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Witt LT, Greenfield KG, Knoop KA. Streptococcus agalactiae and Escherichia coli induce distinct effector γδ T cell responses during neonatal sepsis. iScience 2024; 27:109669. [PMID: 38646164 PMCID: PMC11033170 DOI: 10.1016/j.isci.2024.109669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/22/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Neonates born prematurely are vulnerable to life-threatening conditions such as bacterial sepsis. Streptococcus agalactiae (GBS) and Escherichia coli are frequent causative pathogens of neonatal sepsis, however, it remains unclear if these pathogens induce differential immune responses. We find that γδ T cells rapidly respond to single-organism GBS and E. coli bloodstream infections in neonatal mice. Furthermore, GBS and E. coli induce distinct cytokine production from IFN-γ and IL-17 producing γδ T cells, respectively. We also find that IL-17 production during E. coli infection is driven by γδTCR signaling, whereas IFN-γ production during GBS infection occurs independently of γδTCR signaling. The divergent effector responses of γδ T cells during GBS and E. coli infections impart distinctive neuroinflammatory phenotypes on the neonatal brain. Thus, the neonatal adaptive immune system differentially responds to distinct bacterial stimuli, resulting in unique neuroinflammatory phenotypes.
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Affiliation(s)
- Lila T. Witt
- Department of Immunology, Mayo Clinic, Rochester MN 55901, USA
- Mayo Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN 55901, USA
| | | | - Kathryn A. Knoop
- Department of Immunology, Mayo Clinic, Rochester MN 55901, USA
- Department of Pediatrics, Mayo Clinic, Rochester, MN 55901, USA
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Miao S, Yin J, Liu S, Zhu Q, Liao C, Jiang G. Maternal-Fetal Exposure to Antibiotics: Levels, Mother-to-Child Transmission, and Potential Health Risks. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:8117-8134. [PMID: 38701366 DOI: 10.1021/acs.est.4c02018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Due to its widespread applications in various fields, antibiotics are continuously released into the environment and ultimately enter the human body through diverse routes. Meanwhile, the unreasonable use of antibiotics can also lead to a series of adverse outcomes. Pregnant women and developing fetuses are more susceptible to the influence of external chemicals than adults. The evaluation of antibiotic exposure levels through questionnaire surveys or prescriptions in medical records and biomonitoring-based data shows that antibiotics are frequently prescribed and used by pregnant women around the world. Antibiotics may be transmitted from mothers to their offspring through different pathways, which then adversely affect the health of offspring. However, there has been no comprehensive review on antibiotic exposure and mother-to-child transmission in pregnant women so far. Herein, we summarized the exposure levels of antibiotics in pregnant women and fetuses, the exposure routes of antibiotics to pregnant women, and related influencing factors. In addition, we scrutinized the potential mechanisms and factors influencing the transfer of antibiotics from mother to fetus through placental transmission, and explored the adverse effects of maternal antibiotic exposure on fetal growth and development, neonatal gut microbiota, and subsequent childhood health. Given the widespread use of antibiotics and the health threats posed by their exposure, it is necessary to comprehensively track antibiotics in pregnant women and fetuses in the future, and more in-depth biological studies are needed to reveal and verify the mechanisms of mother-to-child transmission, which is crucial for accurately quantifying and evaluating fetal health status.
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Affiliation(s)
- Shiyu Miao
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Jia Yin
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- School of Environment, Hangzhou Institute for Advanced Study, UCAS, Hangzhou 310024, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Shuang Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qingqing Zhu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chunyang Liao
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- School of Environment, Hangzhou Institute for Advanced Study, UCAS, Hangzhou 310024, China
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, School of Environment and Health, Jianghan University, Wuhan 430056, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Guibin Jiang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- School of Environment, Hangzhou Institute for Advanced Study, UCAS, Hangzhou 310024, China
- Hubei Key Laboratory of Environmental and Health Effects of Persistent Toxic Substances, School of Environment and Health, Jianghan University, Wuhan 430056, China
- College of Resources and Environment, University of Chinese Academy of Sciences, Beijing 100049, China
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Nielsen SY, Hoffmann-Lücke E, Henriksen TB, Hartvigsen CM, Helmig RB, Khalil MR, Møller JK, Pedersen LH, Murra M, Greibe E. Timing and dosage of intrapartum prophylactic penicillin for preventing early-onset group B streptococcal disease: assessing maternal and umbilical cord blood concentration. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-326986. [PMID: 38729749 DOI: 10.1136/archdischild-2024-326986] [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: 02/12/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Timing of administration of antibiotics and concentrations in maternal blood and the umbilical cord blood are important prerequisites for optimal intrapartum antibiotic prophylaxis (IAP) of neonatal early-onset group B streptococcus (GBS) disease. This cohort study aimed to explore penicillin concentrations in mothers and infants at birth in relation to time elapsed from administration to delivery and to the minimal inhibitory concentration (MIC) for GBS. MAIN OUTCOME MEASURES Penicillin G concentrations in maternal and umbilical cord blood in relation to time and dose from administration to time of delivery. RESULTS In 44 mother-infant dyads, median maternal penicillin G concentration was 0.2 mg/L (IQR 0-0.8 mg/L; range 0-1.6 mg/L). Median infant penicillin G concentration was 1.2 mg/L (IQR 0.5-5.0 mg/L; range 0-12.7 mg/L). In all infants (N=38) born less than 4 hours after the latest IAP administration, penicillin G concentrations far exceeded MIC (0.125 mg/L), even after short time intervals between IAP administration and birth. The highest plasma concentrations were reached in umbilical cord blood within 1 hour from IAP administration to birth.For 44 mother-infant dyads, maternal concentrations were very low compared with their infants'; particularly, very high concentrations were seen in the 20 infants with only one dose of IAP. CONCLUSION High concentrations of penicillin G were found in umbilical cord blood of infants born less than 4 hours after IAP administration, well above the MIC for GBS.
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Affiliation(s)
- Stine Yde Nielsen
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Elke Hoffmann-Lücke
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet Faculty of Health, Aarhus, Denmark
| | | | - Rikke Bek Helmig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Mohammed Rohi Khalil
- Department of Obstetrics and Gynecology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
| | | | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark
| | - May Murra
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet Faculty of Health, Aarhus, Denmark
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Kasai Y, Komatsu M, Toyama Y, Nakano S, Hisata K, Yamada M, Shimizu T. Effect of probiotics on mother-to-neonate vertical transmission of group B streptococci: A prospective open-label randomized study. Pediatr Neonatol 2024; 65:145-151. [PMID: 37684161 DOI: 10.1016/j.pedneo.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Group B Streptococci (GBS) are common vaginal bacteria found in 20-30% of pregnant women and a significant cause of invasive infections in newborns. Recently, attention has been focused on the efficacy of probiotics during the perinatal period. However, the effect of probiotic intake on the mother-to-child transmission (MTCT) of GBS remains unknown. METHODS Pregnant women with positive GBS results from vaginal and rectal swab cultures at 35-37 weeks of gestation were randomly assigned to the probiotic group or the control group in an open-label manner at the Department of Obstetrics and Gynecology, San-ikukai Hospital, Tokyo, Japan. The probiotic group received Lactobacillus reuteri during antenatal checkups from 35 to 37-week gestation to 1 month after delivery. Rectal swabs were obtained from the newborns at 5 days and at 1 month of age. Whole-genome sequencing was performed to test for GBS strains in the mother, whose newborn carried GBS at the 1-month checkup. Multi-locus sequence typing and single nucleotide polymorphism analyses were performed to identify MTCT. RESULTS Overall, 67 mother-infant pairs were included, with 31 in the probiotic group and 36 in the control group. The positivity rate of GBS in newborns at 1 month of age was 10% (n = 3) in the probiotic group and 28% (n = 10) in the control group. In newborns carrying GBS at 1 month of age, genetic analysis revealed that the MTCT rate was 6% in the probiotic group and 22% in the control group, although the difference was not statistically significant (p = 0.0927). CONCLUSION No statistically significant difference was found; however, the consumption of L. reuteri by women with GBS-positive pregnancies may inhibit the MTCT of GBS.
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Affiliation(s)
- Yuriha Kasai
- Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mitsutaka Komatsu
- Department of Pediatrics, San-Ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo, 130-0012, Japan.
| | - Yudai Toyama
- Department of Pediatrics, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Saki Nakano
- Department of Pediatrics, Tokyo Rinkai Hospital, 1-4-2 Rinkai-cho, Edogawa-ku, Tokyo, 134-0086, Japan
| | - Ken Hisata
- Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mie Yamada
- Department of Obstetrics and Gynecology, San-Ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo, 130-0012, Japan
| | - Toshiaki Shimizu
- Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
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Samb A, Dierikx TH, Bijleveld YA, de Haan TR, Hodiamont CJ, van Leeuwen E, van Kaam AHLC, Mathôt RAA, Visser DH. Benzylpenicillin concentrations in umbilical cord blood and plasma of premature neonates following intrapartum doses for group B streptococcal prophylaxis. Matern Health Neonatol Perinatol 2023; 9:9. [PMID: 37391853 DOI: 10.1186/s40748-023-00163-3] [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: 03/28/2023] [Accepted: 05/24/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND AND METHOD Dutch obstetrics guideline suggest an initial maternal benzylpenicillin dose of 2,000,000 IU followed by 1,000,000 IU every 4 h for group-B-streptococci (GBS) prophylaxis. The objective of this study was to evaluate whether concentrations of benzylpenicillin reached concentrations above the minimal inhibitory concentrations (MIC) in umbilical cord blood (UCB) and neonatal plasma following the Dutch guideline. RESULTS Forty-six neonates were included. A total of 46 UCB samples and 18 neonatal plasma samples were available for analysis. Nineteen neonates had mothers that received intrapartum benzylpenicillin. Benzylpenicillin in UCB corresponded to concentrations in plasma drawn directly postpartum (R2 = 0.88, p < 0.01). A log-linear regression suggested that benzylpenicillin concentrations in neonates remained above the MIC threshold 0.125 mg/L up to 13.0 h after the last intrapartum dose. CONCLUSIONS Dutch intrapartum benzylpenicillin doses result in neonatal concentrations above the MIC of GBS.
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Affiliation(s)
- Amadou Samb
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands.
| | - Thomas H Dierikx
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Pediatric Gastroenterology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Yuma A Bijleveld
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Timo R de Haan
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Caspar J Hodiamont
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Elisabeth van Leeuwen
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Obstetrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anton H L C van Kaam
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Ron A A Mathôt
- Department of Pharmacy and Clinical Pharmacology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Douwe H Visser
- Amsterdam Reproduction & Development, Amsterdam, the Netherlands
- Department of Neonatology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Berardi A, Trevisani V, Di Caprio A, Caccamo P, Latorre G, Loprieno S, Foglianese A, Laforgia N, Perrone B, Nicolini G, Ciccia M, Capretti MG, Giugno C, Rizzo V, Merazzi D, Fanaro S, Taurino L, Pulvirenti RM, Orlandini S, Auriti C, Haass C, Ligi L, Vellani G, Tzialla C, Tuoni C, Santori D, Baroni L, China M, Bua J, Visintini F, Decembrino L, Creti R, Miselli F, Bedetti L, Lugli L. Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management? Pathogens 2023; 12:pathogens12040588. [PMID: 37111474 PMCID: PMC10140896 DOI: 10.3390/pathogens12040588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The effectiveness of "inadequate" intrapartum antibiotic prophylaxis (IAP administered < 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003-2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined "active" when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an "inactive" IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP "adequate" seems the pathogen's antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.
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Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Viola Trevisani
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Antonella Di Caprio
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Paola Caccamo
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Giuseppe Latorre
- Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Sabrina Loprieno
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandra Foglianese
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Perrone
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | | | - Matilde Ciccia
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Maggiore Hospital, 40133 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Chiara Giugno
- Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy
| | - Vittoria Rizzo
- Neonatal Intensive Care Unit, Bufalini Hospital, Cesena, 47521 Cesena, Italy
| | - Daniele Merazzi
- Division of Neonatology, "Valduce" Hospital, 22100 Como, Italy
| | - Silvia Fanaro
- Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy
| | - Lucia Taurino
- Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy
| | - Rita Maria Pulvirenti
- Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forlì, Italy
| | - Silvia Orlandini
- Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy
| | - Laura Ligi
- Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulia Vellani
- Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
| | - Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Santori
- Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy
| | | | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, "IRCCS Burlo Garofolo", 34137 Trieste, Italy
| | | | - Lidia Decembrino
- ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy
| | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
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Radzinsky VE, Doronina OK, Olenev AS, Stetsyuk OV. Group B streptococcus in obstetrics: unsolved problems. RUDN JOURNAL OF MEDICINE 2023. [DOI: 10.22363/2313-0245-2023-27-1-9-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
For several decades, among all possible pathogens of neonatal infections, group B streptococcus has been one of the leading positions. Sepsis, meningitis, and pneumonia are among the most common clinical manifestations of neonatal infection associated with group B streptococcus. In this review, our goal was to analyze the literature demonstrating a worldwide approach to the prevention of vertical transmission of group B streptococcus from mother to child. When writing the review, scientific publications of foreign and domestic authors from the PubMed database were studied. The review considers the drugs of choice for intranatal antibiotic prophylaxis, and their pharmacodynamic, and pharmacokinetic features. The analysis details the problem of the growth of resistance of group B streptococcus to antibacterial drugs. The antimicrobial activity of lactoferrin was noted at a minimum inhibitory concentration of 500 μg/ml. The presented review also reflects the protective and therapeutic effects of oral intake of probiotics containing Lactobacillus acidophilus, Lactobacillus salivarius, Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14 . Based on the analysis, it can be concluded that penicillin G and ampicillin have the most pronounced bactericidal effect against group B streptococcus. At the same time, the most common side effects of β-lactam penicillins include an allergic reaction with the possible development of anaphylactic shock. Given this, the antibiotics of the first-line reserve group include cefazolin, clindamycin, and vancomycin. At the same time, it is important to take into account the decrease in the therapeutic concentration of clindamycin with a change in the alpha-1-acid glycoprotein in the blood of the mother and fetus, the nephrotoxic effect of vancomycin and the cross-a llergic reaction of cefazolin with antibiotics of the penicillin group. A promising direction in solving the problem of group B streptococcus is the development of new strategies for the prevention of perinatal infection of the fetus and newborn based on a more detailed study of the effects of lactoferrin and probiotics.
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8
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Hesse MR, Prins JR, Hooge MNLD, Winter HLJ, Kosterink JGW, Touw DJ, Mian P. Pharmacokinetics and Target Attainment of Antimicrobial Drugs Throughout Pregnancy: Part I-Penicillins. Clin Pharmacokinet 2023; 62:221-247. [PMID: 36662480 PMCID: PMC9998600 DOI: 10.1007/s40262-023-01211-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Pharmacokinetics (PK) are severely altered in pregnant women due to changes in volume of distribution (Vd) and/or drug clearance (CL), affecting target attainment of antibiotics in pregnant women. This review is part of a series that reviews literature on the description of PK and target attainment of antibiotics in pregnant women with specific focus on penicillins. METHODS A systematic literature search was carried out in PubMed. Articles were labelled as relevant when information on PK of penicillins in pregnant women was available. RESULTS Thirty-two relevant articles were included, 8 of which discussed amoxicillin (with and without clavulanic acid), 15 ampicillin, 4 benzylpenicillin, 1 phenoxymethylpenicillin, and 4 piperacillin (with and without tazobactam). No studies were found on pheneticillin and flucloxacillin in pregnant women. Ten out of 32 articles included information on both Vd and CL. During the second and third trimester of pregnancy, a higher CL and larger Vd was reported than in non-pregnant women and in pregnant women during first trimester. Reduced target attainment was described in second and third trimester pregnant women. Only 7 studies reported dosing advice, 4 of which were for amoxicillin. CONCLUSION The larger Vd and higher CL in second and third trimester pregnant women might warrant a higher dosage or shortening of the dosing interval of penicillins to increase target attainment. Studies frequently fail to provide dosing advice for pregnant women, even if the necessary PK information was available.
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Affiliation(s)
- M R Hesse
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - J R Prins
- Department of Obstetrics and Gynaecology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - M N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - H L J Winter
- Department of Medical Microbiology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - J G W Kosterink
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Pharmaco-Therapy, -Epidemiology, and Economy, Groningen Research Institute for Pharmacy, University of Groningen, Groningen, The Netherlands
| | - D J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Pharmaceutical Analysis, Groningen Research Institute for Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Paola Mian
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen and University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
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9
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Maternal Group B Streptococcal Rectovaginal Colonization after Intrapartum Antibiotic Prophylaxis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121848. [PMID: 36553292 PMCID: PMC9776505 DOI: 10.3390/children9121848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/14/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
Maternal rectovaginal colonization with Group B Streptococcus (GBS) during labor is a prerequisite for neonatal early-onset GBS disease. Intrapartum antibiotic prophylaxis (IAP) has been proven to prevent GBS perinatal infection, while there are few studies on the evaluation of the effectiveness of different antibiotic prophylaxis regimens. This study aimed to assess the maternal rectovaginal GBS colonization status after IAP, antimicrobial susceptibility and maternal and neonatal outcomes among women administered different antibiotic prophylaxis regimens. A prospective study was conducted between June 2018 and June 2022. GBS carriers identified at 35-37 weeks of gestation were provided IAP (penicillin, cefazolin or clindamycin) at delivery based on the local protocol for GBS prevention. Rectovaginal samples were obtained from participants again after delivery. Antimicrobial susceptibility testing in GBS isolates was performed using the broth microdilution method. A total of 295 cases were included in this study. In the postpartum re-examination for GBS, the overall negative rectovaginal culture rate was 90.8% (268/295). Women who received cefazolin prophylaxis had the highest negative culture rate (95.2%, 197/207), which was followed by those who received penicillin (80.7%, 67/83) and clindamycin (80.0%, 4/5) (p = 0.001). All GBS isolates achieved sensitivity to penicillin and cefazolin, whereas resistance to clindamycin was shown in 21.4% of the strains. There were no significant differences in maternal and neonatal outcomes among the IAP groups. The use of IAP is highly effective in reducing the maternal rectovaginal GBS colonization. Cefazolin may offer equivalent efficacy and safety compared to standard penicillin prophylaxis.
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Bekele H, Debella A, Getachew T, Balis B, Tamiru D, Eyeberu A, Tiruye G, Kure MA, Habte S, Eshetu B, Regassa LD, Mesfin S, Alemu A, Dessie Y, Shiferaw K. Prevalence of Group B Streptococcus Recto-Vaginal Colonization, Vertical Transmission, and Antibiotic Susceptibility Among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis. Front Public Health 2022; 10:851434. [PMID: 35651858 PMCID: PMC9149289 DOI: 10.3389/fpubh.2022.851434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Maternal Group B Streptococcus (GBS) recto-vaginal colonization is the most common route for early onset neonatal GBS diseases. A good understanding of the rate of maternal GBS colonization, vertical transmission rate, and antibiotic susceptibility profiles is needed to formulate a broad protection mechanism, like vaccine preparation. For that reason, this meta-analysis aimed at determining the pooled prevalence of GBS recto-vaginal colonization, vertical transmission rate, and antibiotic susceptibility profiles in Ethiopia. Methods Both published and unpublished studies were searched from MEDLINE/PubMed, CINAHL (EBSCO), Embase, Cochrane Library, SCOPUS, Web of Sciences databases, and Google Scholar. Independent selection was then carried out by the authors based on the eligibility criteria and data extraction using Microsoft excel. The authors then used STATA version 14.1 software for further cleaning and analysis. The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines. Using the random-effect model, the prevalence with a 95% confidence interval (CI) and forest plot were used to present the findings. Besides, the studies' heterogeneity was assessed using Cochrane chi-square (I2) statistics, while Egger intercept was used to assess publication bias. Results This review included nineteen studies. The pooled prevalence of recto-vaginal colonization was 15% (95% CI: 11, 19), while the prevalence of vertical transmission was 51% (95% CI: 45, 58) and highest-level susceptibility to vancomycin was 99% (95% CI: 98, 100). However, the GBS susceptibility to tetracycline was 23% (95% CI: 9, 36). Conclusions Nearly one out of seven pregnant women in Ethiopia had recto-vaginal colonization of GBS. As a result, half of the pregnancies end with vertical transmission of GBS. Hence, the review emphasizes that policy and programs should consider planning and implementing prophylactic programs. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021287540.
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Affiliation(s)
- Habtamu Bekele
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bikila Balis
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dawit Tamiru
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Getahun Tiruye
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Abdurke Kure
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sisay Habte
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bajrond Eshetu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sinetibeb Mesfin
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adisu Alemu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kasiye Shiferaw
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Moore RE, Thomas HC, Manning SD, Gaddy JA, Townsend SD. Galacto-Oligosaccharide Supplementation Modulates Pathogen-Commensal Competition between Streptococcus agalactiae and Streptococcus salivarius. Chembiochem 2022; 23:e202100559. [PMID: 34788501 PMCID: PMC9197176 DOI: 10.1002/cbic.202100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/16/2021] [Indexed: 02/06/2023]
Abstract
The members of the infant microbiome are governed by feeding method (breastmilk vs. formula). Regardless of the source of nutrition, a competitive growth advantage can be provided to commensals through prebiotics - either human milk oligosaccharides (HMOs) or plant oligosaccharides that are supplemented into formula. To characterize how prebiotics modulate commensal - pathogen interactions, we have designed and studied a minimal microbiome where a pathogen, Streptococcus agalactiae engages with a commensal, Streptococcus salivarius. We discovered that while S. agalactiae suppresses the growth of S. salivarius via increased lactic acid production, galacto-oligosaccharides (GOS) supplementation reverses the effect. This result has major implications in characterizing how single species survive in the gut, what niche they occupy, and how they engage with other community members.
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Affiliation(s)
- Rebecca E. Moore
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States
| | - Harrison C. Thomas
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States,Vanderbilt University School of Medicine, Nashville, Tennessee 37212, United States
| | - Shannon D. Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48824 United States
| | - Jennifer A. Gaddy
- Tennessee Valley Healthcare Systems, Department of Veterans Affairs, Nashville, Tennessee 37212, United States,Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States,
| | - Steven D. Townsend
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37235, United States,Corresponding Authors
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Klancic T, Black AM, Reimer RA. Influence of antibiotics given during labour and birth on body mass index z scores in children in the All Our Families pregnancy cohort. Pediatr Obes 2022; 17:e12847. [PMID: 34414675 DOI: 10.1111/ijpo.12847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Little is known about obesity risk associated with intrapartum antibiotic prophylaxis (IAP). Our objective was to determine if maternal antibiotic exposure during birth is associated with child body mass index (BMI) z scores in the first 3 years of life. METHODS In 2008 to 2010, 3388 pregnant women were recruited to the All Our Families study. Here, we included women with available data from obstetrical records on antibiotic use during birth (n = 1303) and children with at least one valid BMI z score (final sample n = 1262). The primary outcome was infant BMI z score at 1, 2 and 3 years of age. RESULTS IAP occurred in 432 of 1262 women. Children exposed to IAP had significantly higher mean [standard error (SE)] BMI z scores (1.071 [0.087] unit) at 1 year of age compared to non-exposed infants (0.744 [0.064] unit). Although the association was no longer significant after adjustment for confounding factors in the growth trajectory model, IAP resulted in a 0.255 unit increase in BMI z score at 1 year of age. Differences in BMI z score between exposed and non-exposed at baseline (year 1) only remained significant in sensitivity analysis. CONCLUSION The potential association between maternal IAP and increased infant BMI z score at 1 year of age should be confirmed in other cohorts and warrants investigation of interventions to mitigate this possible risk.
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Affiliation(s)
- Teja Klancic
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Amanda M Black
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Department of Biochemistry & Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Shibata M, Morozumi M, Maeda N, Komiyama O, Shiro H, Iwata S, Ubukata K. Relationship between intrapartum antibiotic prophylaxis and group B streptococcal colonization dynamics in Japanese mother-neonate pairs. J Infect Chemother 2021; 27:977-983. [PMID: 33610482 DOI: 10.1016/j.jiac.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In Japan, universal screening for group B streptococcal (GBS) colonization in pregnant women and intrapartum antibiotic prophylaxis (IAP) are recommended to prevent neonatal GBS infection. However, the dynamics of GBS colonization in Japanese mother/neonate pairs have not been adequately studied. METHODS A prospective cohort study was conducted from July 2018 to March 2019. Rectovaginal samples were collected from pregnant women (33-37 gestation weeks) once. In neonates, nasopharyngeal and rectal samples were collected at three time points: after birth, 1 week after birth, and 1 month after birth. All samples were analyzed for GBS using real-time PCR testing and culture methods. Capsular typing was performed for all GBS isolates and GBS-positive samples using real-time PCR testing. RESULTS The overall maternal and neonatal GBS-positivity rates were 22.7% (57/251) and 8.8% (22/251), respectively. IAP for GBS-positive mothers (96.5%) was highly administered. Eleven (19.3%) neonates born to GBS-positive mothers were GBS-positive, which was significantly higher than the 11 (5.7%) neonates born to GBS-negative mothers. The rate of GBS-positivity in neonates increased with an increased number of GBS colonies in mothers. More neonates were GBS-positive 1 month after birth than 1 week after birth, and there was a higher rate of GBS-positive rectal swabs than nasopharyngeal swabs. Capsular types of GBS that were isolated from each mother and neonate pair were the same, namely, Ib, III, V, and VI. CONCLUSIONS These findings indicate that the efficacy of IAP in preventing GBS transmission to neonates might be limited to within a few weeks after birth.
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Affiliation(s)
- Meiwa Shibata
- Department of Pediatrics, Yokohama Rosai Hospital, Japan; Department of Infectious Diseases, Keio University School of Medicine, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Japan
| | - Osamu Komiyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroyuki Shiro
- Department of Pediatrics, Yokohama Rosai Hospital, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, Keio University School of Medicine, Japan; Department of Infectious Diseases, National Cancer Center Hospital, Japan
| | - Kimiko Ubukata
- Department of Infectious Diseases, Keio University School of Medicine, Japan; Department of General Medicine, Keio University School of Medicine, Japan.
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Jury I, Thompson K, Hirst JE. A scoping review of maternal antibiotic prophylaxis in low- and middle-income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection. Int J Gynaecol Obstet 2021; 155:319-330. [PMID: 33608872 DOI: 10.1002/ijgo.13648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance. OBJECTIVE A scoping review comparing peripartum prophylactic antimicrobial use in low- and middle-income countries (LMICs) with WHO recommendations for prevention and treatment of maternal peripartum infection. SEARCH STRATEGY Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. SELECTION CRITERIA Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for group B streptococcus (GBS), preterm-prelabor rupture of membranes (PPROM), cesarean section, manual placental removal, and third/fourth-degree perineal tears. DATA COLLECTION AND ANALYSIS Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA guidelines. Owing to study heterogeneity, a narrative synthesis was performed. MAIN RESULTS Of 1886 studies, 27 studies from 13 countries involving 43 774 women met the eligibility criteria. Polymerase chain reaction screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance. Evidence around cesarean section antimicrobial prophylaxis largely supports WHO recommendations; however, prolonged or multidrug regimens were reported. CONCLUSION There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist. Given the emergence of antimicrobial resistance, research is needed to ensure that peripartum prophylactic antimicrobial choices remain effective.
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Affiliation(s)
- Imogen Jury
- Medical Sciences Division, University of Oxford Medical School, Oxford, UK
| | - Kelly Thompson
- Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, Australia
| | - Jane E Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, Oxford, UK
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Proportion of Streptococcus agalactiae vertical transmission and associated risk factors among Ethiopian mother-newborn dyads, Northwest Ethiopia. Sci Rep 2020; 10:3477. [PMID: 32103109 PMCID: PMC7044167 DOI: 10.1038/s41598-020-60447-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/12/2020] [Indexed: 12/03/2022] Open
Abstract
Group B Streptococcus (GBS) vertical transmission causes fetal and neonatal colonization and diseases. However, there is scarcity of data in low-income countries including Ethiopia. We conducted a cross-sectional study on 98 GBS positive mothers, and their newborns to find proportion of vertical transmission. GBS was identified from swabs by using recommended methods and vertical transmission at birth was confirmed by the culture of body surface swabs of newborns within 30 minutes following birth. GBS positivity among swabbed specimens collected for other purposes was 160/1540 (10.4%); 98 were from 385 recto-vaginal swabs of pregnant women, and 62 were from 1,155 swabs of the 385 births. Of the 98 GBS positive cases, 62 newborns were GBS colonized with vertical transmission proportion of 63.3%(95% CI: 54.1–72.4%). We identified that the proportion of vertical transmission in this study was within the range of other many global studies, but higher than recently published data in Ethiopia. Maternal educational level, employment and lower ANC visit were significantly associated risk factors to GBS vertical transmission. Efforts need to be made to screen pregnant women during antenatal care and to provide IAP to GBS positive cases to reduce mother to newborn vertical transmission.
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A Retrospective Review of Neonatal Sepsis among GBS-Colonized Women Undergoing Planned Cesarean Section after Labor Onset or Rupture of Membranes. Infect Dis Obstet Gynecol 2020; 2020:4365259. [PMID: 32148387 PMCID: PMC7056999 DOI: 10.1155/2020/4365259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/22/2019] [Accepted: 12/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background Sepsis is a leading cause of mortality and morbidity in neonates, with group B streptococcus (GBS) remaining the most frequent pathogen isolated from term infants. Surveillance data showed that the majority of cases of early-onset GBS disease were neonates born to women who either received no or suboptimal intrapartum antibiotic prophylaxis with a notable portion of those women having a missed opportunity to receive ≥4 hours of chemoprophylaxis. Women planning delivery by cesarean section who present in labor or rupture of membranes prior to their scheduled surgery are unlikely to receive optimal GBS chemoprophylaxis and thus their neonates are at risk of having sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads was extracted from the Consortium on Safe Labor dataset. Women who had an unlabored cesarean section at ≥37 + 0 week gestation were selected and divided into four groups based on GBS status and timing of cesarean section with respect to onset of labor or rupture of membranes. The rate of neonatal sepsis and the patterns of intrapartum antibiotic chemoprophylaxis were determined. Results The sepsis rate (4.5%) among neonates of GBS-colonized women having their unlabored cesarean section after onset of labor or rupture of membranes was significantly higher than that in any other group in this study. In this group, 9.4% of women received chemoprophylaxis for ≥4 hours, while 31% had a missed opportunity to receive ≥4 hours of chemoprophylaxis. Conclusion This study suggests that neonates of GBS-colonized women having a planned cesarean section after onset of labor or rupture of membranes are at increased risk of having a sepsis diagnosis. This finding suggest the need for additional studies to assess the risk of sepsis among neonates of women in this group.
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López-Medina MD, López-Araque AB, Linares-Abad M, López-Medina IM. Umbilical cord separation time, predictors and healing complications in newborns with dry care. PLoS One 2020; 15:e0227209. [PMID: 31923218 PMCID: PMC6953818 DOI: 10.1371/journal.pone.0227209] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/14/2019] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of this study was to explore the umbilical cord separation time, predictors, and healing complications from birth until the newborn was one month old. Design A quantitative longitudinal observational analytical study by stratified random sample was adopted. Setting Public health system hospitals in southern Spain and at newborns’ homes. Participants Between April 2016 and December 2017, the study included 106 neonates born after 35–42 weeks of gestation whose umbilical cord was cured with water and soap and dried later as well as newborns without umbilical canalisation whose mothers enjoyed a low-risk pregnancy. Methods The data collection procedure comprised two blocks: from birth to the time of separation of the umbilical cord and from cord separation to the first month of life of the newborn. Umbilical cord separation time was measured in minutes; socio-demographic and clinical characteristics were measured by means of questionnaires, and the external diameter of the umbilical cord was measured using an electronic stainless-steel calliper and trailing roller. Results The mean umbilical separation time: 6.61 days (±2.33, IC 95%:6.16–7.05). Incidence of omphalitis was 3.7%; granuloma was 8.6%. Separation time predictors were wetting recurrence, birth weight, intrapartum antibiotics, birth season, and Apgar < 9 (R2 = 0.439 F: 15.361, p <0.01). Conclusion The findings support the World Health Organization recommendations: dry umbilical cord cares is a safe practice that soon detaches the umbilical cord, taking into account the factors studied that will vary the length of time until the umbilical cord is separated.
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Affiliation(s)
- María Dolores López-Medina
- Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain
- San José Health Center, Northern Jaén Sanitary District, Linares, Jaén, Spain
- * E-mail:
| | | | - Manuel Linares-Abad
- Department of Nursing, Faculty of Health Sciences, Universidad de Jaén, Jaén, Spain
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Berardi A, Spada C, Vaccina E, Boncompagni A, Bedetti L, Lucaccioni L. Intrapartum beta-lactam antibiotics for preventing group B streptococcal early-onset disease: can we abandon the concept of 'inadequate' intrapartum antibiotic prophylaxis? Expert Rev Anti Infect Ther 2019; 18:37-46. [PMID: 31762370 DOI: 10.1080/14787210.2020.1697233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: Neonatal sepsis remains a serious and potentially fatal illness. Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcal (GBS) early-onset sepsis. The optimal duration of IAP (adequate IAP) to reduce vertical transmission of GBS has been debated. Understanding the mechanism of action of IAP may help in minimizing neonatal evaluation and unnecessary antibiotic use.Areas covered: In recent years, several studies on pharmacokinetics and clinical use of IAP have been published. Although penicillin and ampicillin are the most preferred antibiotics, the clinical efficacy of non-beta-lactam antibiotics, including clindamycin and vancomycin, used in cases of penicillin anaphylaxis-associated allergy, remains debatable. This is a narrative review of the literature regarding the impact of 'inadequate' IAP on the clinical management of women and newborns.Expert opinion: Recent evidence suggests that 'inadequate' IAP with beta-lactams is more effective in preventing vertical transmission of GBS than previously thought. Newborns exposed to intrapartum beta-lactams and who are asymptomatic at birth are likely uninfected, irrespective of IAP duration before delivery. Hence, we may abandon the concept of 'inadequate' IAP with beta-lactams in early-onset GBS sepsis, relying primarily on clinical signs observed at birth for managing IAP-exposed neonates.
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Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera, University of Modena and Reggio Emilia, Modena, Italy
| | - Caterina Spada
- Pediatric Post-graduate School, University of Modena and Reggio Emilia, Modena, Italy
| | - Eleonora Vaccina
- Pediatric Post-graduate School, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Luca Bedetti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera, University of Modena and Reggio Emilia, Modena, Italy
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Liu Y, Li L, Huang T, Wu W, Liang W, Chen M. The Interaction between Phagocytes and Streptococcus agalactiae (GBS) Mediated by the Activated Complement System is the Key to GBS Inducing Acute Bacterial Meningitis of Tilapia. Animals (Basel) 2019; 9:ani9100818. [PMID: 31623233 PMCID: PMC6826838 DOI: 10.3390/ani9100818] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Streptococcus agalactiae (GBS) is a serious threat to farmed tilapia, which results in high mortality and seriously hinders tilapia farming development. The pathogenic mechanism of tilapia infected with GBS which die rapidly in production remains unknown. We provided a comprehensive comparative analysis of the tilapias infected with fish-derived GBS attenuated strain YM001 and its parental virulent strain HN016. The present study indicates that the interaction between phagocytes and GBS mediated by the activated complement system is key to GBS inducing tilapia acute bacterial meningitis. The low survival ability caused by reduced β-lactam antibiotics resistance is one of the important reasons YM001 lost its pathogenicity to tilapia. Our study provided a comprehensive cognition of the mechanism of acute bacterial meningitis caused by GBS. Abstract Streptococcus agalactiae is an important pathogen for tilapia meningitis. Most of the infected tilapia die rapidly in production, when the way to study the pathogenic mechanism of bacteria on host through chronic infection in laboratory is not comprehensive and accurate enough to elucidate the real pathogenic mechanism. The objective of this study was to investigate the mechanism of acute bacterial meningitis of tilapia caused by Streptococcus agalactiae (GBS), and provide a theoretical basis for its prevention and treatment. Duel RNA-seq, proteome analysis, histopathological analysis, plasma biochemical indexes, and blood routine examination were performed on tilapias infected with fish-derived GBS attenuated strain YM001 and its parental virulent strain HN016. The results showed that the contents of white blood cell (WBC), monocytes (MON), and neutrophil (NEU) were significantly lower in the HN016 group compared to that in the YM001 group (p < 0.05). Histopathological examination showed that there were partially lesions in the examined tissues of tilapia infected by HN016, while no obvious histopathological changes occurred in the YM001 group. The differential expressed genes (DEGs) and differential expressed proteins (DEPs) between YM001 and HN016 were mainly enriched in the beta-lactam resistance pathway (oppA1, oppA2, oppB, oppC, oppD, oppF, and mrcA). The DEGs DEPs between YM001-brain and HN016-brain were mainly enriched in the complement and coagulation cascades signaling pathway (C2a, c4b, c3b, c7, CD59, ITGB2, and ITGAX). The present study indicates that the interaction between phagocytes and GBS mediated by the activated complement system is the key to GBS inducing tilapia acute bacterial meningitis. The low survival ability caused by reduced β-lactam antibiotics resistance is one of the important reasons for why YM001 lost its pathogenicity to tilapia.
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Affiliation(s)
- Yu Liu
- Guangxi Academy of Fishery Sciences, Fish diseases control and prevention lab, Qingshan Road NO.8, Nanning 530021, China.
| | - Liping Li
- Guangxi Academy of Fishery Sciences, Fish diseases control and prevention lab, Qingshan Road NO.8, Nanning 530021, China.
| | - Ting Huang
- Guangxi Academy of Fishery Sciences, Fish diseases control and prevention lab, Qingshan Road NO.8, Nanning 530021, China.
| | - Wende Wu
- Guangxi University, Daxuedong Road NO.100, Nanning 530004, China.
| | - Wanwen Liang
- Guangxi Academy of Fishery Sciences, Fish diseases control and prevention lab, Qingshan Road NO.8, Nanning 530021, China.
| | - Ming Chen
- Guangxi Academy of Fishery Sciences, Fish diseases control and prevention lab, Qingshan Road NO.8, Nanning 530021, China.
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Viel-Theriault I, Fell DB, Grynspan D, Redpath S, Thampi N. The transplacental passage of commonly used intrapartum antibiotics and its impact on the newborn management: A narrative review. Early Hum Dev 2019; 135:6-10. [PMID: 31177037 DOI: 10.1016/j.earlhumdev.2019.05.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Abstract
Neonates exposed to intra-amniotic infection are at increased risk of early-onset sepsis. Administration of antibiotics to the mother may offer some protection, however a comprehensive description of the determinants influencing their transplacental passage and delivery to the fetus has not been performed. While penicillin G, ampicillin, cefazolin and gentamicin reach therapeutic levels in the fetal serum rapidly following maternal administration, the transfer of second-line intrapartum antimicrobials, such as vancomycin and clindamycin, is slower and less predictable. Erythromycin, used in the context of preterm premature rupture of the membranes, has suboptimal influx into the fetal compartment. This evidence is predominantly drawn from term pregnancies and situations of low infectious risk; however, prematurity may negatively influence fetal exposure to intrapartum antibiotics. Optimal fetal antimicrobial concentrations to target are poorly defined and the extent to which our review findings apply to preterm early-onset neonatal sepsis prevention is unclear. Interpretation of blood cultures drawn in neonates with expected circulating levels of maternal antimicrobials above the minimal inhibitory concentration for Group B Streptococcus is challenging despite the use of contemporary optimized blood culture media.
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Affiliation(s)
- I Viel-Theriault
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - D B Fell
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - D Grynspan
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - S Redpath
- Division of Neonatology, Department of Pediatrics, The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - N Thampi
- Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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22
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Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 782. Obstet Gynecol 2019; 134:1. [PMID: 31241599 DOI: 10.1097/aog.0000000000003334] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1-2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal-rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including , , and , updates and replaces the obstetric components of the CDC 2010 guidelines, "Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010."
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The Prevalence of Rectovaginal Colonization and Antibiotic Susceptibility Pattern of Streptococcus agalactiae in Pregnant Women in Al-Zahra Hospital, Rasht, Iran. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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24
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Yadeta TA, Worku A, Egata G, Seyoum B, Marami D, Berhane Y. Vertical transmission of group B Streptococcus and associated factors among pregnant women: a cross-sectional study, Eastern Ethiopia. Infect Drug Resist 2018; 11:397-404. [PMID: 29559801 PMCID: PMC5856028 DOI: 10.2147/idr.s150029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Vertically transmitted group B Streptococcus (GBS) causes fetal and neonatal infections. However, there is limited information on the vertical transmission of GBS in low-income countries. This study, therefore, aimed to determine the rate of vertical transmission of GBS and associated factors among pregnant women in Eastern Ethiopia. Subjects and methods A cross-sectional, facility-based study was conducted among pregnant women in Harar town, Eastern Ethiopia, from June to October, 2016. GBS positivity of pregnant women was confirmed by culture of rectovaginal swab. Vertical transmission at birth was confirmed by culture on swabs taken from the ear canal, umbilicus, axilla, groin, and nose within 6 hours after birth. Prevalence ratio (PR) along with 95% CI was estimated to examine factors associated with vertical transmission using log binomial regression analysis. Results Out of 231 GBS-colonized pregnant women at delivery, 104 births were identified as GBS colonized with a vertical transmission rate of 45.02% and 95% CI: 38.49, 51.68. Of 104 vertical transmission cases, 65 (62.50%) received no intrapartum antibiotic prophylaxis (IAP), 28 (26.92%) received it <4 hours before delivery, and 11 (10.58%) received it ≥4 hours before delivery. Pre-labor rupture of membranes at term (PR: 1.93; 95% CI: 1.04, 3.57), prolonged rupture of the membrane ≥18 hours (PR: 1.76; 95% CI: 1.13, 2.74), intrapartum maternal fever (PR: 1.40; 95% CI: 1.13, 1.75), and IAP received ≥4 hours (PR: 0.17; 95% CI: 0.09, 0.30) were significantly associated with vertical transmission of GBS. Conclusion The magnitude of vertical transmission of GBS was very high. However, the rate of adequate IAP received by mothers was very low. Efforts need to be strengthened to screen pregnant women during antenatal care and IAP should be used as necessary. Furthermore, maternal vaccination may provide a feasible strategy to reduce the vertical transmission.
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Affiliation(s)
- Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Worku
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gudina Egata
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Berhanu Seyoum
- Department of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Dadi Marami
- Department of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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25
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Patras KA, Nizet V. Group B Streptococcal Maternal Colonization and Neonatal Disease: Molecular Mechanisms and Preventative Approaches. Front Pediatr 2018; 6:27. [PMID: 29520354 PMCID: PMC5827363 DOI: 10.3389/fped.2018.00027] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS) colonizes the gastrointestinal and vaginal epithelium of a significant percentage of healthy women, with potential for ascending intrauterine infection or transmission during parturition, creating a risk of serious disease in the vulnerable newborn. This review highlights new insights on the bacterial virulence determinants, host immune responses, and microbiome interactions that underpin GBS vaginal colonization, the proximal step in newborn infectious disease pathogenesis. From the pathogen perspective, the function GBS adhesins and biofilms, β-hemolysin/cytolysin toxin, immune resistance factors, sialic acid mimicry, and two-component transcriptional regulatory systems are reviewed. From the host standpoint, pathogen recognition, cytokine responses, and the vaginal mucosal and placental immunity to the pathogen are detailed. Finally, the rationale, efficacy, and potential unintended consequences of current universal recommended intrapartum antibiotic prophylaxis are considered, with updates on new developments toward a GBS vaccine or alternative approaches to reducing vaginal colonization.
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Affiliation(s)
- Kathryn A Patras
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States
| | - Victor Nizet
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States.,Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States
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26
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Bianco A, Larosa E, Pileggi C, Pavia M. Appropriateness of Intrapartum Antibiotic Prophylaxis to Prevent Neonatal Group B Streptococcus Disease. PLoS One 2016; 11:e0166179. [PMID: 27861568 PMCID: PMC5115703 DOI: 10.1371/journal.pone.0166179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 10/24/2016] [Indexed: 10/25/2022] Open
Abstract
The aims of this study were to describe the adherence to CDC guidelines for intrapartum antibiotic prophylaxis (IAP) and to identify possible factors influencing noncompliance with guidelines. We conducted a retrospective study in Italy. Our cohort included women in whom antenatal Group B Streptococcus (GBS) screening was not performed, was performed, but results were not available at the time of labor or delivery and women who were positive for GBS colonization. The indications for complete execution of IAP according to revised CDC guidelines was evaluated. It was considered adequate when performed with a recommended antibiotic at least four hours prior to delivery. The cohort included 902 women. Among those who had performed rectal and vaginal swabs (or recto-vaginal swabs), results were available in 86.9% of vaginal swabs and in 87.1% of rectal swabs and GBS was detected in 59.8% of vaginal swabs and in 71% of rectal swabs. 49.2% women had indication for GBS prophylaxis. Among these, 91.1% received an antibiotic during labor. Totally appropriate IAP was performed in 36.3% deliveries, an inappropriate antibiotic was administered in 10.4% women, the remaining 45.3% women received partially appropriate IAP; of these, 15.5% had received antibiotics through an inappropriate route of administration, 18.2% an inappropriate dosage regimen. Overall, 27.5% women received intrapartum ampicillin with inappropriate timing. Multivariate analysis showed that totally appropriate prophylaxis was significantly more likely in women who had no previous live birth, who had vaginal delivery, and a positive result at antenatal GBS screening. Despite satisfactory GBS screening implementation, there is still a substantial gap between optimal and actual IAP. We hypothesize that the complexity of the CDC guidelines may partially explain this shortcoming. Future efforts will include initiatives focused at enabling and reinforcing adherence to evidence-based prevention practices.
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Affiliation(s)
- Aida Bianco
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Elisabetta Larosa
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Claudia Pileggi
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
| | - Maria Pavia
- Department of Health Sciences, University of Catanzaro "Magna Græcia", Catanzaro, Italy
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Xie Y, Yang J, Zhao P, Jia H, Wang Q. Occurrence and detection method evaluation of group B streptococcus from prenatal vaginal specimen in Northwest China. Diagn Pathol 2016; 11:8. [PMID: 26791082 PMCID: PMC4721209 DOI: 10.1186/s13000-016-0463-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/14/2016] [Indexed: 11/10/2022] Open
Abstract
Sensitive and efficient detection of Group B Streptococcus (GBS) colonization in pregnant women is essential for prescription of prophylaxis at the time of delivery as GBS is an opportunistic pathogen known to cause infant mortality. In this report, two studies were conducted on the methods of GBS detection in Shaanxi province, China, a region lacking data for GBS detection and occurrence. For Study 1, 100 GBS culture-positive vaginal swabs were collected from 1,567 pregnant women for evaluation by direct latex agglutination test. In Study 2, 200 GBS vaginal swabs were evaluated by three culture methods (sheep blood agar (SBA), Columbia colistin-nalidixic agar (CNA), and selective carrot broth (SCB)) followed by analysis using a latex agglutination test. GBS was detected in 6.4 % of specimens in Study 1 and 10.5 % of specimens in Study 2. The results of the latex agglutination test in both studies were accurate with samples exhibiting high to moderate GBS growth, but the accuracy declined for samples with low GBS growth. The evaluation of culture methods for GBS detection revealed the sensitivity of SCB (95.2 %, p = 0.004) was significantly higher than that of the SBA medium (57.1 %). The sensitivity reported for SCB (95.2 %) was higher than CNA (76.0 %), but the difference was not statistically significant (p =0.078). These results indicate a selective broth, such as SCB, is ideal for accuracy at low growth levels, but a direct latex agglutination test could be used as an alternative for rapid detection of GBS in circumstances requiring immediate detection.
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Affiliation(s)
- Yun Xie
- Department of Clinical Microbiology, Medical Laboratory Centre, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, 710061, China.
| | - JunLan Yang
- Department of Clinical Microbiology, Medical Laboratory Centre, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, 710061, China.
| | - Peng Zhao
- Colleges of Life Sciences, Northwest University, Xi'an, Shaanxi, 710069, China.
| | - Hui Jia
- Department of Clinical Microbiology, Medical Laboratory Centre, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, 710061, China.
| | - Qi Wang
- Department of Clinical Laboratory, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710004, China.
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