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Constantinou G, Ayers S, Mitchell EJ, Moore S, Jones AM, Downe S, Walker KF, Daniels J. The acceptability of group B streptococcal bacteria (GBS) testing to women, including self-swabbing procedures: A qualitative study. Midwifery 2024; 135:104063. [PMID: 38896943 DOI: 10.1016/j.midw.2024.104063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 02/16/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Group B streptococcus (GBS) is a bacterium carried by 20-25 % of pregnant women in the UK, which can be transmitted from pregnant women to their babies at the time of birth. Women can be tested for GBS in pregnancy using a vaginal-rectal swab, however, this testing is currently not routinely offered in the UK. A large clinical trial is underway to determine the clinical and cost-effectiveness of routine testing (ISRCTN reference number ISRCTN49639731). A crucial part of understanding whether this type of test should be implemented is women's views on the acceptability of being offered GBS tests, their preferences towards testing procedures and their willingness to receive these tests. AIM To explore women's views on the acceptability of different methods of Group B streptococcal bacteria (GBS) testing in pregnancy, including self-swabbing procedures. METHODS A convenience sample of 19 women (5 pregnant and 14 postpartum) were interviewed using a semi-structured interview guide. Interviews were transcribed and analysed using systematic thematic analysis. RESULTS Findings show that many of the women interviewed were not concerned about being offered a GBS test, were willing to provide a sample and felt positive towards samples being taken to detect GBS. Women varied in their preferences on the best time for sampling. Some thought being approached during pregnancy gave them time to understand the purpose of testing, prepare for what may happen next and ask questions about potential treatment if needed. Others thought labour was a good time to provide accurate results on GBS carriage at birth and reduce unnecessary worry during pregnancy. However, women were concerned that they may be unable to make an informed decision in labour due to time, pain and the prospect of birthing quickly. Women perceived clinician swabbing as more accurate than self-sampling; however, many thought clinician swabbing might be embarrassing so self-swabs should be available to increase uptake for some women. CONCLUSIONS Overall, women thought both pregnancy and labour were acceptable times to test for GBS. The majority found both clinician and self-swabbing procedures acceptable; however, many had a preferred swabbing option and thought women should be given the choice of the swabbing procedure most acceptable to them. It is important that women are given information about GBS testing and its procedures in pregnancy regardless of when the GBS swabbing is performed.
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Affiliation(s)
- Georgina Constantinou
- Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, Northampton Square EC1V 0HB, London.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health & Psychological Sciences, City, University of London, Northampton Square EC1V 0HB, London
| | | | - Sarah Moore
- Nottingham Clinical Trials Unit, University of Nottingham, London
| | - Anne-Marie Jones
- Nottingham Clinical Trials Unit, University of Nottingham, London
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, London
| | - Kate F Walker
- Population and Lifespan Unit, School of Medicine, University of Nottingham, London
| | - Jane Daniels
- Nottingham Clinical Trials Unit, University of Nottingham, London
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Kuld R, Krauth A, Kühr J, Krämer J, Dittrich R, Häberle L, Müller A. Possible Rates of Detection of Neonatal Sepsis Pathogens in the Context of Microbiological Diagnostics in Mothers - Real World Data. Geburtshilfe Frauenheilkd 2023; 83:1382-1390. [PMID: 37928410 PMCID: PMC10624541 DOI: 10.1055/a-2091-0856] [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: 02/13/2023] [Accepted: 05/07/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The aim of this study was to identify the rate of detection of neonatal sepsis pathogens in maternal microbiological smears. Study Design This is a retrospective study conducted at a Level 1 perinatal center in the context of routine care from 2014 to 2019. For all premature infants and neonates with neonatal sepsis, the neonatal and maternal microbiological findings were examined to see if there was a match. Results During the study period, a total of 948 premature or newborn infants were identified as having a neonatal infection. Among all of the premature or newborn infants, 209 (22%) met the diagnostic criteria for neonatal sepsis; of these, 157 were premature births and 52 were full-term births. We evaluated the microbiological findings for these 209 mother and child pairs. No pathogens were detected in 27 out of 157 mothers of premature infants (17.1%) and in 31 out of 52 mothers of full-term infants (59.6%). In the premature infant group there were pairs with matching pathogens in 30 out of 130 cases (23.1%, 95% CI: 16.1-31.3), and in the full-term infant group there was a match in 4 out of 21 cases (19%, 95% CI: 5.4-41.9). The number needed to test to have a 90% probability of success for pathogen detection varies between 9 and 11 in the most favorable case and 26 and 32 in the least favorable case, depending on the evaluation method. Conclusion In cases of neonatal sepsis, the sepsis-causing pathogen was successfully detected through prior analysis of a maternal smear in 7% of full-term infants and in 19% of premature infants. The number needed to test was relatively high in all groups. The value of maternal smears for identifying neonatal sepsis-causing pathogens needs to be critically questioned.
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Affiliation(s)
- Raffael Kuld
- Klinik für Frauenheilkunde und Geburtshilfe, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Krauth
- Klinik für Kinderheilkunde, Franz-Lust-Kinderklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Joachim Kühr
- Klinik für Kinderheilkunde, Franz-Lust-Kinderklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Janine Krämer
- Klinik für Frauenheilkunde und Geburtshilfe, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Ralf Dittrich
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Lothar Häberle
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Müller
- Klinik für Frauenheilkunde und Geburtshilfe, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Dangor Z, Seale AC, Baba V, Kwatra G. Early-onset group B streptococcal disease in African countries and maternal vaccination strategies. Front Public Health 2023; 11:1214844. [PMID: 37457277 PMCID: PMC10338870 DOI: 10.3389/fpubh.2023.1214844] [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: 04/30/2023] [Accepted: 05/31/2023] [Indexed: 07/18/2023] Open
Abstract
Invasive group B streptococcal (GBS) disease is the commonest perinatally-acquired bacterial infection in newborns; the burden is higher in African countries where intrapartum antibiotic prophylaxis strategies are not feasible. In sub-Saharan Africa, almost one in four newborns with GBS early-onset disease will demise, and one in ten survivors have moderate or severe neurodevelopmental impairment. A maternal GBS vaccine to prevent invasive GBS disease in infancy is a pragmatic and cost-effective preventative strategy for Africa. Hexavalent polysaccharide protein conjugate and Alpha family surface protein vaccines are undergoing phase II clinical trials. Vaccine licensure may be facilitated by demonstrating safety and immunological correlates/thresholds suggestive of protection against invasive GBS disease. This will then be followed by phase IV effectiveness studies to assess the burden of GBS vaccine preventable disease, including the effect on all-cause neonatal infections, neonatal deaths and stillbirths.
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Affiliation(s)
- Ziyaad Dangor
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Anna C. Seale
- Bill and Melinda Gates Foundation, Seattle, WA, United States
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Vuyelwa Baba
- Department of Obstetrics and Gynaecology, University of the Witwatersrand, Johannesburg, South Africa
| | - Gaurav Kwatra
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Unit, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Maternity care provider acceptance of a future Group B Streptococcus vaccine - A qualitative study in three countries. Vaccine 2023; 41:2013-2021. [PMID: 36803900 DOI: 10.1016/j.vaccine.2023.02.037] [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: 12/13/2022] [Revised: 01/26/2023] [Accepted: 02/11/2023] [Indexed: 02/21/2023]
Abstract
INTRODUCTION There are vaccines in clinical trials that target the bacterium Group B Streptococcus (GBS). When approved, GBS vaccines will be intended for administration to pregnant women to prevent infection in their infants. The success of any vaccine will depend on its' uptake in the population. Experience with prior maternal vaccines, e.g. influenza, Tdap and COVID-19 vaccines, teaches us that acceptance of vaccines, especially if novel, is challenging for pregnant women, and that provider recommendation is a key driver of vaccine uptake. METHODS This study investigated attitudes of maternity care providers towards the introduction of a GBS vaccine in three countries (the United States (US), Ireland, and the Dominican Republic (DR)) with different GBS prevalence and prevention practices. Semi-structured interviews with maternity care providers were transcribed and coded for themes. The constant comparative method, and inductive theory building were used to develop conclusions. RESULTS Thirty-eight obstetricians, 18 general practitioners and 14 midwives participated. There was variability in provider attitudes towards a hypothetical GBS vaccine. Responses ranged from enthusiasm to doubts over the need for a vaccine. Attitudes were influenced by perceived additional benefits of a vaccine over current strategy and confidence in the safety of vaccines during pregnancy. Knowledge, experience and approaches to GBS prevention differed geographically and according to provider type, and influenced how participants assessed the risks and benefits of a GBS vaccine. CONCLUSION Maternity care providers are engaged in the topic of GBS management and there is opportunity to leverage attitudes and beliefs that will support a strong recommendation for a GBS vaccine. However, knowledge of GBS, and of the limitations of current prevention strategies vary among providers in different regions, and between different provider types. Targeted educational efforts with antenatal providers should focus on highlighting safety data the potential benefits of vaccination over current strategies.
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Tittel-Elmer M, de Tejada BM, Renzi G, Schrenzel J. Performance of the HiberGene Group B Streptococcus kit, a loop-mediated isothermal amplification-based assay for GBS screening during pregnancy. Eur J Clin Microbiol Infect Dis 2023; 42:217-219. [PMID: 36449147 PMCID: PMC9836968 DOI: 10.1007/s10096-022-04534-0] [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: 08/23/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
Timely and accurate detection of Group B Streptococcus (GBS) carriage in pregnant women allows for targeted peripartum prophylaxis. Replacing culture-based screening by molecular biology assays enables faster results obtention, better targeted antibiotic prophylaxis, and reduces the laboratory workload. Here, we present a comparative analysis between a Loop Mediated Isothermal Amplification assay (HiberGene GBS kit) and culture (gold-standard). The HiberGene GBS kit showed a sensitivity of 97.9% and a specificity of 96.8% compared with culture. The limit of detection was estimated at 103 cfu/ml and results were obtained within 30 min. HiberGene GBS assay can be used for peripartum GBS screening and targeted antibiotic prophylaxis provided sample processing can be swiftly performed around the clock.
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Affiliation(s)
- Mireille Tittel-Elmer
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Begoña Martinez de Tejada
- Obstetrics Division, Departement of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland ,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gesuele Renzi
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals, Geneva, Switzerland ,Faculty of Medicine, University of Geneva, Geneva, Switzerland ,Genomic Research Laboratory, Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
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Kugelman N, Kleifeld S, Shaked-Mishan P, Assaf W, Marom I, Cohen N, Gruber M, Lavie O, Waisman D, Kedar R, Bardicef M, Damti A. Group B Streptococcus real-time PCR may potentially reduce intrapartum maternal antibiotic treatment. Paediatr Perinat Epidemiol 2022; 36:548-552. [PMID: 34888893 DOI: 10.1111/ppe.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/30/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Protocols for preventing early-onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real-time polymerase chain reaction (PCR) can provide a result within 30-60 min and has been found to be specific and sensitive for defining intrapartum GBS status. OBJECTIVE To evaluate whether implementation of GBS fast real-time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics. METHODS This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35-37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real-time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration. RESULTS Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real-time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1). CONCLUSIONS Compared with antepartum universal culture screening or intrapartum risk-factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real-time PCR, without compromising the sensitivity of GBS detection.
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Affiliation(s)
- Nir Kugelman
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shiran Kleifeld
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Wisam Assaf
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Inbal Marom
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadav Cohen
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Gruber
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dan Waisman
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Carmel Medical Center, Haifa, Israel
| | - Reuven Kedar
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mordehai Bardicef
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amit Damti
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Pangerl S, Sundin D, Geraghty S. Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy. J Adv Nurs 2022; 78:3247-3260. [PMID: 35429021 PMCID: PMC9546437 DOI: 10.1111/jan.15249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 02/22/2022] [Accepted: 03/11/2022] [Indexed: 12/03/2022]
Abstract
Aims To investigate Group B Streptococcus (GBS) colonization in pregnancy; adherence to antenatal GBS screening and adherence to the intrapartum antibiotics protocol within two models of care (midwifery and non‐midwifery led). Design This retrospective quantitative study has employed a descriptive design using administrative health data. Methods Data from five maternity hospitals in metropolitan and regional Western Australia that included 22,417 pregnant women who gave birth between 2015 and 2019 were examined, applying descriptive statistics using secondary data analysis. Results The study revealed an overall GBS colonization rate of 21.7% with similar rates in the different cohorts. A lower adherence to screening was found in the midwifery led model of care (MMC, 68.76%, n = 7232) when compared with the non‐midwifery led model of care (NMMC, 90.49%, n = 10,767). Over the 5 years, screening rates trended down in the MMC with stable numbers in the counterpart. Adherence in relation to intrapartum antibiotic prophylaxis revealed discrepant findings between the study groups. Conclusion Adherence to screening and management guidelines of maternal GBS colonization in pregnancy is lower within the MMC when compared with the NMMC. Impact This is the first cohort study to describe the adherence to the recommended Western Australian GBS screening guidelines in the two different models of care. Findings may assist in the guidance and improvement of clinical protocols as well as the planning of clinical care in relation to GBS screening to reduce the risk of neonatal GBS infection.
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Affiliation(s)
- Sabine Pangerl
- King Edward Memorial Hospital Perth Western Australia Australia
| | - Deborah Sundin
- Edith Cowan University Perth Western Australia Australia
| | - Sadie Geraghty
- The University of Notre Dame Australia Fremantle Western Australia Australia
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Assessing standards for prevention of early onset group B streptococcal (GBS) disease in Ireland. Ir J Med Sci 2021; 191:785-791. [PMID: 33988805 PMCID: PMC8120250 DOI: 10.1007/s11845-021-02639-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/03/2021] [Indexed: 11/26/2022]
Abstract
Background: Early onset group B streptococcal (GBS) disease can cause significant neonatal morbidity and mortality. There is currently no Irish national guideline for GBS screening, and protocols vary across maternity units. Polymerase chain reaction (PCR) testing at induction or labour onset informs triage for antibiotic prophylaxis; however, there are human and infrastructural resource requirements to enable widespread implementation. Aim: Our aim was to identify current standard practices for GBS prevention in Irish obstetric and neonatal services and to utilise this data to inform the need for, and potential impact of implementation of, a national guideline. Methods: A questionnaire on GBS screening, management and existing resources was completed by an informed staff member from each of the 19 Irish maternity units, including questions regarding timing and method of screening, antibiotic usage, and neonatal management. Results: One unit (5.2%) performs routine GBS screening at 35–37 weeks of gestation. Twelve units (63%) screen for GBS following spontaneous rupture of membranes (SROM) after 37 weeks, of which two (17%) perform PCR and ten (83%) culture testing. Seventeen units (89.3%) have access to a GeneXpert PCR machine, and of these, two (11.7%) use the machine for rapid GBS testing. Two units screen patients for GBS at either the start of labour or induction of labour. Four units (21%) use the neonatal early onset sepsis (EOS) calculator. Sixteen units (84%) do not treat asymptomatic infants born to GBS-positive mothers. Conclusion: There is a lack of consistency in the methods for GBS screening and disease prevention across the country, highlighting the need for a national guideline accompanied by an implementation plan and budget to standardise care.
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Filkins L, Hauser JR, Robinson-Dunn B, Tibbetts R, Boyanton BL, Revell P. American Society for Microbiology Provides 2020 Guidelines for Detection and Identification of Group B Streptococcus. J Clin Microbiol 2020; 59:e01230-20. [PMID: 33115849 PMCID: PMC7771461 DOI: 10.1128/jcm.01230-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Laura Filkins
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jocelyn R Hauser
- Public Health Laboratory, DC Department of Forensic Sciences, Washington, DC, USA
| | | | - Robert Tibbetts
- Department of Pathology, Henry Ford Health System, Detroit, Michigan, USA
| | - Bobby L Boyanton
- Department of Pathology, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Paula Revell
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
- Department Pathology and Immunology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
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Helmig RB, Gertsen JB. Intrapartum PCR-assay for detection of Group B Streptococci (GBS). Eur J Obstet Gynecol Reprod Biol X 2019; 4:100081. [PMID: 31673691 PMCID: PMC6817646 DOI: 10.1016/j.eurox.2019.100081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 12/01/2022] Open
Abstract
Objective We have recently introduced intrapartum PCR-testing for group B streptococcus (GBS) in women in labor with prolonged rupture of membranes or preterm delivery to offer intrapartum antibiotic prophylaxis only for GBS positive women. The goal of the present study is to report our experience and results from the first half year of GBS testing. Study design This is a retrospective study. Rectovaginal swabs from 321 women presenting in the labor ward with pre-labor rupture of membranes for >14 h/rupture of membranes during delivery for >14 h, or labor between gestational weeks 35 0/7 and 36 6/7 from February 7, 2017 to August 6, 2017, were tested. We performed a molecular GBS test (Xpert GBS®, Cepheid Ltd., Sunnyvale, USA). Data from patient files including mode of delivery, use of antibiotics, infection of mother and child are presented in more detail. Data on the PCR results from the first year of testing were also collected. Results In the first half-year of testing a positive GBS test result was found in 58 (18.1%) and a negative test result in 263 women (81.9%). No invalid test result was achieved. The indication for performing PCR testing was PROM > 14 h or rupture of membranes during labor for >14 h in 266 women (82.9%) and labor in gestational weeks 35 0/7–36 6/7 in 44 women (13.7%). In the remaining 11 women, the PCR test was performed for other reasons. Of the 321 women tested 126 (39%) received antibiotics during labor. Ten women (3.4%) were treated after delivery on suspicion of infection. 25 newborns (7.8%) were treated with antibiotics. In 11 cases, the treatment was stopped after 2–4 days as there were no signs of infection. Conclusions The introduction of the intrapartum GBS test in selected groups of women who gave birth in our department has been well accepted by the women, the midwifes and doctors. The result of the test is available within two hours, and as we only offer intrapartum antibiotic prophylaxis to GBS-positive women, we have reduced the use of antibiotics to approximately 40% in the groups tested, without an increase of infection in mother or child.
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Affiliation(s)
- Rikke B Helmig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Skejby, Denmark
| | - Jan B Gertsen
- Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Denmark
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Clinical impact of rapid polymerase chain reaction (PCR) test for group B Streptococcus (GBS) in term women with ruptured membranes. Ir J Med Sci 2019; 188:1269-1274. [PMID: 30706295 DOI: 10.1007/s11845-019-01977-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/24/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Early-onset group B Streptococcus (EOGBS/GBS) infection remains a significant cause of neonatal morbidity and mortality. AIMS Aiming to improve antimicrobial stewardship and reduce unnecessary maternal and infant exposure to intrapartum antibiotic prophylaxis (IAP), this study assessed the clinical use of a commercially available GBS polymerase chain reaction (PCR) assay for term women with pre-labour rupture of membranes. METHODS This was a retrospective study in a tertiary level maternity unit of term women with pre-labour rupture of membranes (ROM), without any clinical suspicion of infection performed between November and December 2017. GBS PCR tests were cross-referenced with patient clinical data. PCR test results, the impact of testing on antibiotic administration, pyrexia in labour, induction, interventional delivery rates and neonatal outcomes were analysed. RESULTS Of 200 patients included in the study, 29 were positive (14.5%) and 166 were negative (83%), with five invalid results (2.5%). One hundred and twenty three women had > 18-h ruptured membranes and 86 women (70%) who would have been eligible for IAP based on risk factors avoided antibiotic therapy following a negative PCR test. There were no significant differences in induction or interventional delivery rates between GBS-positive and GBS-negative women following PCR testing. During the study period, there were no cases of EOGBS. CONCLUSIONS In a centre adhering to a risk-factor-based GBS policy, the introduction of limited rapid GBS screening for term women with pre-labour rupture of membranes resulted in a clinically significant reduction in prophylactic antibiotic use.
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