pregnancy (diabetes, hypertensive diseases, and hypothyroidism), twinning, and others, were also collected from patients. RESULTS The sample consisted of 501 pregnant women, and the prevalence of group B streptococcus was 14%. The mean age was 29 years, and the mean BMI was 30.7. During pregnancy, 204 patients had some type of infection, and 201 used antibiotics. Ninety-five patients were diagnosed with gestational diabetes mellitus and 74 with some type of hypertensive disease. CONCLUSIONS The prevalence of group B streptococcus observed did not differ from that observed in other studies. None of the factors studied can be considered as risk or protective factors for maternal colonization by group B streptococcus.
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Maternal Carriage of Group B Streptococcus and Escherichia coli in a District Hospital in Mozambique. Pediatr Infect Dis J 2018; 37:1145-1153. [PMID: 30312265 DOI: 10.1097/inf.0000000000001979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND In low-income countries, data on prevalence and effects of group B Streptococcus (GBS) and Escherichia coli (E. coli) colonization among pregnant women are scarce, but necessary to formulate prevention strategies. We assessed prevalence of GBS and E. coli colonization and factors associated among pregnant women, its effect in newborns and acceptability regarding the utilized sampling methods in a semirural Mozambican hospital. METHODS Pregnant women were recruited from June 2014 to January 2015, during routine antenatal clinics at gestational age ≥ 34 weeks (n = 200); or upon delivery (n = 120). Maternal risk factors were collected. Vaginal and vagino-rectal samples for GBS and E. coli determination were obtained and characterized in terms of antimicrobial resistance and serotype. Anti-GBS antibodies were also determined. Neonatal follow-up was performed in the first 3 months after birth. Semistructured interviews were performed to investigate acceptability of sample collection methods. RESULTS In total, 21.3% of women recruited were GBS carriers, while 16.3% were positive for E. coli. Prevalence of HIV was 36.6%. No association was found between being colonized by GBS and E. coli and maternal risk factors. GBS isolates were fully susceptible to penicillin and ampicillin. Serotypes V (32.4%), Ia (14.7%) and III (10.3%) were the most commonly found and 69.2% of the women tested had immunoglobuline G antibodies against GBS. E. coli isolates showed resistance to ampicillin in 28.9% and trimethoprim/sulfamethoxazole in 61.3% of the cases. CONCLUSION Prevalence of GBS and/or E. coli colonization among pregnant women is high in this semirural community and comparable with those reported in similar settings. Four serotypes accounted for nearly 70% of all isolates of GBS. Population-based data on infant GBS infections would enable the design of prevention strategies for GBS disease in Mozambique.
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Amaya-Arias AC, Zuluaga O, Idárraga D, Eslava-Schmalbach JH. Adaptation and validation for Colombia of the WHO safe childbirth checklist. COLOMBIA MEDICA (CALI, COLOMBIA) 2018; 49:201-212. [PMID: 30410194 PMCID: PMC6220487 DOI: 10.25100/cm.v49i2.2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction Most maternal that deaths occur in developing countries are considered unfair and can be avoided. In 2008, The WHO proposed a checklist for delivery care, in order to assess whether a simple, low-cost intervention had an impact on maternal and neonatal mortality in low-income countries. Aim To translate, adapt and validate the content of the WHO Safe Childbirth Checklist (SCC) for its use in Colombia. Methods The translation of the list was carried out, adaptation was made to our context and validation of content through a panel of experts composed of 17 health workers with experience in maternal and neonatal care and safety. The reliability among the judges was calculated (Rwg) and according to the results, items were modified or added to each section of the list. Results Modifications were made to the wording of 28 items, none was eliminated, and 19 new items were added. The most important modifications were made to the management guidelines that accompany each item and the items included refer to risks inherent to our environment. Conclusion The Colombian version of the SCC will be a useful tool to improve maternal and neonatal care and thereby will contribute to reducing maternal and neonatal morbidity and mortality in our country.
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Affiliation(s)
- Ana Carolina Amaya-Arias
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia
| | - Oscar Zuluaga
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia
| | - Douglas Idárraga
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia
| | - Javier H Eslava-Schmalbach
- Centro de Desarrollo Tecnológico - Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E). Bogota, Colombia.,Hospital Universitario Nacional de Colombia, Facultad de Medicina- Universidad Nacional de Colombia. Bogota, Colombia
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13
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Nogacka AM, Salazar N, Arboleya S, Suárez M, Fernández N, Solís G, de Los Reyes-Gavilán CG, Gueimonde M. Early microbiota, antibiotics and health. Cell Mol Life Sci 2018; 75:83-91. [PMID: 28988290 PMCID: PMC11105232 DOI: 10.1007/s00018-017-2670-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 12/19/2022]
Abstract
The colonization of the neonatal digestive tract provides a microbial stimulus required for an adequate maturation towards the physiological homeostasis of the host. This colonization, which is affected by several factors, begins with facultative anaerobes and continues with anaerobic genera. Accumulating evidence underlines the key role of the early neonatal period for this microbiota-induced maturation, being a key determinant factor for later health. Therefore, understanding the factors that determine the establishment of the microbiota in the infant is of critical importance. Exposure to antibiotics, either prenatally or postnatally, is common in early life mainly due to the use of intrapartum prophylaxis or to the administration of antibiotics in C-section deliveries. However, we are still far from understanding the impact of early antibiotics and their long-term effects. Increased risk of non-communicable diseases, such as allergies or obesity, has been observed in individuals exposed to antibiotics during early infancy. Moreover, the impact of antibiotics on the establishment of the infant gut resistome, and on the role of the microbiota as a reservoir of resistance genes, should be evaluated in the context of the problems associated with the increasing number of antibiotic resistant pathogenic strains. In this article, we review and discuss the above-mentioned issues with the aim of encouraging debate on the actions needed for understanding the impact of early life antibiotics upon human microbiota and health and for developing strategies aimed at minimizing this impact.
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Affiliation(s)
- Alicja M Nogacka
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias, Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Paseo Rio Linares s/n, 33300, Villaviciosa, Asturias, Spain
| | - Nuria Salazar
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias, Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Paseo Rio Linares s/n, 33300, Villaviciosa, Asturias, Spain
| | - Silvia Arboleya
- APC Microbiome Institute, University College Cork, Cork, Ireland
- Teagasc Food Research Centre, Moorepark, Fermoy, Cork, Ireland
| | - Marta Suárez
- Pediatrics Service, Hospital Universitario Central de Asturias, SESPA, Oviedo, Asturias, Spain
| | - Nuria Fernández
- Pediatrics Service, Hospital Universitario Central de Asturias, SESPA, Oviedo, Asturias, Spain
| | - Gonzalo Solís
- Pediatrics Service, Hospital Universitario Central de Asturias, SESPA, Oviedo, Asturias, Spain
| | - Clara G de Los Reyes-Gavilán
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias, Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Paseo Rio Linares s/n, 33300, Villaviciosa, Asturias, Spain
| | - Miguel Gueimonde
- Department of Microbiology and Biochemistry of Dairy Products, Instituto de Productos Lácteos de Asturias, Consejo Superior de Investigaciones Científicas (IPLA-CSIC), Paseo Rio Linares s/n, 33300, Villaviciosa, Asturias, Spain.
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Pérez-Moreno MO, Picó-Plana E, Grande-Armas J, Centelles-Serrano MJ, Arasa-Subero M, Ochoa NC, (led by MO Pérez-Moreno) MOTSGGESSAGTE. Group B streptococcal bacteriuria during pregnancy as a risk factor for maternal intrapartum colonization: a prospective cohort study. J Med Microbiol 2017; 66:454-460. [DOI: 10.1099/jmm.0.000465] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mar Olga Pérez-Moreno
- Institud d’Investigació Sanitària Père Virgili, Tarragona, España
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
| | - Ester Picó-Plana
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
- Present address: Catlab (Centre d’analítiques Terrassa), Vial Sant, Jordi s/n, Poligon Industrial Can Mitjans, 08232, Viladecavalls, Barcelona, Spain
| | - Jesús Grande-Armas
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
- Present address: Servicio Análisis Clínicos, Hospital San Juan de Dios, Carretera Santa Cruz-La Laguna, 53, 38009, Santa Cruz de Tenerife (Tenerife), España
| | - Mª José Centelles-Serrano
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
- Institud d’Investigació Sanitària Père Virgili, Tarragona, España
| | - Mercé Arasa-Subero
- Servei d’Obstetricia i Ginecologia. Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes,14. 43500 Tortosa, Tarragona, Spain
- ASSIR (Atenció a la salut sexual i reproductiva) Regió Sanitària Terres de l´Ebre Avda. Colom 18-20. 43500 Tortosa, Tarragona, Spain
| | - Núria Colomé- Ochoa
- Servei d’Obstetricia i Ginecologia. Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes,14. 43500 Tortosa, Tarragona, Spain
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Berardi A, Buffagni AM, Rossi C, Vaccina E, Cattelani C, Gambini L, Baccilieri F, Varioli F, Ferrari F. Serial physical examinations, a simple and reliable tool for managing neonates at risk for early-onset sepsis. World J Clin Pediatr 2016; 5:358-364. [PMID: 27872823 PMCID: PMC5099587 DOI: 10.5409/wjcp.v5.i4.358] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/06/2016] [Accepted: 10/09/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether serial physical examinations (SPEs) are a safe tool for managing neonates at risk for early-onset sepsis (EOS).
METHODS This is a retrospective cohort study of neonates (≥ 34 wks’ gestation) delivered in three high-volume level IIIbirthing centres in Emilia-Romagna (Italy) during a 4-mo period (from September 1 to December 31, 2015). Neonates at risk for EOS were managed according to the SPEs strategy, these were carried out in turn by bedside nursing staff and physicians. A standardized form detailing general wellbeing, skin colour and vital signs was filled in and signed at standard intervals (at age 3, 6, 12, 18, 36 and 48 h) in neonates at risk for EOS. Three independent reviewers reviewed all charts of neonates and abstracted data (gestational age, mode of delivery, group B streptococcus status, risk factors for EOS, duration of intrapartum antibiotic prophylaxis, postpartum evaluations, therapies and outcome). Rates of sepsis workups, empirical antibiotics and outcome of neonates at-risk (or not) for EOS were evaluated.
RESULTS There were 2092 live births and 1 culture-proven EOS (Haemophilus i) (incidence rates of 0.48/1000 live births). Most newborns with signs of illness (51 out of 101, that is 50.5%), and most of those who received postpartum antibiotics (17 out of 29, that is 58.6%) were not at risk for EOS. Compared to neonates at risk, neonates not at risk for EOS were less likely to have signs of illness (51 out of 1442 vs 40 out of 650, P = 0.009) or have a sepsis workup (25 out of 1442 vs 28 out of 650, P < 0.001). However, they were not less likely to receive empirical antibiotics (17 out of 1442 vs 12 out of 650, P = 0.3). Thirty-two neonates were exposed to intrapartum fever or chorioamnionitis: 62.5% (n = 20) had a sepsis workup and 21.9% (n = 7) were given empirical antibiotics. Among 216 neonates managed through the SPEs strategy, only 5.6% (n = 12) had subsequently a sepsis workup and only 1.9% (n = 4) were given empirical antibiotics. All neonates managed through SPEs had a normal outcome. Among 2092 neonates, only 1.6% (n = 34) received antibiotics; 1.4% (n = 29) were ill and 0.2% (n = 5) were asymptomatic (they were treated because of risk factors for EOS).
CONCLUSION The SPEs strategy reduces unnecessary laboratory evaluations and antibiotics, and apparently does not worsen the outcome of neonates at-risk or neonates with mild, equivocal, transient symptoms.
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Melo SCCSD, Santos NCDS, Oliveira MD, Scodro RBDL, Cardoso RF, Pádua RAF, Silva FTR, Costa AB, Carvalho MDDB, Pelloso SM. ANTIMICROBIAL SUSCEPTIBILITY OF Streptococcus agalactiae ISOLATED FROM PREGNANT WOMEN. Rev Inst Med Trop Sao Paulo 2016; 58:83. [PMID: 27828624 PMCID: PMC5096637 DOI: 10.1590/s1678-9946201658083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/13/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION: Group B streptococcus (GBS) or Streptococcus agalactiae can colonize the gastrointestinal and genitourinary tracts and has been considered one of the most important risk factors for the development of neonatal disease. The present study evaluated the antimicrobial susceptibility of GBS isolates from pregnant women who were attended at a public health service in Northern Paraná, Brazil. METHODS: A descriptive analytical cross-sectional study was performed with 544 pregnant women, at ≥ 35 weeks of gestation. One hundred and thirty-six GBS isolates from pregnant women were tested for antimicrobial susceptibility. RESULTS: All of the GBS isolates showed susceptibility to the drug that is most frequently used for intrapartum prophylaxis: penicillin. Resistance to clindamycin and erythromycin was detected, thus decreasing the options of prophylaxis in women who are allergic to penicillin. CONCLUSIONS: Additional studies should be conducted to increase the knowledge of GBS sensitivity profile to antimicrobials in other health centers.
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Affiliation(s)
| | | | - Marcia de Oliveira
- State University of Maringá, Department of Clinical Analysis and Biomedicine. Maringá, Paraná, Brazil. E-mails: ; ; ; or ;
| | - Regiane Bertin de Lima Scodro
- State University of Maringá, Department of Clinical Analysis and Biomedicine. Maringá, Paraná, Brazil. E-mails: ; ; ; or ;
| | - Rosilene Fressatti Cardoso
- State University of Maringá, Department of Clinical Analysis and Biomedicine. Maringá, Paraná, Brazil. E-mails: ; ; ; or ;
| | - Rúbia Andreia Falleiros Pádua
- State University of Maringá, Department of Clinical Analysis and Biomedicine. Maringá, Paraná, Brazil. E-mails: ; ; ; or ;
| | | | - Aline Balandis Costa
- State University of Northern Paraná, Nursing Sector. Bandeirantes, Paraná, Brazil. E-mails: ;
| | | | - Sandra Marisa Pelloso
- State University of Maringá, Postgraduate Program in Health Sciences Maringá, Paraná, Brazil. E-mails: ; ; or
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17
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Streptococcus agalactiaefrom pregnant women: antibiotic and heavy-metal resistance mechanisms and molecular typing. Epidemiol Infect 2016; 144:3205-3214. [DOI: 10.1017/s0950268816001692] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
SUMMARYWe investigated the antibiotic and heavy-metal resistance mechanisms, virulence genes and clonal relationships of macrolide- and/or lincosamide-resistant (M+/−LR)Streptococcus agalactiae(group BStreptococcus, GBS) isolates from pregnant women in La Rioja in Northern Spain, a region with a significant immigrant population. In total 375 GBS isolates were recovered during 2011. About three-quarters of isolates were from European nationals and the remainder distributed among 23 other nationalities. Seventy-five (20%) were classified as M+/−LRstrains and 28 (37%) of these were resistant to ⩾3 classes of antibiotics. Capsular serotypes III (29·3%), V (21·3%) and II (12%) were the most frequent. A wide variety of antibiotic resistance genes were detected in M+/−LRstrains; notably, 5·3% harboured thelsa(C) gene associated with cross-resistance, andtet(W) was identified in a single strain. We report, for the first time, the detection of cadmium and copper resistance encoded bytcrB+cadA+cadCgenes in 20 M+/−LRstrains, which raises the possibility of co-selection of antibiotic and heavy-metal resistance disseminated through mobile genetic elements. The M+/−LRstrains were highly diverse by DNA macrorestriction profiles (65 patterns) and 16 multilocus sequence types (STs) distributed among six clonal complexes; the most frequent were ST1, ST19, and ST12, and two strains were novel (ST586 and ST601). In conclusion, a wide diversity of genetic lineages of macrolide, lincosamide and heavy-metal- resistant GBS strains was observed in an ethnically diverse maternal population.
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Padilla-Ortega B, Delgado-Palacio S, García-Garrote F, Rodríguez-Gómez JM, Romero-Hernández B. [Microbiological diagnosis of bacterial infection associated with delivery and postpartum]. Enferm Infecc Microbiol Clin 2015; 34:309-14. [PMID: 26706393 DOI: 10.1016/j.eimc.2015.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 10/29/2015] [Indexed: 01/17/2023]
Abstract
The newborn may acquire infections during delivery due to maternal colonization of the birth canal, by microorganisms such as Streptococcus agalactiae that caused early neonatal infection, or acquisition through the placenta, amniotic fluid or birth products. After birth, the newborn that needs hospitalization can develop nosocomial infections during their care and exceptionally through lactation by infectious mastitis or incorrect handling of human milk, which does not require to stop breastfeeding in most cases. It is important and necessary to perform microbiological diagnosis for the correct treatment of perinatal infections, especially relevant in preterm infants with low or very low weight with high mortality rates.
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Affiliation(s)
- Belén Padilla-Ortega
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Susana Delgado-Palacio
- Departamento de Microbiología y Bioquímica de Productos Lácteos, Instituto de Productos Lácteos de Asturias (IPLA)-Consejo Superior de Investigaciones Científicas (CSIC), Villaviciosa, Asturias, España
| | | | - Juan Miguel Rodríguez-Gómez
- Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, España
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Garnizov TM. Asymptomatic bacteriuria in pregnancy from the perspective of public health and maternal health care: review and case report. BIOTECHNOL BIOTEC EQ 2015. [DOI: 10.1080/13102818.2015.1114429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Teodor Markov Garnizov
- Department of Obstetrics and Gynecology, Postpartum Unit, Medical University of Sofia, University Obstetrics and Gynecology Hospital “Maichin Dom”, Sofia, Bulgaria
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20
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de Melo SCCS, Gavena AAF, Silva FTR, Moreira RC, de Lima Scodro RB, Cardoso RF, Siqueira VLD, de Pádua RAF, Carvalho MDDB, Pelloso SM. Performance of Hitchens-Pike-Todd-Hewitt medium for group B streptococcus screening in pregnant women. PLoS One 2015; 10:e0123988. [PMID: 25881083 PMCID: PMC4400012 DOI: 10.1371/journal.pone.0123988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
Group B streptococcus (GBS), which commonly colonizes the female genital tract and rectum, can cause infections in newborns with varying severity, possibly leading to death. The aim of the present study was to evaluate Hitchens-Pike-Todd-Hewitt (HPTH) medium performance for GBS screening in pregnant women. A descriptive analytical cross-sectional study was performed with 556 pregnant women, of which 496 were at 35-37 weeks of gestation and 60 were at ≥ 38 weeks of gestation. The study was conducted from September 2011 to March 2014 in northern Paraná, Brazil. Vaginal and anorectal clinical specimens from each pregnant woman were plated on sheep blood agar (SBA) and seeded on HPTH medium and Todd-Hewitt enrichment broth. Of the 496 pregnant women at 35-37 weeks of gestation, 141 (28.4%) were positive for GBS, based on the combination of the three culture media and clinical specimens. The GBS colonization rates that were detected by each medium were 22.2% for HPTH medium, 21.2% for SBA, and 13.1% for Todd-Hewitt enrichment broth. Of the 60 pregnant women at ≥ 38 weeks of gestation, seven (11.7%) were positive for GBS. These results demonstrate that HPTH medium and SBA were more sensitive than Todd-Hewitt enrichment broth for GBS screening in pregnant women and good GBS recovery in culture, indicating that the two media should be used together for vaginal and anorectal specimens.
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Affiliation(s)
- Simone Cristina Castanho Sabaini de Melo
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
- Nursing Sector, State University of Northern Paraná, Bandeirantes, Paraná, Brazil
- * E-mail:
| | | | | | | | | | | | - Vera Lúcia Dias Siqueira
- Department of Clinical Analysis and Biomedicine, State University of Maringá, Maringá, Paraná, Brazil
| | | | | | - Sandra Marisa Pelloso
- Postgraduate Program in Health Sciences, State University of Maringá, Maringá, Paraná, Brazil
- Department of Nursing, State University of Maringá, Maringá, Paraná, Brazil
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21
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[Serotypes and antibiotic resistance patterns in beta-hemolytic Streptococcus agalactiae isolates in colonized mothers and newborns with invasive disease]. Enferm Infecc Microbiol Clin 2014; 33:84-8. [PMID: 25542335 DOI: 10.1016/j.eimc.2014.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Current preventive measures against neonatal disease caused by Streptococcus agalactiae (GBS) are prenatal screening and intrapartum antibiotic prophylaxis with appropriate antimicrobials. An alternative to this strategy would be the administration of a polysaccharide vaccine as the distribution of capsular serotypes of circulating strains needs to be known. METHODS A study was made of 188 strains from pregnant women carrying GBS and 24 newborns with neonatal disease. Susceptibility testing was performed with penicillin, erythromycin and clindamycin following CLSI standards, and capsular serotype was determined by two methods: latex agglutination and PCR. RESULTS Of the 188 strains of S.agalactiae from the pregnant women, there was 80.8% agreement in the results between the two techniques. Resistant to erythromycin and clindamycin was found in 16.5% and 10.1%, respectively. For neonatal strains, 95.8% of the results obtained by the two techniques were identical. The rates of resistance to erythromycin and clindamycin were 8.3% and 4.1%, respectively. In both groups, most frequently isolated serotype was iii, and the most related to antimicrobial resistance serotype was v. CONCLUSION Epidemiological studies are necessary to continue surveillance of serotypes causing invasive disease and its antibiotic sensitivity patterns using sensitive and specific methods.
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22
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Giménez M, Sanfeliu I, Sierra M, Dopico E, Juncosa T, Andreu A, Lite J, Guardià C, Sánchez F, Bosch J. [Group B streptococcal early-onset neonatal sepsis in the area of Barcelona (2004-2010). Analysis of missed opportunities for prevention]. Enferm Infecc Microbiol Clin 2014; 33:446-50. [PMID: 25541009 DOI: 10.1016/j.eimc.2014.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/28/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To study the evolution of the incidence of early-onset neonatal sepsis (EOS) by Streptococcus agalactiae in the area of Barcelona and to analyze failure of compliance with the prevention protocol. METHODS A retrospective review was carried out on EOS cases in 8 Health-Care Centers in the Barcelona area between 2004 and 2010. RESULTS Forty-nine newborns from 48 mothers were diagnosed with EOS. The incidence was 0.29‰ living newborns (0.18-0.47‰), with no significant differences in the fluctuations along the 7 years. The mortality rate was 8.16%. In 68.5% cases the maternal colonization studies were negative, and in 21% these studies were not performed. No risk factors were detected in 58.3% of pregnant women, and 22.9% of births were premature. In 58% of cases intra-partum antibiotic prophylaxis was not administered because it was not indicated, and in 42% due to failure to follow the protocol (3 strains were resistant to erythromycin). Resistance to clindamycin was 33.3%. The Streptococcus agalactiae serotypes more frequently isolated were iii, v, and ia. CONCLUSIONS No significant changes were detected in the incidence of Streptococcus agalactiae EOS in the 7 years of the study. The increased sensitivity of screening methods with the use of molecular techniques, the performance of susceptibility testing of strains isolated from pregnant women, and the improvement of communication between Health-Care Centers, can contribute to a better implementation of the protocol, as well as to reduce the incidence of EOS.
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Affiliation(s)
- Montserrat Giménez
- Servicio de Microbiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Isabel Sanfeliu
- Servicio de Microbiología, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | | | - Eva Dopico
- Laboratori Clínic de L'Hospitalet, L'Hospitalet de Llobregat, Barcelona, España
| | - Teresa Juncosa
- Servicio de Microbiología, Hospital Universitari Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Antonia Andreu
- Servicio de Microbiología, Hospital Vall d'Hebron, Barcelona, España
| | - Josep Lite
- Laboratorio de Mirobiología, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, España
| | - Cèlia Guardià
- Laboratori Barcelonès Nord i Vallès Oriental, Institut Català de la Salut, Badalona, Barcelona, España
| | - Ferran Sánchez
- Servicio de Microbiología, Hospital de Sant Pau, Barcelona, España
| | - Jordi Bosch
- Servicio de Microbiología, Hospital Clínic, Barcelona, España
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Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP, Hakansson S, Hod M, Hughes R, Kurtzer M, Poyart C, Shinwell E, Stray-Pedersen B, Wielgos M, El Helali N. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med 2014; 28:766-82. [PMID: 25162923 DOI: 10.3109/14767058.2014.934804] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.
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Affiliation(s)
- G C Di Renzo
- Department of Ob/Gyn and Centre for Perinatal and Reproductive Medicine, Santa Maria della Misericordia University Hospital , Perugia , Italy
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Melin P, Efstratiou A. Group B streptococcal epidemiology and vaccine needs in developed countries. Vaccine 2014; 31 Suppl 4:D31-42. [PMID: 23973345 DOI: 10.1016/j.vaccine.2013.05.012] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
Abstract
Development of a group B streptococcal vaccine (GBS) vaccine is the most promising approach for the prevention of GBS infections in babies, given the potential adverse effects of intrapartum antibiotic prophylaxis as well as the need for effective prevention of both adult and late perinatal disease. There are numerous prevention strategies at this time but none are 100% effective in the eradication of neonatal early onset GBS disease and there are no preventative strategies for late onset disease. The need for a GBS vaccine is therefore, of utmost importance. Efforts applying genomics to GBS vaccine development have led to the identification of novel vaccine candidates. The publication of GBS whole genomes coupled with new technologies including multigenome screening and bioinformatics has also allowed researchers to overcome the serotype limitation of earlier vaccine preparations in the search of a universal effective vaccine against GBS. This review brings together the key arguments concerning the potential need of a GBS vaccine in developed countries and describes the current status with GBS epidemiology and microbiology in these countries.
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Affiliation(s)
- Pierrette Melin
- National Reference Centre for Group B Streptococci, Medical Microbiology Department, University Hospital of Liege, Sart Tilman B-23, 4000 Liege, Belgium.
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25
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[Streptococcus agalactiae late-onset neonatal infections in Barcelona (1996-2010)]. Enferm Infecc Microbiol Clin 2013; 32:574-8. [PMID: 24246776 DOI: 10.1016/j.eimc.2013.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/15/2013] [Accepted: 09/18/2013] [Indexed: 11/23/2022]
Abstract
OBJETIVE To study the characteristics and evolution of group B Streptococcus (GBS) late-onset diseases, over a period of 15years in 8hospitals the Barcelona area and analyze the possible impact of prophylactic measures for the prevention of early-onset neonatal infections. METHODS Retrospective review of all patients diagnosed with late-onset neonatal disease due to GBS from 1996 to 2010. RESULTS A total of 143 patients were diagnosed. Of these, 51 were born in others hospitals. The overalll incidence was 0.42 per 1000 live births, varying between 0.14‰ in the year 2000 and 0.80‰ in 2009. A slight but sustained tendency of increased risk was observed over the years, 6.9% in the overall disease (with no statistical significance). Sepsis/bacteremia was detected in 63.6% of the newborns, meningitis in 32.8%, and arthritis/osteomyelitis in 3.5%. In cases with known obstetrics dates, 53% of mothers had been colonized by GBS during pregnancy, 53.8% received intrapartum antibiotic prophylaxis, and 41.2% had some obstetric risk factors, particularly premature birth in 35.9%. There was a 2.8% mortality rate in the neonates, and predominant serotypes were III and Ia. CONCLUSIONS The incidence of GBS late-onset disease has not decreased despite the control practices of early-onset disease, and possibility of this appearing must be taken into account.
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