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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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Hayes K, Janssen P, Payne BA, Jevitt C, Johnston W, Johnson P, Butler M. Oral Probiotic Supplementation in Pregnancy to Reduce Group B Streptococcus Colonisation (OPSiP trial): study protocol for a double-blind parallel group randomised placebo trial. BMJ Open 2024; 14:e076455. [PMID: 38316588 PMCID: PMC10860072 DOI: 10.1136/bmjopen-2023-076455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Group B streptococcus (GBS), or Streptococcus agalactiae, remains a leading cause of neonatal morbidity and mortality. Canadian guidelines advise universal maternal screening for GBS colonisation in pregnancy in conjunction with selective antibiotic therapy. This results in over 1000 pregnant individuals receiving antibiotic therapy to prevent one case of early-onset neonatal GBS disease, and over 20 000 pregnant individuals receiving antibiotic therapy to prevent one neonatal death. Given the growing concern regarding the risk of negative sequela from antibiotic exposure, it is vital that alternative approaches to reduce maternal GBS colonisation are explored.Preliminary studies suggest some probiotic strains could confer protection in pregnancy against GBS colonisation. METHODS AND ANALYSIS This double-blind parallel group randomised trial aims to recruit 450 pregnant participants in Vancouver, BC, Canada and will compare GBS colonisation rates in those who have received a daily oral dose of three strains of probiotics with those who have received a placebo. The primary outcome will be GBS colonisation status, measured using a vaginal/rectal swab obtained between 35 weeks' gestation and delivery. Secondary outcomes will include maternal antibiotic exposure and urogenital infections. Analysis will be on an intention-to-treat basis. PATIENT OR PUBLIC INVOLVEMENT There was no patient or public involvement in the design of the study protocol. ETHICS AND DISSEMINATION This study protocol received ethics approval from the University of British Columbia's Clinical Research Ethics Board, Dublin City University and Health Canada. Findings will be presented at research rounds, conferences and in peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03407157.
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Affiliation(s)
- Kelly Hayes
- BCCHR, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Nursing, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Patricia Janssen
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Beth A Payne
- Paediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Research, Women's Health Research Institute, Vancouver, BC, Canada
| | - Cecilia Jevitt
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Will Johnston
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Michelle Butler
- Faculty of Science and Health, Dublin City University, Dublin, Ireland
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Boureka E, Krasias D, Tsakiridis I, Karathanasi AM, Mamopoulos A, Athanasiadis A, Dagklis T. Prevention of Early-Onset Neonatal Group B Streptococcal Disease: A Comprehensive Review of Major Guidelines. Obstet Gynecol Surv 2023; 78:766-774. [PMID: 38134342 DOI: 10.1097/ogx.0000000000001223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Importance Group B Streptococcus (GBS) colonization during pregnancy is associated with significant neonatal morbidity and mortality and represents a major public health concern, often associated with poor screening and management. Objective The aim of this study was to review and compare the most recently published influential guidelines on the screening and management of this clinical entity during antenatal and intrapartum periods. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists, the Royal College of Obstetricians and Gynecologists, the Royal Australian and New Zealand College of Obstetricians and Gynecologists, and the Society of Obstetricians and Gynecologists of Canada on the prevention of early-onset neonatal group B streptococcal disease was carried out. Results There is a consensus among the reviewed guidelines regarding the optimal screening specimen type, indications for intrapartum antibiotic administration such as bacteriuria during pregnancy, clinical signs of chorioamnionitis or maternal pyrexia, and history of GBS-related neonatal disease. There is also agreement on several conditions where no intervention is recommended, that is, antepartum treatment of GBS and GBS-positive women with planned cesarean delivery and intact membranes. Controversy exists regarding the optimal screening time, with the Royal College of Obstetricians and Gynecologists stating against routine screening and on management strategies related to preterm labor and preterm prelabor rupture of membranes. Conclusions The development of consistent international practice protocols for the timely screening of GBS and effective management of this clinical entity both during pregnancy and the intrapartum period seems of paramount importance to safely guide clinical practice and subsequently improve neonatal outcomes.
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Affiliation(s)
| | | | | | | | - Apostolos Mamopoulos
- Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Professor, Third Department of Obstetrics and Gynaecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hutton EK, Simioni JC, Thabane L, Morrison KM. Associations of intrapartum antibiotics and growth, atopy, gastrointestinal and sleep outcomes at one year of age. Pediatr Res 2023; 94:1026-1034. [PMID: 36807614 DOI: 10.1038/s41390-023-02525-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Studies investigating neonatal outcomes following intrapartum antibiotic exposure show conflicting results. METHODS Data were collected prospectively in pregnancy to 1-year-of-age, from 212 mother-infant pairs. Adjusted multivariable regression models estimated relationships following exposure to intrapartum antibiotics among vaginally-born, full-term infants and outcomes related to growth, atopic disease, gastrointestinal symptoms, and sleep at 1-year. RESULTS Intrapartum antibiotic exposure (n = 40) was not associated with mass, ponderal index, BMI z-score (1- year), lean mass index (5-months) or height. Antibiotic exposure in labour ≥4-h was associated with increase in fat mass index at 5-months (β 0.42 [95% CI: 0.03, 0.80], p = 0.03). Intrapartum antibiotic was associated with atopy in the first year (OR: 2.93 [95% CI: 1.34, 6.43], p = 0.007). Antibiotic exposure during intrapartum or day 1-7 was associated with newborn fungal infection requiring antifungal therapy (OR 3.04 [95% CI: 1.14, 8.10], p = 0.026), and number of fungal infections (IRR: 2.90 [95% CI: 1.02, 8.27], p = 0.046). CONCLUSION Intrapartum and early life exposure to antibiotics were independently associated with measures of growth, atopy, and fungal infections suggesting that intrapartum and early neonatal antibiotics be used prudently following careful risk-benefit analysis. IMPACT This prospective study: Shows a shift in fat mass index at 5 months associated with antibiotic administration ≥4 h in labour; an earlier age than previously reported; Shows atopy reported less frequently among those not exposed to intrapartum antibiotics; Supports earlier research of increased likelihood of fungal infection following exposure to intrapartum or early-life antibiotics; Adds to growing evidence that antibiotics used intrapartum and in early neonatal periods influence longer-term outcomes for infants. Suggests that use of intrapartum and early neonatal antibiotics should be used prudently after careful consideration of risk and benefit.
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Affiliation(s)
- Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Julia C Simioni
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
- McMaster Midwifery Research Centre, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
- Centre for Metabolism Obesity and Diabetes Research, Hamilton, ON, Canada.
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Spénard E, Tordjman L, Marrié-Mas AE, Dal Soglio D, Eberle A, Labbé AC, Boucoiran I. Evaluation of a clinical protocol for the management of fever in labor among pregnant women at term: A quality-improvement study. Int J Gynaecol Obstet 2023; 161:225-233. [PMID: 36181701 DOI: 10.1002/ijgo.14488] [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: 05/24/2022] [Revised: 09/02/2022] [Accepted: 09/25/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the impact of a quality-improvement initiative designed to increase diagnostic accuracy and adequate management of clinical chorioamnionitis (CC) at a tertiary center. Chorioamnionitis occurs in 1%-13% of term pregnancies and increases maternal and neonatal peripartum complications; often over-diagnosed, it leads to unnecessary investigations and treatments. METHODS This was an interrupted time-series study. In September 2017 two interventions were implemented: (1) staff training and (2) standardized clinical protocol for the management of fever in labor. All singleton term pregnancies were included. CC cases were reviewed in the pre-intervention (2015-2016, n = 179) and post-intervention (2017-2018, n = 142) groups. CC criteria based on the American College of Obstetricians and Gynecologists guidelines, antibiotics, maternal and neonatal outcomes, and pathology were compared. A cost-consequence analysis was performed. RESULTS Incidence of CC decreased from 8.2 to 5.6 per 10 person-year (P < 0.001). This was associated with a significant increase in diagnostic accuracy from 15.7% to 73.2% (P < 0.001). Weight-adjusted tobramycin dosage improved from 8.8% to 69.1% (P < 0.001). Maternal length of hospitalization and readmissions decreased significantly, without affecting neonatal sepsis rate. Interventions decreased yearly hospital costs associated with CC by 23.4%. CONCLUSION Standardizing the management of fever in labor significantly increased the diagnostic accuracy of CC and decreased the misuse of antibiotics in term pregnancies. CC costs decreased by 23.4%.
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Affiliation(s)
- Elisabeth Spénard
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada
| | - Laurent Tordjman
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada.,Department of Obstetrics and Gynecology, Hôpital Maisonneuve-Rosemont, CIUSSS EMTL, Montreal, Québec, Canada
| | | | | | - Alexa Eberle
- Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Annie-Claude Labbé
- Department of Microbiology, Infectiology and Immunology, Université de Montréal, Montreal, Québec, Canada.,Service of Infectious Diseases, Hôpital Maisonneuve-Rosemont, CIUSSS EMTL, Montreal, Québec, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, Université de Montréal, Montreal, Québec, Canada.,Mother and Child Infectious Disease Centre, Department of Obstetrics and Gynecology, CHU Sainte-Justine, Montreal, Québec, Canada.,School of Public Health, Université de Montréal, Montreal, Québec, Canada
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Delara M, Vadlamudi NK, Sadarangani M. Strategies to Prevent Early and Late-Onset Group B Streptococcal Infection via Interventions in Pregnancy. Pathogens 2023; 12:pathogens12020229. [PMID: 36839501 PMCID: PMC9959229 DOI: 10.3390/pathogens12020229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/04/2023] Open
Abstract
Group B Streptococcus is a Gram-positive bacterium that typically colonizes 10-30% of pregnant women, causing chorioamnionitis, preterm birth, and stillbirth, as well as neonatal sepsis and meningitis with early-onset disease (EOD) or late-onset disease (LOD) due to ascending infection or transmission during delivery. While there are some differences between EOD and LOD in terms of route of transmission, risk factors, and serotypes, the only preventive approach currently is maternal intrapartum antibiotic prophylaxis (IAP) which will not be able to fully address the burden of the disease since this has no impact on LOD. Probiotics and immunization in pregnancy may be more effective than IAP for both EOD and LOD. There is mixed evidence of probiotic effects on the prevention of GBS colonization, and the data from completed and ongoing clinical trials investigating different GBS vaccines are promising. Current vaccine candidates target bacterial proteins or the polysaccharide capsule and include trivalent, tetravalent, and hexavalent protein-polysaccharide conjugate vaccines. Some challenges in developing novel GBS vaccines include the lack of a correlate of protection, the potential for serotype switching, a need to understand interactions with other vaccines, and optimal timing of administration in pregnancy to maximize protection for both term and preterm infants.
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Affiliation(s)
- Mahin Delara
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- Correspondence: (M.D.); (M.S.)
| | - Nirma Khatri Vadlamudi
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada
- Correspondence: (M.D.); (M.S.)
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Duggan HL, Chow SSW, Austin NC, Shah PS, Lui K, Tan K. Early-onset sepsis in very preterm neonates in Australia and New Zealand, 2007-2018. Arch Dis Child Fetal Neonatal Ed 2023; 108:31-37. [PMID: 35705325 DOI: 10.1136/archdischild-2021-323243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the epidemiology and population trends of early-onset sepsis in very preterm neonates admitted to neonatal intensive care units (NICU) in Australia and New Zealand. DESIGN Retrospective observational cohort study using a dual-nation registry database. SETTING 29 NICUs that have contributed to the Australian and New Zealand Neonatal Network. PARTICIPANTS Neonates born at <32 weeks' gestation born between 2007 and 2018 and then admitted to a NICU. MAIN OUTCOME MEASURES Microorganism profiles, incidence, mortality and morbidity. RESULTS Over the 12-year period, 614 early-onset sepsis cases from 43 178 very preterm admissions (14.2/1000 admissions) were identified. The trends of early-onset sepsis incidence remained stable, varying between 9.8 and 19.4/1000 admissions (linear trend, p=0.56). The leading causative organisms were Escherichia coli (E. coli) (33.7%) followed by group B Streptococcus (GBS) (16.1%). The incidence of E. coli increased between 2007 (3.2/1000 admissions) and 2018 (8.3/1000 admissions; p=0.02). Neonates with E. coli had higher odds of mortality compared with those with GBS (OR=2.8, 95% CI 1.2 to 6.1). Mortality due to GBS decreased over the same period (2007: 0.6/1000 admissions, 2018: 0.0/1000 admissions; p=0.01). Early-onset sepsis tripled the odds of mortality (OR=3.0, 95% CI 2.4 to 3.7) and halved the odds of survival without morbidity (OR=0.5, 95% CI 0.4 to 0.6). CONCLUSION Early-onset sepsis remains an important condition among very preterm populations. Furthermore, E. coli is a dominant microorganism of very preterm early-onset sepsis in Australia and New Zealand. Rates of E. coli have been increasing in recent years, while GBS-associated mortality has decreased.
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Affiliation(s)
- Husharn L Duggan
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Sharon S W Chow
- Australia and New Zealand Neonatal Network, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Nicola C Austin
- Department of Paediatrics, Christchurch Women's Hospital, Christchurch, New Zealand
| | | | - Kei Lui
- Australia and New Zealand Neonatal Network, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Newborn Care, The Royal Hospital for Women, Newborn Intensive Care Unit, Randwick, New South Wales, Australia
| | - Kenneth Tan
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia .,Monash Newborn, Monash Health, Clayton, Victoria, Australia
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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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Assabahi A, Driggers R, Keeys CA, Mader A, Norris P. Evaluation of appropriate vancomycin prescribing for the prevention of newborn group B streptococcal infections in a community hospital obstetrics service. J Perinat Med 2022; 50:1218-1224. [PMID: 35794077 DOI: 10.1515/jpm-2021-0558] [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: 10/28/2021] [Accepted: 06/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The 2019 American College of Obstetricians and Gynecologists (ACOG) guidelines update for the prevention of perinatal group B Streptococcus (GBS) infections stipulate that vancomycin should be reserved to treat penicillin-allergic women at high risk for anaphylaxis with documented GBS resistance to clindamycin. Protocols and policies were adapted at the community hospital to incorporate these new guidelines. The primary objective of this research was to evaluate institutional compliance to these guidelines and secondarily, clinical outcomes. METHODS Clinical pharmacists, in collaboration with an obstetrician, performed this hospital-based study. All instances of intravenous (IV) vancomycin therapy in GBS-positive patients were assessed from 1/1/2018 through 1/1/2021 and compared to the 2010 and 2019 ACOG guidelines. Treatment was analyzed to determine the appropriateness of both indication for use and dosage regimen as co-primary endpoints. Secondary endpoints included renal monitoring parameters, suspected adverse reactions, and early onset GBS disease in newborns, specifically sepsis, meningitis, and/or pneumonia. RESULTS L&D admissions during the study period included 15,129 patients. All 30 L&D patients who received IV vancomycin for GBS prophylaxis were included in the study. This project demonstrated low compliance to the ACOG guidelines and identified previously unrecognized opportunities for improvement. CONCLUSIONS The low compliance observed in this study, with the exception of documenting GBS status, occurred in spite of hospital adoption of a GBS order set, an updated vancomycin protocol and targeted education of clinical pharmacists. Assessment of the causes of noncompliance identified several potential corrective actions, especially in ordering and monitoring vancomycin.
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Affiliation(s)
- Amirah Assabahi
- Pharmacy Department, Sibley Memorial Hospital - Johns Hopkins Medicine, Washington, DC, USA
| | - Rita Driggers
- Maternal Fetal Medicine Sibley Memorial Hospital - Johns Hopkins Medicine, Baltimore, USA
| | - Christopher A Keeys
- Pharmacy Department, Sibley Memorial Hospital - Johns Hopkins Medicine, Washington, DC, USA
| | - Alexa Mader
- Pharmacy Department, Sibley Memorial Hospital - Johns Hopkins Medicine, Washington, DC, USA
| | - Paul Norris
- Pharmacy Department, Sibley Memorial Hospital - Johns Hopkins Medicine, Washington, DC, USA
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Obiakor CV, Parks J, Takaro TK, Tun HM, Morales-Lizcano N, Azad MB, Mandhane PJ, Moraes TJ, Simons E, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. Early Life Antimicrobial Exposure: Impact on Clostridioides difficile Colonization in Infants. Antibiotics (Basel) 2022; 11:antibiotics11070981. [PMID: 35884235 PMCID: PMC9311587 DOI: 10.3390/antibiotics11070981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 11/16/2022] Open
Abstract
The relationship between antibiotic use and Clostridioides difficile (C. difficile) has been well established in adults and older children but remains unclear and is yet to be fully examined in infant populations. This study aimed to determine the separate and cumulative impact from antibiotics and household cleaning products on C. difficile colonization in infants. This study included 1429 infants at 3–4 months of age and 1728 infants at 12 months of age from the Canadian Healthy Infant Longitudinal Development (CHILD) birth cohort. The levels of infant antimicrobial exposure were obtained from hospital birth charts and standardized questionnaires. Infant gut microbiota was characterized by Illumina 16S ribosomal ribonucleic acid (rRNA) gene sequencing. Analysis of C. difficile was performed using a quantitative polymerase chain reaction (qPCR). Overall, C. difficile colonized 31% and 46% of infants at 3–4 months and 12 months, respectively. At 3–4 months, C. difficile colonization was significantly higher in infants exposed to both antibiotics and higher (above average) usage of household cleaning products (adjusted odds ratio (aOR) 1.50, 95% CI 1.03–2.17; p = 0.032) than in infants who had the least antimicrobial exposure. This higher colonization persisted up to 12 months of age. Our study suggests that cumulative exposure to systemic antibiotics and higher usage of household cleaning products facilitates C. difficile colonization in infants. Further research is needed to understand the future health impacts.
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Affiliation(s)
| | - Jaclyn Parks
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (J.P.); (T.K.T.)
- Cancer Control Research, BC Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Tim K. Takaro
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; (J.P.); (T.K.T.)
| | - Hein M. Tun
- School of Public Health, University of Hong Kong, Hong Kong;
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong
- Microbiota I-Center (MagIC), The Chinese University of Hong Kong, Hong Kong
| | - Nadia Morales-Lizcano
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (N.M.-L.); (J.A.S.)
| | - Meghan B. Azad
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada; (M.B.A.); (E.S.)
| | | | - Theo J. Moraes
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada; (T.J.M.); (P.S.)
| | - Elinor Simons
- Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, MB R3A 1S1, Canada; (M.B.A.); (E.S.)
| | - Stuart E. Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, BC V6H 0B3, Canada;
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, ON M5G 1X8, Canada; (T.J.M.); (P.S.)
| | - James A. Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (N.M.-L.); (J.A.S.)
| | - Anita L. Kozyrskyj
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Correspondence:
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11
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Li LX, Oliver C, Ronzoni S, Zaltz A, Leis JA, Elligsen M, Lam PW. Improving Intrapartum Group B Streptococcus Prophylaxis in Patients with a Reported Penicillin or Cephalosporin Allergy: A Quality Improvement Project. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:769-776. [PMID: 35338006 DOI: 10.1016/j.jogc.2022.02.128] [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: 12/13/2021] [Revised: 01/28/2022] [Accepted: 02/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the impact of a standardized allergy-guided approach to Group B Streptococcus (GBS) prophylaxis in pregnant women with reported penicillin or cephalosporin allergy. METHODS This interrupted time-series analysis included obstetric patients requiring GBS prophylaxis who reported penicillin or cephalosporin allergies. Patients were divided into baseline (April 1, 2019 to July 21, 2020) and intervention (July 22, 2020 to July 31, 2021) groups. The primary outcome was prophylaxis appropriateness, based on antibiotic type, nature of reaction, and cross-reactivity risk. Secondary outcomes included type of prophylaxis received and antibiotic-related adverse events. RESULTS The study included 88 patients in the baseline period and 52 patients in the intervention period. Appropriate prophylaxis increased from 47% (41/88) to 85% (44/52), with the segmented regression model confirming a statistically significant increase over time (incidence rate ratio 1.57; 95% CI 1.02-2.43, P = 0.04, slope coefficient 1.06/month; 95% CI 1.01-1.10, P = 0.01). Penicillin and cefazolin use increased from 61% (54/88) to 87% (45/52) in the intervention period (P = 0.002), and no hypersensitivity reactions occurred during this period. CONCLUSIONS Implementation of standardized allergy-guided prophylaxis safely improved appropriate β-lactam antibiotic use in obstetric patients requiring GBS prophylaxis who reported penicillin and cephalosporin allergies.
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Affiliation(s)
- Linda X Li
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON , Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON
| | - Cyndy Oliver
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Stefania Ronzoni
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Arthur Zaltz
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Jerome A Leis
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON , Department of Medicine, University of Toronto, Toronto, ON
| | - Marion Elligsen
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Philip W Lam
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON , Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON.
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12
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Ting JY, Autmizguine J, Dunn MS, Choudhury J, Blackburn J, Gupta-Bhatnagar S, Assen K, Emberley J, Khan S, Leung J, Lin GJ, Lu-Cleary D, Morin F, Richter LL, Viel-Thériault I, Roberts A, Lee KS, Skarsgard ED, Robinson J, Shah PS. Practice Summary of Antimicrobial Therapy for Commonly Encountered Conditions in the Neonatal Intensive Care Unit: A Canadian Perspective. Front Pediatr 2022; 10:894005. [PMID: 35874568 PMCID: PMC9304938 DOI: 10.3389/fped.2022.894005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Neonates are highly susceptible to infections owing to their immature cellular and humoral immune functions, as well the need for invasive devices. There is a wide practice variation in the choice and duration of antimicrobial treatment, even for relatively common conditions in the NICU, attributed to the lack of evidence-based guidelines. Early decisive treatment with broad-spectrum antimicrobials is the preferred clinical choice for treating sick infants with possible bacterial infection. Prolonged antimicrobial exposure among infants without clear indications has been associated with adverse neonatal outcomes and increased drug resistance. Herein, we review and summarize the best practices from the existing literature regarding antimicrobial use in commonly encountered conditions in neonates.
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Affiliation(s)
- Joseph Y Ting
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie Autmizguine
- Division of Infectious Diseases, Department of Pediatrics, Université de Montreal, Montreal, QC, Canada.,Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
| | - Michael S Dunn
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Julie Choudhury
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julie Blackburn
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montreal, Montreal, QC, Canada
| | - Shikha Gupta-Bhatnagar
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Katrin Assen
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Julie Emberley
- Division of Neonatology, Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada
| | - Sarah Khan
- Department of Microbiology, McMaster University, Hamilton, ON, Canada
| | - Jessica Leung
- Department of Pediatrics, University of Massachusetts, Worcester, MA, United States
| | - Grace J Lin
- School of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Frances Morin
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Lindsay L Richter
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Pediatrics, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ashley Roberts
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Erik D Skarsgard
- Division of Pediatric Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Joan Robinson
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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13
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Naumkina EVE, Kravchenko EN, Kuklina LV. Experience in the diagnosis of group B Streptococcus infections in pregnant women and newborns in a perinatal center. Klin Lab Diagn 2021; 66:755-759. [PMID: 35020289 DOI: 10.51620/0869-2084-2021-66-12-755-759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Serogroup B streptococci (Streptococcus agalactiae) are one of the main etiological agents responsible for the occurrence of severe perinatal infections in both postpartum women and newborns. The experience of microbiological diagnostics of infections caused by streptococcus serogroup B (GBS) according to the data of the microbiological laboratory of the perinatal center is generalized. In the study of biomaterial from patients, the proportion of positive cultures of Streptococcus agalactiae was 2.2% in cervical samples, 8.8% in vaginal contents, 6.6%; 2.8% and 0.7% in amniotic fluid, placenta and urine, respectively. In 57% of cases, GBS was released at a concentration of more than 5 lg / ml and in 73% of cases as part of polymicrobial associations with other opportunistic microorganisms. In the biomaterial from newborns, GBS was found in 2.5% of positive findings in blood samples, 4.6% in tracheobronchial lavages and 2.7% in detachable skin of the armpit when taking material immediately after childbirth and 1, 1% and 0.7%, respectively, during examination in the second stage of nursing. 5 cases of GBS isolation in newborns ended in early neonatal mortality with definitive diagnoses of congenital pneumonia and IUI of newborns, while there was only partial coincidence of the results of microbiological studies of the genital tract of the mother and biomaterials from the newborn. Relatively frequent findings of GBS in newborns of the high-risk group in intensive care unit indicate intrauterine infection with this pathogen. The examination of smears from the cervical canal is not informative in relation toGBS infection in comparison with the examination of the vaginal contents and recto-vaginal smears. The results of the introduction of microbiological screening and its effectiveness in real practice to prevent the development of early and late forms of GBS infections in newborns require further analysis.
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Affiliation(s)
- Elena Vital Evna Naumkina
- Federal State Budgetary Educational Institution of Higher Education «Omsk State Medical University».,Budgetary Healthcare Institution of the Omsk Region "City Clinical Perinatal Center"
| | - E N Kravchenko
- Federal State Budgetary Educational Institution of Higher Education «Omsk State Medical University»
| | - L V Kuklina
- Federal State Budgetary Educational Institution of Higher Education «Omsk State Medical University»
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14
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Abu-Raya B, Jost M, Bettinger JA, Bortolussi R, Grabowski J, Lacaze-Masmonteil T, Robinson JL, Posfay-Barbe KM, Galanis E, Schutt E, Mäusezahl M, Kollmann TR. Listeriosis in infants: Prospective surveillance studies in Canada and Switzerland. Paediatr Child Health 2021; 26:e277-e282. [PMID: 34880959 DOI: 10.1093/pch/pxab035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives International data on listeriosis during infancy from large populations are essential to guide evidence-based empiric antibiotic guidelines for sepsis in infancy. We aimed to determine the incidence, clinical manifestations, and outcome of listeriosis in infants <6 months of age in Canada and Switzerland. Methods Prospective, active surveillance of listeriosis in infants <6 months of age was conducted through the Canadian Paediatric Surveillance Program (May 2015 to April 2017) and the Swiss Paediatric Surveillance Unit (April 2017 to March 2018). Confirmed and probable cases were included. Results In Canada, eight sporadic listeriosis cases were reported (incidence, 1.1/100,000 live births/year). In Switzerland, four cases were reported (incidence, 4.5/100,000 live births/year) of which three were part of a confirmed outbreak with an unclear source. In the two countries, eight of the 12 cases (66.6%) presented as early-onset disease (within the first 7 days of life) and none presented after 28 days life. Conclusions Neonatal listeriosis is rare. Infants presenting with sepsis, especially after 4 weeks of life, may not routinely require empiric antibiotic coverage for listeriosis. Outbreak-related cases still occur. Continued surveillance is important.
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Affiliation(s)
- Bahaa Abu-Raya
- Vaccine Evaluation Center, British Columbia Children's Hospital, Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia,Canada
| | - Marianne Jost
- Federal Office of Public Health, Department of communicable diseases, Bern, Switzerland
| | - Julie A Bettinger
- Vaccine Evaluation Center, British Columbia Children's Hospital, Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia,Canada
| | - Robert Bortolussi
- Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Janet Grabowski
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thierry Lacaze-Masmonteil
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Klara M Posfay-Barbe
- Department of Pediatrics, Pediatric Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Eleni Galanis
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | | | - Mirjam Mäusezahl
- Federal Office of Public Health, Department of communicable diseases, Bern, Switzerland
| | - Tobias R Kollmann
- Vaccine Evaluation Center, British Columbia Children's Hospital, Department of Pediatrics, Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia,Canada
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15
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Yuan XY, Liu HZ, Liu JF, Sun Y, Song Y. Pathogenic mechanism, detection methods and clinical significance of group B Streptococcus. Future Microbiol 2021; 16:671-685. [PMID: 34098731 DOI: 10.2217/fmb-2020-0189] [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] [Indexed: 12/26/2022] Open
Abstract
Group B Streptococcus (GBS) is the main pathogen of perinatal infection. It can lead to adverse pregnancy, maternal infection, premature delivery, abortion, stillbirth and a series of adverse maternal and infant outcomes such as neonatal sepsis, meningitis or pneumonia during delivery. In order to reduce the infection of perinatal pregnant and the adverse pregnancy outcome, more attention should be paid in the clinical practice, screening efforts, universal detection of GBS infection for pregnant women and preventive treatment for the possible mother infant infection. In this study, the biological characteristics, immunophenotype, major pathogenic mechanism, laboratory test methods and clinical significance of GBS are summarized.
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Affiliation(s)
- Xiao-Yan Yuan
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
| | - Hai-Zhu Liu
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
| | - Jia-Fei Liu
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China.,Department of Medical Laboratory Sciences, Weifang Medical University, Weifang, Shandong, 261000, PR China
| | - Yong Sun
- Department of Clinical Lab, Yantai Laiyang Central Hospital, Yantai, Shandong, 264200, PR China
| | - Yu Song
- Department of Central Lab, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, PR China
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16
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Epidemiology of Sepsis Among Children and Neonates in Germany: Results From an Observational Study Based on Nationwide Diagnosis-Related Groups Data Between 2010 and 2016. Crit Care Med 2021; 49:1049-1057. [PMID: 33729720 DOI: 10.1097/ccm.0000000000004919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Worldwide, more than half of all sepsis cases occur in pediatric and adolescent patients, particularly in neonates. Previous population-based studies in these age groups often were limited to either neonatal or pediatric patients admitted to ICUs. We aimed to investigate the overall and age-specific incidence and case fatality of sepsis in children in Germany, a high-income country with a total population of 82 million. DESIGN Retrospective observational study based on the German Diagnosis-related Groups statistics of the years 2010-2016. SETTING All acute care hospitals in Germany except for prison and psychiatric hospitals. PATIENTS Pediatric patients less than or equal to 19 years with International Classification of Diseases, 10th Revision-coded sepsis, neonates with International Classification of Diseases, 10th Revision-coded neonatal sepsis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed pediatric sepsis incidence in patients aged birth to less than or equal to 19 years old, case fatality, and underlying comorbidities, and neonatal sepsis incidence and case fatality within the neonatal period. We identified 14,635 pediatric sepsis cases among 15.4 million pediatric hospitalizations between 2010 and 2016 (= 0.1% of pediatric hospitalizations). The incidence of pediatric sepsis was 14 cases per 100,000 children between 0 and 19 years. Case fatality was 16.6% and decreased from 17.8% (2010) to 15.0% (2016). A total of 11.5% of hospital deaths in the age group 0-19 years were associated with pediatric sepsis. Sepsis incidence and case fatality were highest in children less than 1 year old and declined in older children and adolescents. Admissions with pediatric sepsis were more common in children with preexisting comorbidities compared with those without (0.52% vs 0.03% of pediatric admissions). In neonates, the incidence of neonatal sepsis was 1,006 cases per 100,000 live births. Case fatality was 3.9%. While 17.7% of very low birth weight infants had neonatal sepsis, only 2.1% of low birth weight and 0.6% of normal birth weight neonates were affected, respectively. CONCLUSIONS Sepsis is also in Germany a common and frequently fatal condition in pediatric patients, particularly among neonates and children with comorbidities.
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17
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Prescott S, Dreisbach C, Baumgartel K, Koerner R, Gyamfi A, Canellas M, St Fleur A, Henderson WA, Trinchieri G. Impact of Intrapartum Antibiotic Prophylaxis on Offspring Microbiota. Front Pediatr 2021; 9:754013. [PMID: 34956974 PMCID: PMC8703107 DOI: 10.3389/fped.2021.754013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Infants are born into a world filled with microbes and must adapt without undue immune response while exploiting the microbiota's ability to produce otherwise unavailable nutrients. The process by which humans and microbes establish this relationship has only recently begun to be studied with the aid of genomic methods. Nearly half of all pregnant women receive antibiotics during gestation to prevent maternal and neonatal infection. Though this has been largely successful in reducing early-onset sepsis, we have yet to understand the long-term consequences of antibiotic administration during gestation to developing infants. Studies involving antibiotic use in infants suggest that dysbiosis during this period is associated with increased obesity, allergy, autoimmunity, and chronic diseases in adulthood, however, research around the limited doses of intravenous antibiotics used for intrapartum prophylaxis is limited. In this mini review, we focused on the state of the science regarding the effects of intrapartum antibiotic prophylaxis on the newborn microbial colonization process. Although, the literature indicates that there is wide variety in the specific bacteria that colonize infants from birth, limited parenteral antibiotic administration prior to delivery consistently affects the microbiota of infants by decreasing bacteria in the phylum Bacteroidetes and increasing bacteria in the phylum Proteobacteria, thus altering the normal pattern of colonization that infants experience. Delivery by cesarean section and formula feeding magnify and prolong this effect. Our mini review shows that the impact of intravenous antibiotic administration during gestation has on early colonization, growth, or immune programming in the developing offspring has not been well studied in human or animal models.
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Affiliation(s)
- S Prescott
- Laboratory of Integrative Immunology, Center for Cancer Research, National Institutes of Health, Bethesda, MD, United States.,College of Nursing, University of South Florida, Tampa, FL, United States
| | - C Dreisbach
- Data Science Institute, Columbia University, New York, NY, United States
| | - K Baumgartel
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - R Koerner
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - A Gyamfi
- School of Nursing, University of Connecticut, Storrs, CT, United States
| | - M Canellas
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - A St Fleur
- College of Nursing, University of South Florida, Tampa, FL, United States
| | - W A Henderson
- School of Nursing, University of Connecticut, Storrs, CT, United States.,School of Medicine, University of Connecticut, Farmington, CT, United States
| | - G Trinchieri
- Laboratory of Integrative Immunology, Center for Cancer Research, National Institutes of Health, Bethesda, MD, United States
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18
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Sgro M, Campbell DM, Mellor KL, Hollamby K, Bodani J, Shah PS. Early-onset neonatal sepsis: Organism patterns between 2009 and 2014. Paediatr Child Health 2020; 25:425-431. [PMID: 33173553 PMCID: PMC7606168 DOI: 10.1093/pch/pxz073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/08/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To evaluate trends in organisms causing early-onset neonatal sepsis (EONS). Congruent with recent reports, we hypothesized there would be an increase in EONS caused by Escherichia coli. STUDY DESIGN National data on infants admitted to neonatal intensive care units from 2009 to 2014 were compared to previously reported data from 2003 to 2008. We report 430 cases of EONS from 2009 to 2014. Bivariate analyses were used to analyze the distribution of causative organisms over time and differences by gestational age. Linear regression was used to estimate trends in causative organisms. RESULTS Since 2003, there has been a trend of increasing numbers of cases caused by E coli (P<0.01). The predominant organism was E coli in preterm infants and Group B Streptococcus in term infants. CONCLUSIONS With the majority of EONS cases now caused by E coli, our findings emphasize the importance of continued surveillance of causative organism patterns and developing approaches to reduce cases caused by E coli.
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Affiliation(s)
- Michael Sgro
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario
| | - Douglas M Campbell
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Pediatrics, St. Michael’s Hospital, Toronto, Ontario
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | | | | | - Jaya Bodani
- Department of Pediatrics, Regina Qu’Appelle Health Region, Regina, Saskatchewan
| | - Prakesh S Shah
- Division of Neonatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario
- Maternal-Infant Care Research Center, Mount Sinai Hospital, Toronto, Ontario
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19
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Santana FAF, de Oliveira TVL, Filho MBDS, da Silva LSC, de Brito BB, de Melo FF, Souza CL, Marques LM, Oliveira MV. Streptococcus agalactiae: Identification methods, antimicrobial susceptibility, and resistance genes in pregnant women. World J Clin Cases 2020; 8:3988-3998. [PMID: 33024755 PMCID: PMC7520794 DOI: 10.12998/wjcc.v8.i18.3988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 07/28/2020] [Accepted: 08/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is a normal component of the gastrointestinal and genital microbiota in humans and can lead to important infections in newborns.
AIM To compare GBS isolation and identification methods as well as to assess the antibiotic susceptibility and to identify resistance genes in GBS strains from pregnant women attended in healthcare services from the city of Vitória da Conquista, in Bahia State, Brazil.
METHODS From January 2017 to February 2018, vaginorectal swabs were obtained from 186 participants and the samples were seeded onto chromogenic agar for GBS before and after inoculation in selective broth. Confirmatory identification using 3 CAMP and latex tests was performed in samples with GBS-suggestive colonies. Then, disk diffusion antibiograms were performed in GBS-positive samples, and the detection of the resistance genes ermB, ermTR, mefA, and linB in the clindamycin and/or erythromycin-resistant samples was carried out.
RESULTS Thirty-two samples (17.2%) were GBS-positive. The culture in chromogenic agar after sample incubation in selective broth was the most sensitive method (96.9%) for GBS detection. All isolates were susceptible to penicillin, ampicillin, cefotaxime, and vancomycin. Clindamycin resistance was observed in 6 samples (18.8%), while 8 samples (25%) were erythromycin-resistant. All erythromycin and/or clindamycin-resistant GBS strains had negative D-tests. Two strains (25%) presented an M phenotype and 6 isolates (75%) presented a cMLSB phenotype. The ermB gene was identified in 4 samples (44.4%), the mefA gene was also found in 4 samples (44.4%), the ermTR gene was identified in 1 isolate (11.1%), and the linB gene was not found in any isolate.
CONCLUSION This study evidenced that the screening for SGB can be performed by means of various methods, including chromogenic media, and that the chemoprophylaxis for pregnant women who cannot use penicillin must be susceptibility-guided.
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Affiliation(s)
| | - Tais Viana Ledo de Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Cláudio Lima Souza
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Lucas Miranda Marques
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
- Campus Soane Nazaré de Andrade, Universidade Estadual de Santa Cruz, Ilhéus 45662900, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
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20
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Alhafez L, Berghella V. Evidence-based labor management: first stage of labor (part 3). Am J Obstet Gynecol MFM 2020; 2:100185. [PMID: 33345911 DOI: 10.1016/j.ajogmf.2020.100185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/01/2020] [Accepted: 07/11/2020] [Indexed: 12/27/2022]
Abstract
There are several interventions during the first stage of labor that have been studied. Vaginal disinfection with chlorhexidine cannot be recommended. Intrapartum antibiotic prophylaxis is recommended for group B streptococcus-positive women. Antibiotic therapy can be considered in women with term prelabor rupture of membranes whose latency is expected to be >12 hours. Aromatherapy with essential oils through inhalation or back massage can be considered. Immersion in water can be considered. Oral restriction of fluid or solid food is not recommended. In the setting of oral restriction, intravenous fluid containing dextrose at a rate of 250 mL/h is recommended. Upright positions and ambulation are recommended in women without regional anesthesia, and women with regional anesthesia can adopt whatever position they find most comfortable and choose to ambulate or not ambulate. Continuous bladder catheterization cannot be recommended. There is no recommended frequency of cervical examinations or sweeping of membranes. The use of a partogram cannot be recommended as a routine intervention. Routine use of the peanut ball cannot be recommended. Antispasmodic agents cannot be recommended. Routine amniotomy alone in normally progressing spontaneous first stage of labor cannot be recommended. Oxytocin augmentation is recommended to shorten the time to delivery for women making slow progress in spontaneous labor, and higher doses of oxytocin can be considered. Early intervention with oxytocin and amniotomy for the prevention and treatment of dysfunctional or slow labor is recommended. Routine use of intrauterine pressure catheter and ultrasound cannot be recommended. Cesarean delivery for arrest should not be performed unless labor has arrested for a minimum of 4 hours with adequate uterine activity or 6 hours with inadequate uterine activity in a woman with rupture of membranes, adequate oxytocin, and ≥6 cm cervical dilation.
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Affiliation(s)
- Leen Alhafez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
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21
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Antibiotic Resistance and Molecular Epidemiological Characteristics of Streptococcus agalactiae Isolated from Pregnant Women in Guangzhou, South China. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2020; 2020:1368942. [PMID: 32399123 PMCID: PMC7210523 DOI: 10.1155/2020/1368942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/16/2020] [Accepted: 03/07/2020] [Indexed: 11/17/2022]
Abstract
Streptococcus agalactiae colonization in pregnant women can cause postpartum intrauterine infections and life-threatening neonatal infections. To formulate strategies for the prevention and treatment of S. agalactiae infections, we performed a comprehensive analysis of antibiotic resistance and a molecular-based epidemiological investigation of S. agalactiae in this study. Seventy-two S. agalactiae strains, collected from pregnant women, were subjected to antibiotic susceptibility tests; then, the screened erythromycin and clindamycin nonsusceptible isolates were used for macrolides and clindamycin resistance genes detection, respectively. Detection of resistance genes, serotyping, and determination of virulence genes were performed by polymerase chain reaction. The clonal relationships among the colonized strains were evaluated by multilocus sequence typing. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) mass peak analysis was performed to discriminate the specific sequence types (STs). In our study, 69.4% and 47.2% of the strains were nonsusceptible to erythromycin and clindamycin, respectively; the multidrug resistance rate was 66.7%. All erythromycin nonsusceptible strains harbored resistance genes, whereas only 52.9% of the clindamycin nonsusceptible strains possessed the linB gene. Erythromycin resistance was mainly mediated by the ermB or mefA/E genes. Four serotypes were identified, and the most common serotype was serotype III (52.8%), followed by Ib (22.2%), Ia (18.0%), and II (4.2%). All the strains were divided into 18 STs that were assigned to nine clonal complexes. Most of the major STs were distributed into specific serotypes, including ST19/serotype III, ST17/serotype III, ST485/serotype Ia, ST862/serotype III, and ST651/serotype III. Analysis of virulence genes yielded seven clusters, of which bca-cfb-scpB-lmb (61.6%) was the predominant virulence gene cluster. Among all ST strains distributed in this region, only the ST17 strains had a mass peak at 7620 Da. The outcomes of this study are beneficial for the epidemiological comparison of colonized S. agalactiae in different regions and may be helpful for developing the strategies for the prevention of S. agalactiae infection in Guangzhou. Furthermore, our results show that MALDI-TOF MS can be used for the rapid identification of the ST17 strains.
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Sharpe M, Shah V, Freire-Lizama T, Cates EC, McGrath K, David I, Cowan S, Letkeman J, Stewart-Wilson E. Effectiveness of oral intake of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on Group B Streptococcus colonization during pregnancy: a midwifery-led double-blind randomized controlled pilot trial. J Matern Fetal Neonatal Med 2019; 34:1814-1821. [PMID: 31362572 DOI: 10.1080/14767058.2019.1650907] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Group B streptococcus (GBS) vaginal/rectal colonization in pregnancy has been associated with early-onset GBS disease (EOGBSD), a leading cause of neonatal morbidity and mortality. In Canada, universal screening for GBS colonization is offered to pregnant people at 35-37 weeks' gestation and those who test positive are offered intrapartum antibiotic prophylaxis (IAP). Universal screening and treatment with IAP have not eradicated all cases of EOGBSD, and IAP has documented side effects. Probiotic supplements have been proposed as a possible way to reduce GBS colonization. MATERIALS AND METHODS Pregnant midwifery clients >18 years of age and <45 years of age and with a gestational age of <25 weeks at the time of enrolment were randomly assigned to receive two capsules of probiotics (Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14) or placebo orally daily for 12 weeks at 23-25 weeks' gestation. The primary aim was to determine the feasibility of a larger study. The rate of GBS vaginal/rectal colonization at 35-37 weeks' gestation was also assessed in both groups. RESULTS In total, 139 pregnant midwifery clients were randomized (probiotic group [N = 73] and placebo group [N = 66]). Of these, 113 were included in the final analysis (probiotic group [N = 57] and placebo group [N = 56]). Baseline characteristics between groups were similar with the exception of gestational age (p < .01). The recruitment rate was low at 12%, but the mean compliance rate was 87%. The eligibility/ineligibility criteria were too strict and changes to the study design will be required for the larger proposed study. The rates of vaginal/rectal GBS colonization did not differ significantly between groups (15.8 versus 21.43%; p = .48). No adverse effects were documented in the probiotic group. CONCLUSION This was the first midwifery-led trial involving a natural health product in the province of Ontario. Although treatment with oral probiotics is feasible, the results were not superior to placebo in reducing the rate of GBS colonization. An adequately powered, randomly controlled trial is required to assess the effectiveness of the two probiotic strains.
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Affiliation(s)
- Mary Sharpe
- Midwifery Education Program, Ryerson University, Toronto, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada
| | | | | | - Kory McGrath
- Midwifery Education Program, Ryerson University, Toronto, Canada
| | - Iuliana David
- Midwifery Education Program, Ryerson University, Toronto, Canada
| | - Sara Cowan
- Department of Psychology, Ryerson University, Toronto, Canada
| | - Janaya Letkeman
- Midwifery Education Program, Ryerson University, Toronto, Canada
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da Silva HD, Kretli Winkelströter L. Universal gestational screening for Streptococcus agalactiae colonization and neonatal infection — A systematic review and meta-analysis. J Infect Public Health 2019; 12:479-481. [DOI: 10.1016/j.jiph.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/16/2019] [Accepted: 03/03/2019] [Indexed: 10/27/2022] Open
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Sgro M, Kobylianskii A, Yudin MH, Tran D, Diamandakos J, Sgro J, Campbell DM. Population-based study of early-onset neonatal sepsis in Canada. Paediatr Child Health 2019; 24:e66-e73. [PMID: 30996609 PMCID: PMC6462127 DOI: 10.1093/pch/pxy018] [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: 11/13/2022] Open
Abstract
OBJECTIVE To determine the incidence, types of organisms and resistance patterns involved in early-onset neonatal sepsis in Canada. STUDY DESIGN Early-onset neonatal sepsis cases were identified through the Canadian Paediatric Surveillance Program. Neonates were excluded if they were asymptomatic or if intracranial procedures preceded a positive cerebrospinal fluid culture. RESULTS One hundred and twenty-seven cases were identified (0.17 cases per 1000 live births). Group B Streptococcus accounted for 41.7%, Escherichia coli for 35.4%. Antibiotic resistance was present in 33.9% of all cases. 55.6% of E coli cases were resistant, most commonly to ampicillin. Infecting organism species were associated with gestational age, being very low birth weight, time at sepsis presentation, maternal antibiotic prophylaxis and rupture of membranes lasting over 18 hours. Group B Streptococcus was most common in term and E coli in preterm neonates. Twenty-two per cent of E coli cases presented after 48 hours, compared to 6% of Group B Streptococcus cases. CONCLUSION We identify a lower rate of early-onset neonatal sepsis than historically suggested, with differing dominant organisms based on gestational ages and other factors, as well as high rates of resistance especially among E coli cases.
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Affiliation(s)
- Michael Sgro
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Paediatrics, St. Michael’s Hospital, Toronto, Ontario
- Department of Paediatrics, University of Toronto, Toronto, Ontario
| | - Anna Kobylianskii
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario
| | - Mark H Yudin
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario
- Department of Obstetrics and Gynaecology, St. Michael’s Hospital, Toronto, Ontario
| | - Dat Tran
- Department of Paediatrics, University of Toronto, Toronto, Ontario
- Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Julia Diamandakos
- Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario
| | - Jonathan Sgro
- Department of Science, University of Western Ontario, London, Ontario
| | - Douglas M Campbell
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario
- Department of Paediatrics, St. Michael’s Hospital, Toronto, Ontario
- Department of Paediatrics, University of Toronto, Toronto, Ontario
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Seedat F, Geppert J, Stinton C, Patterson J, Freeman K, Johnson SA, Fraser H, Brown CS, Uthman OA, Tan B, Robinson ER, McCarthy ND, Clarke A, Marshall J, Visintin C, Mackie A, Taylor-Phillips S. Universal antenatal screening for group B streptococcus may cause more harm than good. BMJ 2019; 364:l463. [PMID: 30787018 DOI: 10.1136/bmj.l463] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Farah Seedat
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Julia Geppert
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Chris Stinton
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Jacoby Patterson
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Karoline Freeman
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Samantha Ann Johnson
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Hannah Fraser
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Colin Stewart Brown
- Bacteria Reference Department, National Infection Service, Public Health England, London, UK
| | - Olalekan A Uthman
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Bee Tan
- Department of Cardiovascular Sciences, Robert Kilpatrick Clinical Sciences Building, University of Leicester, LE2 7LX, UK
| | - Esther R Robinson
- Field Service, National Infection Service, Public Health England, Nottingham, UK
| | - Noel Denis McCarthy
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | - Aileen Clarke
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
| | | | | | | | - Sian Taylor-Phillips
- Division of Health Sciences, University of Warwick Medical School, Gibbet Hill Campus, Coventry CV4 7AL, UK
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Clinical and Biochemical Effects of Recombinant Human Granulocyte Colony-Stimulating Factor on the Prognosis of Preterm Infants with Early Onset Neonatal Sepsis. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2019. [DOI: 10.5812/pedinfect.67807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Al Hazzani AA, Bawazeer RA, Shehata AI. Epidemiological characterization of serotype group B Streptococci neonatal infections associated with interleukin-6 level as a sensitive parameter for the early diagnosis. Saudi J Biol Sci 2018; 25:1356-1364. [PMID: 30505181 PMCID: PMC6252016 DOI: 10.1016/j.sjbs.2015.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/21/2015] [Accepted: 10/23/2015] [Indexed: 11/22/2022] Open
Abstract
Group B streptococcal infection (Streptococcus agalactiae) is one of the leading causes of life-threatening disease in the early neonatal period, resulting in sepsis, pneumonia, and meningitis. During invasive infections, an excessive release of pro-inflammatory cytokine, such as interleukin-6 (IL-6), thus IL-6 gene is significant, as a diagnostic marker of systemic infection of the newborns. The present study aimed to describe the epidemiology diagnostic of GBS disease in neonatal by phenotypic and genotypic methods. Nine hundred and ninety-six samples were taken at Maternity and Children Hospital, Jeddah, Saudi Arabia for a period of one year (2011-2012). Results indicated that out of 217 infected samples, twenty (9.23.0%) were positive for group B Streptococci bacteria. This study also shows that female infants are more susceptible than males. The level of IL-6 was higher in mothers above 30 years. Twenty positive Streptococci group B isolates showed bands with the cylE gene primers in the border between 228 bp, 267 bp and 50 bp. Molecular detection by Real time polymerase chain reaction was also done to detect the target (Sip gene) encoding the Sip surface immunogenic protein. Specific primers and TaqMan probe were chosen for this purpose. A Real-time PCR method targeting the sip gene of GBS in neonates after delivery has been evaluated.
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Affiliation(s)
| | | | - Afaf I. Shehata
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 22452, Riyadh 11495, Saudi Arabia
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Mader J, Craig C. Management of Group B Streptococcus-Positive Women With Preterm Premature Rupture of the Membranes: Still a Therapeutic Dilemma. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1627-1631. [PMID: 30539732 DOI: 10.1016/j.jogc.2018.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/31/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
We discuss the management of GBS positive women with PPROM, an aspect of obstetrical management that remains controversial despite the publication of new randomized control trials in recent years. Clinical practice guidelines from several countries' national organizations are compared and contrasted, and areas of uncertainty are identified.
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Affiliation(s)
- Joanna Mader
- Faculty of Medicine, Dalhousie University, Halifax, NS.
| | - Catherine Craig
- Faculty of Medicine, Dalhousie University, Halifax, NS; Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS
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Chen JC, Jenkins-Marsh S, Flenady V, Ireland S, May M, Grimwood K, Liley HG. Early-onset group B streptococcal disease in a risk factor-based prevention setting: A 15-year population-based study. Aust N Z J Obstet Gynaecol 2018; 59:422-429. [PMID: 30203834 DOI: 10.1111/ajo.12891] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 07/29/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Intrapartum chemoprophylaxis reduces early-onset group B streptococcal disease (EOGBSD) in newborns. Some guidelines advise that intrapartum antibiotics should be offered following universal antenatal screening for GBS carriage and others recommend intrapartum antibiotics based on clinical risk factors alone. Since 1999, Queensland guidelines have recommended a risk factor-based approach. We examined trends in EOGBSD rates over time in Queensland in the setting of these guidelines and whether management of cases reflected the recommendations. METHODS A state-wide retrospective search of pathology databases, allowing near-complete, population-based case identification, was conducted to detect live-born infants from January 2000 to December 2014 with GBS cultured from blood or cerebrospinal fluid within seven days of age. A nested audit of EOGBSD cases comparing two epochs, 2000-2010 and 2011-2014, was performed to determine patient characteristics and guideline adherence for each case. RESULTS Mean incidence of EOGBSD in Queensland from 2000 to 2014 was 0.33 per 1000 live births (SD± 0.08) with no changing trend over time. The case-mortality rate in the 2011-2014 epoch was 1.2% compared to 11.9% in 2000-2004 (odds ratio (OR) 0.09, 95% confidence interval (CI) 0.002-0.67). The proportion of EOGBSD cases who were preterm infants decreased from 29.8% to 13.3% (OR 0.36, 95% CI 0.14-0.84). Of cases with risk factors in the 2011-2014 epoch, 46% received intrapartum antibiotics compared to 25% in 2000-2004 (OR 2.49, 95% CI 0.86-7.58, P = 0.09). CONCLUSIONS EOGBSD incidence rate in Queensland remained low during 2000-2014. However, both the 2011-2014 case-mortality rate and the proportion of preterm cases significantly decreased. Missed opportunities for intrapartum chemoprophylaxis remain.
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Affiliation(s)
- Julie C Chen
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Sue Jenkins-Marsh
- Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Vicki Flenady
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Susan Ireland
- Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Meryta May
- Sullivan Nicolaides Pathology, Brisbane, Queensland, Australia.,Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Infectious Diseases, School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Helen G Liley
- Faculty of Clinical Medicine and Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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Wilson RD. Woman's Pre-Conception Evaluation: Genetic and Fetal Risk Considerations for Counselling and Informed Choice. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:935-949. [DOI: 10.1016/j.jogc.2017.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/26/2017] [Accepted: 07/26/2017] [Indexed: 12/30/2022]
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Hijona JJ, Carballo AL, Sánchez MS, Dyachkova N, Expósito JF, Alcázar JL. Vaginal antiseptics reduce the risk of perinatal infection with group B streptococci. J Matern Fetal Neonatal Med 2018; 32:2741-2745. [PMID: 29699432 DOI: 10.1080/14767058.2018.1449196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of dequalinium chloride (DQC; 10 mg vaginal tablets), administered shortly prior to delivery in women with group B streptococcus (GBS) infection. METHODS This observational, longitudinal, and prospective study involved 201 pregnant women at term, potentially carriers of GBS bacteria, scheduled for induction with oxytocin and with no premature rupture of amniotic membranes. RESULTS A total of 163 women (81.09%) tested positive for GBS in their first vaginal swab (pre-DQC administration). In their second swab, post-DQC administration, 48 women were positive (23.88%) and 153 (76.12%) were negative. The number of GBS-colonized women after the administration of DQC was reduced by 57.21%. In the third swab, postpartum, 57 women were positive (28.35%). None of the newborns were positive for GBS in the oropharynx swab. The median DQC exposure time was 9.98 hours. Adverse events associated with the prophylactic treatment were reported in five women (vulvovaginal irritation). CONCLUSIONS The administration of a single vaginal tablet of 10 mg DQC the day before induction reduced the number of GBS-colonized women by 57.21%, causing no maternal and perinatal adverse events.
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Affiliation(s)
- Jesús Joaquín Hijona
- a Department of Gynecology and Obstetrics , Complejo Hospitalario de Jaén , Jaén , Spain
| | - Antonio Luis Carballo
- a Department of Gynecology and Obstetrics , Complejo Hospitalario de Jaén , Jaén , Spain
| | | | - Nataliya Dyachkova
- a Department of Gynecology and Obstetrics , Complejo Hospitalario de Jaén , Jaén , Spain
| | | | - José Luis Alcázar
- c Department of Pediatrics , Complejo Hospitalario de Jaén , Jaén , Spain
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Gopal Rao G, Townsend J, Stevenson D, Nartey G, Hiles S, Bassett P, Lamagni T, Nicholl R. Early-onset group B Streptococcus (EOGBS) infection subsequent to cessation of screening-based intrapartum prophylaxis: findings of an observational study in West London, UK. BMJ Open 2017; 7:e018795. [PMID: 29158327 PMCID: PMC5701994 DOI: 10.1136/bmjopen-2017-018795] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/26/2017] [Accepted: 10/02/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe the impact on early-onset group B Streptococcus (EOGBS) infection rates following reversion from screening-based to risk-based intrapartum antimicrobial prophylaxis (IAP) for prevention. SETTING Maternity services provided by secondary healthcare organisation in North West London. PARTICIPANTS All women who gave birth in the healthcare organisation between April 2016 and March 2017. There were no exclusions. DESIGN Observational study comparing EOGBS rates in the postscreening period (2016-2017) with prescreening (2009-2013) and screening periods (2014-2015). METHODS Local guidelines for risk-based IAP were reintroduced in April 2016. Compliance with guidelines was audited. Gestational age, mode of delivery, maternal demographics and EOGBS rates in three time periods were compared using Poisson regression analysis. EOGBS was defined through GBS being cultured from blood, cerebrospinal fluid or other sterile fluids within 6 days of birth. PRIMARY OUTCOME EOGBS rates/1000 live births in prescreening, screening and postscreening periods RESULTS: Incremental changes in maternity population were observed throughout the study period (2009 onwards), in particular the ethnic profile of mothers. Of the 5033 live births in postscreening period, 9 babies developed EOGBS infection. Only one of the mothers of affected babies had a risk factor indicating use of IAP. Comparison of postscreening period with screening period showed a fivefold increase in EOGBS rates after adjustment for ethnicity (1.79 vs 0.33/1000 live births; risk ratio =5.67, p=0.009). There was no significant difference between prescreening and postscreening periods with rates of infection reverting to their prescreening level. CONCLUSIONS This study provides further evidence of efficacy of screening-based IAP compared with risk-based IAP in prevention of EOGBS in newborns in an area of high incidence.
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Affiliation(s)
- Guduru Gopal Rao
- Department of Microbiology, Northwick Park Hospital, Harrow, UK
- Faculty of Medicine, Imperial College London, London, UK
| | - Jane Townsend
- Department of Microbiology, Northwick Park Hospital, Harrow, UK
| | | | - Grace Nartey
- Department of Maternity Services, Northwick Park Hospital, Harrow, UK
| | - Stephen Hiles
- Department of Research and Development, Northwick Park Hospital, Harrow, UK
| | | | - Theresa Lamagni
- National Infection Service, Public Health England Colindale, London, UK
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Girard M, Laforce-Lavoie A, de Grandmont MJ, Cayer MP, Fournier D, Delage G, Thibault L. Optimization of cord blood unit sterility testing: impact of dilution, analysis delay, and inhibitory substances. Transfusion 2017; 57:1956-1967. [PMID: 28474347 DOI: 10.1111/trf.14147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Different methods are used by cord blood banks to prepare samples for sterility testing. Suboptimal methods can result in the release of contaminated products. In our organization, samples are prepared by diluting the final product in RPMI-1640 medium. In this work, we have compared our method with different approaches to verify whether optimization should be sought. STUDY DESIGN AND METHODS Cord blood units (n = 6 units per bacterial strain) characterized to contain inhibitory substances or not were inoculated (10 colony-forming units/mL) with Streptococcus agalactiae, Staphylococcus epidermidis, Klebsiella pneumoniae, Escherichia coli, or Bacteroides fragilis. After plasma and red blood cell removal, stem cell concentrates were diluted in RPMI-1640, thioglycollate, or the unit's plasma. These products, as well as final product, plasma, and red blood cell fractions, were held from 0 to 72 hours at 20 to 24°C before inoculation in culture bottles and detection using the BacT/ALERT 3D system. RESULTS Dilution of cell concentrates in RPMI-1640 allowed bacterial detection in 93.3% of noninhibitory cord blood samples after a 24-hour storage period. Thioglycollate medium better promoted bacterial growth in inhibitory cord blood samples that were held for 72 hours before testing (66.7%) compared with RPMI-1640 (45.0%). Less than 33% of all spiked plasma samples were detected by the BacT/ALERT 3D system. CONCLUSION Diluting cord blood samples in culture medium containing bacterial growth promoting substances is a suitable option for sterility testing, whereas the use of plasma should be proscribed, because it might lead to false-negative results. Because inhibitory substances affect bacterial growth, inoculation of culture bottles should be done rapidly after sample preparation.
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Affiliation(s)
- Mélissa Girard
- Research and Development, Héma-Québec, Québec, Québec, Canada
| | | | | | | | | | - Gilles Delage
- Medical Affairs, Héma-Québec, Montréal, Québec, Canada
| | - Louis Thibault
- Research and Development, Héma-Québec, Québec, Québec, Canada
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Ouchenir L, Renaud C, Khan S, Bitnun A, Boisvert AA, McDonald J, Bowes J, Brophy J, Barton M, Ting J, Roberts A, Hawkes M, Robinson JL. The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics 2017; 140:peds.2017-0476. [PMID: 28600447 DOI: 10.1542/peds.2017-0476] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The pathogens that cause bacterial meningitis in infants and their antimicrobial susceptibilities may have changed in this era of increasing antimicrobial resistance, use of conjugated vaccines, and maternal antibiotic prophylaxis for group B Streptococcus (GBS). The objective was to determine the optimal empirical antibiotics for bacterial meningitis in early infancy. METHODS This was a cohort study of infants <90 days of age with bacterial meningitis at 7 pediatric tertiary care hospitals across Canada in 2013 and 2014. RESULTS There were 113 patients diagnosed with proven meningitis (n = 63) or suspected meningitis (n = 50) presented at median 19 days of age, with 63 patients (56%) presenting a diagnosis from home. Predominant pathogens were Escherichia coli (n = 37; 33%) and GBS (n = 35; 31%). Two of 15 patients presenting meningitis on day 0 to 6 had isolates resistant to both ampicillin and gentamicin (E coli and Haemophilus influenzae type B). Six of 60 infants presenting a diagnosis of meningitis from home from day 7 to 90 had isolates, for which cefotaxime would be a poor choice (Listeria monocytogenes [n = 3], Enterobacter cloacae, Cronobacter sakazakii, and Pseudomonas stutzeri). Sequelae were documented in 84 infants (74%), including 8 deaths (7%). CONCLUSIONS E coli and GBS remain the most common causes of bacterial meningitis in the first 90 days of life. For empirical therapy of suspected bacterial meningitis, one should consider a third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram-negative meningitis.
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Affiliation(s)
- Lynda Ouchenir
- Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Christian Renaud
- Centre hospitalier universitaire Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Sarah Khan
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Jane McDonald
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Jennifer Bowes
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Jason Brophy
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Michelle Barton
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Joseph Ting
- British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Ashley Roberts
- British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Michael Hawkes
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Joan L Robinson
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
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Jefferies AL. Management of term infants at increased risk for early-onset bacterial sepsis. Paediatr Child Health 2017; 22:223-228. [PMID: 29480905 DOI: 10.1093/pch/pxx023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Early-onset neonatal bacterial sepsis (EOS) is sepsis occurring within the first 7 days of life. This statement provides updated recommendations for the care of term (≥37 weeks' gestational age) newborns at risk of EOS, during the first 24 hours of life. Maternal Group B streptococcus (GBS) colonization in the current pregnancy, GBS bacteriuria, a previous infant with invasive GBS disease, prolonged rupture of membranes (≥18 hours) and maternal fever (temperature ≥38°C) are the factors most commonly associated with EOS. These risk factors are additive; the presence of more than one factor increases the likelihood of EOS. At present, there is no laboratory test, including white blood cell indices, that has sufficient sensitivity to allow clinicians to safely rule out EOS. All unwell infants with clinical signs suggesting sepsis must be treated empirically with antibiotics, once cultures have been taken. The management of well-appearing, at-risk term infants depends on the number of risk factors (including maternal GBS colonization) and whether maternal intrapartum antibiotic prophylaxis for GBS was used. In some cases, management should be individualized. Careful assessment and observation of these at-risk infants are a fundamental component of appropriate care.
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Affiliation(s)
- Ann L Jefferies
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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Gopal Rao G, Nartey G, McAree T, O'Reilly A, Hiles S, Lee T, Wallace S, Batura R, Khanna P, Abbas H, Tilsed C, Nicholl R, Lamagni T, Bassett P. Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study. BMJ Open 2017; 7:e014634. [PMID: 28420662 PMCID: PMC5541438 DOI: 10.1136/bmjopen-2016-014634] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/20/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Against a background of failure to prevent neonatal invasive early-onset group B Streptococcus infections (GBS) in our maternity unit using risk-based approach for intrapartum antibiotic prophylaxis, we introduced an antenatal GBS carriage screening programme to identify additional women to target for prophylaxis. OBJECTIVES To describe the implementation and outcome of an antepartum screening programme for prevention of invasive early-onset GBS infection in a UK maternity unit. DESIGN Observational study of outcome of screening programme (intervention) with comparison to historical controls (preintervention). SETTING Hospital and community-based maternity services provided by Northwick Park and Central Middlesex Hospitals in North West London. PARTICIPANTS Women who gave birth between March 2014 and December 2015 at Northwick Park Hospital. METHODS Women were screened for GBS at 35-37 weeks and carriers offered intrapartum antibiotic prophylaxis. Screening programme was first introduced in hospital (March 2014) and then in community (August 2014). Compliance was audited by review of randomly selected case records. Invasive early-onset GBS infections were defined through GBS being cultured from neonatal blood, cerebrospinal fluid or sterile fluids within 0-6 days of birth. MAIN OUTCOME Incidence of early-onset GBS infections. RESULTS 6309 (69%) of the 9098 eligible women were tested. Screening rate improved progressively from 42% in 2014 to 75% in 2015. Audit showed that 98% of women accepted the offer of screening. Recto-vaginal GBS carriage rate was 29.4% (1822/6193). All strains were susceptible to penicillin but 11.3% (206/1822) were resistant to clindamycin. Early onset GBS rate fell from 0.99/1000 live births (25/25276) in the prescreening period to 0.33/1000 in the screening period (Rate Ratio=0.33; p=0.08). In the subset of mothers actually screened, the rate was 0.16/1000 live births (1/6309), (Rate Ratio=0.16; p<0.05). CONCLUSIONS Our findings confirm that an antenatal screening programme for prevention of early-onset GBS infection can be implemented in a UK maternity setting and is associated with a fall in infection rates.
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Affiliation(s)
- G Gopal Rao
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
- Faculty of Medicine, Imperial College, London, UK
| | - G Nartey
- Department of Maternity Services., Northwick Park Hospital, Harrow, UK
| | - T McAree
- Department of Maternity Services., Northwick Park Hospital, Harrow, UK
| | - A O'Reilly
- Department of Maternity Services., Northwick Park Hospital, Harrow, UK
| | - S Hiles
- Department of Research, Northwick Park Hospital, Harrow, UK
| | - T Lee
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
| | - S Wallace
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
| | - R Batura
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
| | - P Khanna
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
| | - H Abbas
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
| | - C Tilsed
- Departments of Microbiology,Northwick Park Hospital, Harrow, UK
| | - R Nicholl
- Neonatology Unit, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
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Allen UD. A Pregnant Patient with a Previous Pregnancy Complicated by Group B Streptococcal Disease in the Infant. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00212-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Serotype Distribution, Population Structure, and Antimicrobial Resistance of Group B Streptococcus Strains Recovered from Colonized Pregnant Women. J Clin Microbiol 2016; 55:412-422. [PMID: 27852675 DOI: 10.1128/jcm.01615-16] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 11/12/2016] [Indexed: 11/20/2022] Open
Abstract
Using serotyping, multilocus sequence typing, and whole-genome sequencing (WGS) of selected strains, we studied the population structure of 102 group B Streptococcus (GBS) isolates prospectively sampled in 2014 from vaginal/rectal swabs of healthy pregnant women in metropolitan Toronto, Canada. We also determined the susceptibilities of each of the colonizing isolates to penicillin, erythromycin, clindamycin, tetracycline, and other antimicrobial agents. Overall, we observed a high rate of tetracycline resistance (89%) among colonizing GBS isolates. We found resistance to erythromycin in 36% of the strains, and 33% were constitutively or inducibly resistant to clindamycin. The most frequently identified serotypes were III (25%), Ia (23%), and V (19%). Serotype IV accounted for 6% of the colonizing isolates, a rate consistent with that observed among patients with invasive GBS infections in metropolitan Toronto. The majority of serotype IV isolates belonged to sequence type (ST)459, a tetracycline-, erythromycin-, and clindamycin-resistant ST first identified in Minnesota, which is considered to be the main driver of serotype IV GBS expansion in North America. WGS revealed that ST459 isolates from Canada are clonally related to colonizing and invasive ST459 organisms circulating in regions of the United States. We also used WGS to study recombination in selected colonizing strains from metropolitan Toronto, which revealed multiple episodes of capsular switching. Present and future circulating GBS organisms and their genetic diversity may influence GBS vaccine development.
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Sefty H, Klivitsky A, Bromberg M, Dichtiar R, Ami MB, Shohat T, Glatman-Freedman A. Factors associated with choice of approach for Group B streptococcus screening. Isr J Health Policy Res 2016; 5:42. [PMID: 27879969 PMCID: PMC5109778 DOI: 10.1186/s13584-016-0103-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 08/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The crude rate of early-onset Group B streptococcus disease (EOGBS) in Israel has been consistently under 0.5 for 1000 live births for the past 8 years. The Israeli Ministry of Health has adapted the risk factor based approach for preventing EOGBS and universal bacteriological screening for GBS is not recommended. In spite of this policy, there are indications that many pregnant women in Israel undergo bacteriological screening for GBS. The objective of this study is to assess the rate and characteristics of pregnant women who undergo screening for group B streptococcus (GBS) colonization in Israel. METHODS Survey of expectant mothers who came to give birth in 29 delivery rooms throughout Israel during the month of July 2012 regarding GBS screening practice and demographics. RESULTS A total of 2968 pregnant women participated in the assessment. Among them, 935 women (31.5 %) had been tested for GBS colonization. About 90 % of those women had no risk factors, only 542 women (60 %) underwent testing during the recommended gestational timing (35-37 weeks) and 23 % of the tested women reported being GBS carriers. GBS screening as part of the routine pregnancy follow- up was associated with: residence district, intermediate or high socioeconomic rank, being a member of certain health maintenance organization and being Jewish. Characteristics found to be significantly associated with being a GBS carrier were: low socioeconomic rank, and having a risk factor for GBS infection. CONCLUSIONS A substantial number of pregnant women in Israel undergo screening for GBS colonization despite the national policy against universal screening. While GBS colonization was more prevalent in women of lower socioeconomic status, screening is done more often in those of higher socioeconomic status, suggesting unnecessary monetary expenses.
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Affiliation(s)
- H. Sefty
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
- The Israel Center for Disease Control, Gertner Institute, Chaim Sheba Medical Center, Tel Hashomer, 52621 Israel
| | - A. Klivitsky
- Pediatric Infectious Disease unit, E.Wolfson Medical Center, Holon, Israel
| | - M. Bromberg
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
| | - R. Dichtiar
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
| | - M. Ben Ami
- Department of Obstetrics and Gynecology, Poriya Medical Center, Tiberias, Israel
- School of Medicine, Bar Ilan University, Ramat Gan, Israel
| | - T. Shohat
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
- School of Public Health, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A. Glatman-Freedman
- Israel Center for Disease Control, Ministry of Health, Tel Hashomer, Israel
- Departments of Pediatrics and Family and Community Medicine, New York Medical College, Valhalla, NY USA
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Simioni J, Hutton EK, Gunn E, Holloway AC, Stearns JC, McDonald H, Mousseau A, Schertzer JD, Ratcliffe EM, Thabane L, Surette MG, Morrison KM. A comparison of intestinal microbiota in a population of low-risk infants exposed and not exposed to intrapartum antibiotics: The Baby & Microbiota of the Intestine cohort study protocol. BMC Pediatr 2016; 16:183. [PMID: 27832763 PMCID: PMC5103394 DOI: 10.1186/s12887-016-0724-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 11/02/2016] [Indexed: 02/08/2023] Open
Abstract
Background The intestinal microbiota influences metabolic, nutritional, and immunologic processes and has been associated with a broad range of adverse health outcomes including asthma, obesity and Type 2 diabetes. Early life exposures may alter the course of gut microbial colonization leading to differences in metabolic and immune regulation throughout life. Although approximately 50 % of low-risk full-term infants born in Canada are exposed to intrapartum antibiotics, little is known about the influence of this common prophylactic treatment on the developing neonatal intestinal microbiota. The purpose of this study is to describe the intestinal microbiome over the first 3 years of life among healthy, breastfed infants born to women with low-risk pregnancies at full term gestation and to determine if at 1 year of age, the intestinal microbiome of infants exposed to intrapartum antibiotics differs in type and quantity from the infants that are not exposed. Methods A prospectively followed cohort of 240 mother-infant pairs will be formed by enrolling eligible pregnant women from midwifery practices in the City of Hamilton and surrounding area in Ontario, Canada. Participants will be followed until the age of 3 years. Women are eligible to participate in the study if they are considered to be low-risk, planning a vaginal birth and able to communicate in English. Women are excluded if they have a multiple pregnancy or a preterm birth. Study questionnaires are completed, anthropometric measures are taken and biological samples are acquired including eight infant stool samples between 3 days and 3 years of age. Discussion Our experience to date indicates that midwifery practices and clients are keen to participate in this research. The midwifery client population is likely to have high rates of breastfeeding and low rates of intervention, allowing us to examine the comparative development of the microbiome in a relatively healthy and homogenous population. Results from this study will make an important contribution to the growing understanding of the patterns of intestinal microbiome colonization in the early years of life and may have implications for best practices to support the establishment of the microbiome at birth. Electronic supplementary material The online version of this article (doi:10.1186/s12887-016-0724-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Simioni
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - Eileen K Hutton
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Gunn
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada
| | - Alison C Holloway
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jennifer C Stearns
- Department of Medicine, McMaster University, Hamilton, ON, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Helen McDonald
- Midwifery Education Program, McMaster University, Hamilton, ON, Canada
| | - Andrea Mousseau
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
| | - Jonathan D Schertzer
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada.,Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Elyanne M Ratcliffe
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.,Centre for Evaluation of Medicines, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Michael G Surette
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada.,Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster University, HSC 3A59 1280 Main St W, L8N 3Z5, Hamilton, ON, Canada.
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Defez M, Khizar F, Maurin M, Biot F, Pons JC, Sergent F. Intérêt d’un test de PCR en temps réel en intrapartum en comparaison à la culture de fin de grossesse pour le dépistage du streptocoque du groupe B chez la femme enceinte. ACTA ACUST UNITED AC 2016; 45:1151-1158. [DOI: 10.1016/j.jgyn.2016.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 05/19/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
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Gouvea MIS, Joao EC, Teixeira MDLB, Read JS, Fracalanzza SEL, Souza CTV, Souza MJD, Torres Filho HM, Leite CCF, do Brasil PEAA. Accuracy of a rapid real-time polymerase chain reaction assay for diagnosis of group B Streptococcus colonization in a cohort of HIV-infected pregnant women. J Matern Fetal Neonatal Med 2016; 30:1096-1101. [PMID: 27333822 DOI: 10.1080/14767058.2016.1205021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There are limited data regarding Xpert performance to detect Group B Streptococcus (GBS) in HIV-infected pregnant women. We evaluated the accuracy of a rapid real-time polymerase chain reaction (PCR) test in a cohort of HIV-infected women. METHODS At 35-37 weeks of pregnancy, a pair of combined rectovaginal swabs were collected for two GBS assays in a cohort of sequentially included HIV-infected women in Rio de Janeiro: (1) culture; and (2) real-time PCR assay [GeneXpert GBS (Cepheid, Sunnyvale, CA)]. Using culture as the reference, sensitivity, specificity, positive and negative-likelihood ratios were estimated. RESULTS From June 2012 to February 2015, 337 pregnant women met inclusion criteria. One woman was later excluded, due to failure to obtain a result in the index test; 336 were included in the analyses. The GBS colonization rate was 19.04%. Sensitivity and specificity of the GeneXpert GBS assay were 85.94% (95% CI: 75.38-92.42) and 94.85% (95% CI: 91.55-96.91), respectively. Positive and negative predictive values were 79.71% (95% CI: 68.78-87.51) and 96.63% (95% CI: 93.72-98.22), respectively. CONCLUSIONS GeneXpert GBS is an acceptable test for the identification of GBS colonization in HIV-infected pregnant women and represents a reasonable option to detect GBS colonization in settings where culture is not feasible.
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Affiliation(s)
- Maria Isabel S Gouvea
- a Infectious Diseases Department, Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil.,b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
| | - Esau C Joao
- a Infectious Diseases Department, Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil
| | - Maria de Lourdes B Teixeira
- a Infectious Diseases Department, Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil.,b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
| | - Jennifer S Read
- c Department of Epidemiology and Biostatistics , University of California at San Francisco , San Francisco , CA , USA
| | - Sergio E L Fracalanzza
- d Laboratório de Bacteriologia Médica do Instituto de Microbiologia Prof. Paulo de Góes , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Claudia T V Souza
- b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
| | - Maria José de Souza
- e Department of Bacteriology , Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil , and
| | - Helio M Torres Filho
- f Laboratório Richet , Núcleo de Apoio à Pesquisa Clínica , Rio de Janeiro , Brazil
| | - Cassiana C F Leite
- f Laboratório Richet , Núcleo de Apoio à Pesquisa Clínica , Rio de Janeiro , Brazil
| | - Pedro E A A do Brasil
- b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
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Epidemiology of Invasive Group B Streptococcal Disease in Alberta, Canada, from 2003 to 2013. J Clin Microbiol 2016; 54:1774-1781. [PMID: 27098960 DOI: 10.1128/jcm.00355-16] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 04/12/2016] [Indexed: 11/20/2022] Open
Abstract
Group B streptococci (GBS) cause severe invasive disease in both neonates and adults. Understanding the epidemiology of GBS provides information that can include determining disease prevalence rates in defined populations and geographic regions, documenting the success of GBS screening programs, and understanding antimicrobial susceptibility patterns. In Alberta, only neonatal invasive GBS (iGBS) disease is notifiable to health authorities. We performed a surveillance study of iGBS in Alberta, Canada, from 2003 to 2013. Over the 11-year period, the disease incidence rate increased from a low of 3.92 cases/100,000 population to a high of 5.99 cases/100,000 population. The capsular polysaccharide serotypes (CPSs) found were CPS III (20.3%), CPS V (19.1%), CPS Ia (18.9%), CPS Ib (12.7%), CPS II (11.1%), CPS IV (6.3%), and nontypeable GBS (9.4%). Rates of early-onset disease (0 to 7 days) increased from 0.15 cases/1,000 live births (in 2003) to 0.34 cases/1,000 live births (in 2013). Rates of late-onset disease (>7 to 90 days) also rose, from 0.15 cases/1,000 live births (in 2003) to 0.39 cases/1,000 live births (in 2013). Alberta also experienced an increase in CPS IV isolates, from 2 cases (in 2003) to 24 cases (in 2013), of which the majority were hvgA negative (93.4%) [corrected]. The predominant sequence type (ST) in 2013 was ST459. Erythromycin resistance rose from 23.6% to 43.9% (in 2013). Clindamycin resistance also increased, from 12.2% to 32.5%. In summary, Alberta, Canada, has experienced an increase in GBS disease; the increase includes both neonatal and adult disease. CPS IV cases also notably increased during the surveillance period, as did resistance to erythromycin and clindamycin.
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Adamyan LV, Kuzmin VN, Arslanyan KN, Kharchenko EI. [Spread of nosocomial infection in obstetric hospitals]. TERAPEVT ARKH 2016; 87:109-112. [PMID: 26821427 DOI: 10.17116/terarkh20158711109-112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The paper highlights the topical problems of nosocomial infection in the practice of obstetrics and perinatology. It systematizes procedures for controlling the occurrence of nosocomial infection and preventing its spread, such as identification of risk groups and risk factors and prerequisites for complications of epidemiological surveillance, as well as specific diagnosis in pregnant women. Group B streptococcus, one of the major pathogens of nosocomial infection, is described.
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Affiliation(s)
- L V Adamyan
- Department of Reproductive Surgery and Medicine, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia; Acad. V. I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow
| | - V N Kuzmin
- Department of Reproductive Surgery and Medicine, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia; Maternity Hospital, Infectious Diseases Hospital One, Moscow, Russia
| | - K N Arslanyan
- Department of Reproductive Surgery and Medicine, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia; Acad. V. I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Moscow
| | - E I Kharchenko
- Department of Reproductive Surgery and Medicine, A.I. Evdokimov Moscow State University of Medicine and Dentistry, Ministry of Health of Russia, Moscow, Russia; Vidnoe Perinatal Center, Vidnoe, Moscow Region, Russia
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Is Preterm Premature Rupture of Membranes Latency Influenced by Single Versus Multiple Agent Antibiotic Prophylaxis in Group B Streptococcus Positive Women Delivering Preterm? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 37:777-783. [PMID: 26605446 DOI: 10.1016/s1701-2163(15)30147-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the influence of antibiotic regimen on the duration of latency (time from preterm pre-labour rupture of membranes [PPROM] to delivery) and significant infectious neonatal morbidity from rupture of membranes to delivery < 37 weeks' gestational age in women known to be group B Streptococcus (GBS) positive. METHODS We obtained data from the Nova Scotia Atlee Perinatal Database. In a retrospective, cohort, population-based study, we included pregnancies complicated by PPROM but excluded pregnancies in this group requiring immediate delivery. The cohort was categorized by antibiotic regimen (single vs. multiple agents) and we compared latency and adverse neonatal outcomes according to antibiotic regimen used. Summary characteristics were compared using chi-square analysis with significance < 0.05. Logistic regression was used to estimate adjusted odds ratios, 95% confidence intervals, and mean differences for all outcomes and to account for confounding variables. RESULTS From 1988 to 2011, the potential study population was 119 158 pregnancies. In total, 3435 deliveries were identified to be PPROM (3%). Of these, 303 mother-baby pairs (9%) were known to be GBS positive by urine or swab culture. Adjusted comparisons of latency and neonatal sepsis showed no difference according to antibiotic regimen (P > 0.05). CONCLUSION The 2013 SOGC guideline on GBS prophylaxis recommends antibiotic therapy in women with PPROM for both latency and prevention of GBS-related neonatal sepsis. This clinically relevant evaluation in a select preterm group demonstrated that type of antibiotic regimen did not influence either latency with PPROM and GBS positive culture or rates of neonatal sepsis. Ongoing evaluation of serious neonatal outcomes is essential in view of this new recommendation.
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Riddell CA, Hutcheon JA, Dahlgren LS. Differences in obstetric care among nulliparous First Nations and non-First Nations women in British Columbia, Canada. CMAJ 2015; 188:E36-E43. [PMID: 26527824 DOI: 10.1503/cmaj.150223] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Canada's Aboriginal population faces significantly higher rates of stillbirth and neonatal and postnatal death than those seen in the general population. The objective of this study was to compare indicators of obstetric care quality and use of obstetric interventions between First Nations and non-First Nations mothers in British Columbia, Canada. METHODS We linked obstetrical medical records with the First Nations Client File for all nulliparous women who delivered single infants in British Columbia from 1999 to 2011. Using logistic regression models, we examined differences in the proportion of women who received services aligned with best practice guidelines, as well as the overall use of obstetric interventions among First Nations mothers compared with the general population, controlling for geographic barriers (distance to hospital) and other relevant confounders. RESULTS During the study period, 215,993 single births occurred in nulliparous women in British Columbia, 9152 of which were to members of our First Nations cohort. First Nations mothers were less likely to have early ultrasonography (adjusted risk difference = 10.2 fewer women per 100 deliveries [95% confidence interval {CI} -11.3 to -9.3]), to have at least 4 antenatal care visits (3.6 fewer women per 100 deliveries [95% CI -4.6 to -2.6]), and to undergo labour induction after prolonged (> 24 hours) prelabour rupture of membranes (-5.9 [95% CI -11.8 to 0.1]) or at post-dates gestation (-10.6 [95% CI -13.8 to -7.5]). Obstetric interventions including epidural, labour induction, instrumental delivery and cesarean delivery were used less often in First Nations mothers. INTERPRETATION We identified differences in the obstetric care received by First Nations mothers compared with the general population. Such differences warrant further investigation, given increases in perinatal mortality that are consistently shown and that may be a downstream consequence of differences in care.
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Affiliation(s)
- Corinne A Riddell
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
| | - Leanne S Dahlgren
- Department of Epidemiology, Biostatistics, and Occupational Health (Riddell), McGill University, Montréal, Qué.; Department of Obstetrics and Gynecology (Hutcheon, Dahlgren), University of British Columbia, Vancouver, BC
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Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr 2015; 166:1070-4. [PMID: 25641240 PMCID: PMC4767008 DOI: 10.1016/j.jpeds.2014.12.023] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/12/2014] [Accepted: 12/10/2014] [Indexed: 02/08/2023]
Abstract
Since 1992, professional societies or public health agencies in the United States– and elsewhere– have issued several generations of recommendations for prevention or management of early-onset neonatal sepsis (EOS). Despite those efforts, recommendations remain inconsistent, clarifications are necessary, local adaptations are common, and compliance rates are low. We postulate that lack of consensus, especially regarding postnatal management of the neonate, is largely a result of two sets of factors. First, obstetrical prevention strategies have substantially reduced incidence of EOS, potentially changing the utility of predictive strategies based on risk factors. Second, recent data better delineate relationships among risk factors, clinical signs, and EOS, suggesting that risk predictors may have different utilities in different groups. The purpose of this commentary is to explore these questions and to suggest new approaches to management of newborns who may be at risk for EOS.
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Affiliation(s)
- William E. Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - James L. Wynn
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Vanderbilt University, Nashville, TN, USA
| | - Richard A. Polin
- Division of Neonatal-Perinatal Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database Syst Rev 2014; 2014:CD003520. [PMID: 25504106 PMCID: PMC11262555 DOI: 10.1002/14651858.cd003520.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although early-onset group B β-hemolytic streptococcus (GBS) infection is rare, it accounts for approximately 30% of neonatal infections, has a high mortality rate, and is acquired through vertical transmission from colonized mothers. Several trials have demonstrated the efficacy of intrapartum antibiotic prophylaxis (IAP) for preventing early-onset disease (EOD). Vaginal disinfection with chlorhexidine during labour has been proposed as another strategy for preventing GBS EOD in the preterm and term neonate. Chlorhexidine has been found to have no impact on antibiotic resistance, is inexpensive, and applicable to poorly equipped delivery sites. OBJECTIVES To determine the effectiveness of vaginal disinfection with chlorhexidine during labour in women who are colonized with GBS for preventing early-onset GBS infection in preterm and term neonates. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014) and reference lists of retrieved studies. SELECTION CRITERIA Randomized and quasi-randomized trials comparing vaginal disinfection with chlorhexidine (vaginal wash or gel/cream) versus placebo, or no treatment. DATA COLLECTION AND ANALYSIS Three review authors independently assessed the trials for inclusion and risk of bias, extracted the data and checked them for accuracy. MAIN RESULTS We identified no new trials eligible for inclusion in this update. One study was moved from included to excluded studies from the previous version of the review. Four studies, including 1125 preterm and term infants, met the inclusion criteria and reported on at least one of the outcomes of interest. For the comparison chlorhexidine (vaginal wash or gel) versus placebo or no treatment, two studies (n = 987) were pooled. There was no statistically significant difference in early-onset GBS disease (sepsis and/or meningitis) comparing chlorhexidine (vaginal wash or gel/cream) versus placebo or no treatment; risk ratio (RR), 2.32 (95% confidence interval (CI) 0.34 to 15.63); I-squared (I²) = 0% or in GBS pneumonia; RR 0.35 (95% CI 0.01 to 8.6); test for heterogeneity not applicable. The outcome of colonization of the neonate with GBS was reported in three studies (n = 328); RR 0.64 (95% CI 0.40 to 1.01; there was substantial between-study heterogeneity (Chi² = 3.19; P = 0.20; I² = 37%). Maternal mild side effects (stinging or local irritation) (three trials, 1066 women) were more commonly seen in women treated with chlorhexidine (RR 8.50 (95% CI 1.60 to 45.28); there was no heterogeneity (Chi² = 0.01, df = 1 (P = 0.91); I² = 0%). No side effects were reported among the neonates.For the comparison chlorhexidine vaginal wash verus mechanical washing with placebo or no treatment (one study, n = 79), there was a significant reduction in neonatal colonization with GBS; RR 0.32 (95% CI 0.12 to 0.90). Tests for heterogeneity not applicable. There were no other significant results for this comparison.For the comparison chlorhexidine gel or cream versus placebo or no treatment, there were no statistically significant results for the outcomes reported on.The quality of the trials varied and the overall risk of bias was rated as unclear or high. The quality of the evidence using GRADE was very low for the outcomes of the comparison chlorhexidine (vaginal wash or gel/cream) versus placebo or no treatment. These outcomes included: early-onset GBS disease (sepsis and/or meningitis), GBS pneumonia, neonatal colonization with GBS, neonatal mortality due to early-onset GBS infection and adverse (mild) effects in the mother and the neonate. AUTHORS' CONCLUSIONS The quality of the four included trials varied as did the risk of bias and the quality of the evidence using GRADE was very low. Vaginal chlorhexidine was not associated with reductions in any of the primary outcomes of early-onset GBS disease (sepsis and/or meningitis) or GBS pneumonia. Vaginal chlorhexidine may reduce GBS colonization of neonates. The intervention was associated with an increased risk of maternal mild adverse effects. The review currently does not support the use of vaginal disinfection with chlorhexidine in labour for preventing early-onset disease. Results should be interpreted with caution as the methodological quality of the studies was poor. As early-onset GBS disease is a rare condition trials with very large sample sizes are needed to assess the effectiveness of vaginal chlorhexidine to reduce its occurrence. In the era of intrapartum antibiotic prophylaxis, such trials may be difficult to justify especially in developed countries.
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Affiliation(s)
- Arne Ohlsson
- Departments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation, University of Toronto, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
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Abstract
BACKGROUND Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit. OBJECTIVES To assess the effect of intrapartum antibiotics for maternal Group B haemolytic streptococci (GBS) colonization on mortality from any cause, from GBS infection and from organisms other than GBS. SEARCH METHODS We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 11 March 2014. SELECTION CRITERIA Randomized trials assessing the impact of maternal IAP on neonatal GBS infections were included. DATA COLLECTION AND ANALYSIS We independently assessed eligibility and quality of the studies. MAIN RESULTS We did not identify any new trials from the updated search so the results remain unchanged as follows.We included four trials involving 852 women.Three trials (involving 500 women) evaluating the effects of IAP versus no treatment were included. The use of IAP did not significantly reduce the incidence of all cause mortality, mortality from GBS infection or from infections caused by bacteria other than GBS. The incidence of early GBS infection was reduced with IAP compared to no treatment (risk ratio (RR) 0.17, 95% confidence interval (CI) 0.04 to 0.74, three trials, 488 infants; risk difference -0.04, 95% CI -0.07 to -0.01; number needed to treat to benefit 25, 95% CI 14 to 100, I² 0%). The incidence of LOD or sepsis from organisms other than GBS and puerperal infection was not significantly different between groups.One trial (involving 352 women) compared intrapartum ampicillin versus penicillin and reported no significant difference in neonatal or maternal outcomes.We found a high risk of bias for one or more key domains in the study methodology and execution. AUTHORS' CONCLUSIONS Intrapartum antibiotic prophylaxis appeared to reduce EOGBSD, but this result may well be due to bias as we found a high risk of bias for one or more key domains in the study methodology and execution. There is lack of evidence from well designed and conducted trials to recommend IAP to reduce neonatal EOGBSD.Ideally the effectiveness of IAP to reduce neonatal GBS infections should be studied in adequately sized double-blind controlled trials. The opportunity to conduct such trials has likely been lost, as practice guidelines (albeit without good evidence) have been introduced in many jurisdictions.
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Affiliation(s)
- Arne Ohlsson
- Departments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation, University of Toronto, 600 University Avenue, Toronto, Ontario, Canada, M5G 1X5
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Cayer MP, Girard M, Fournier D, Delage G, Thibault L. Antimicrobial activity in cord blood units: occurrence and levels of antibiotics. Transfusion 2014; 54:2505-13. [PMID: 24724982 DOI: 10.1111/trf.12655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antibiotic prophylaxis treatment at delivery is highly recommended for reducing the risk of infection for mothers positive for group B streptococcus. It is therefore expected that some cord blood (CB) products will contain residual antibiotics. This study aimed to determine the incidence and level of β-lactam antibiotics in CB products. STUDY DESIGN AND METHODS The antimicrobial activity of 60 CB plasma by-products was evaluated using disk diffusion assays on 10 bacteria species. Plasma samples showing antimicrobial activity were either treated with β-lactamase enzyme to inhibit β-lactam antibiotics or heated to 56°C for 30 minutes to inhibit complement proteins. β-Lactam antibiotic concentrations were determined by comparison with a standard curve obtained with known concentrations of antibiotics. RESULTS Antimicrobial activity against mostly Gram-positive microorganisms was observed in 33% of CB units. The β-lactamase enzyme abolished the antimicrobial activity in the majority of these CB products. Up to 5 μg/mL penicillin and 14 μg/mL ampicillin were measured in these products. CONCLUSION Approximately one-third of CB products contain significant amounts of plasma with residual antibiotics, which can affect the survival and growth of bacterial contaminants when performing the sterility test and potentially lead to false-negative results. Additional work is required to better understand whether residual antibiotics in CB affect penicillin-allergic patients.
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