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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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Wadilo F, Hailemeskel E, Kedir K, El-Khatib Z, Asogba PC, Seyoum T, Landis FC, Howe R, Boltena MT. Prevalence of Group B Streptococcus maternal colonization, serotype distribution, and antimicrobial resistance in Sub-Saharan Africa: A systematic review and meta-analysis. J Glob Antimicrob Resist 2023; 32:134-144. [PMID: 36813256 DOI: 10.1016/j.jgar.2023.02.004] [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: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Group B Streptococcus (GBS)-associated maternal, perinatal, and neonatal mortality and morbidity disproportionately affects Sub-Saharan Africa (SSA). This systematic review and meta-analysis aimed to address the estimated prevalence, antimicrobial susceptibility, and serotype distribution of GBS isolates in SSA. METHODS This study was done according to PRISMA guidelines. MEDLINE/PubMed, CINAHL (EBSCO), Embase, SCOPUS, Web of Sciences databases, and Google Scholar were used to retrieve both published and unpublished articles. STATA software version 17 was used for data analysis. Forest plots using the random-effect model were used to present the findings. Heterogeneity was assessed using Cochrane chi-square (I2) statistics, while the Egger intercept was used to assess publication bias. RESULTS Fifty-eight studies that fulfilled the eligibility criteria were included for meta-analysis. The pooled prevalence of maternal rectovaginal colonization and vertical transmission of GBS were 16.06, 95% CI [13.94, 18.30] and 43.31%, 95% CI [30.75, 56.32], respectively. The highest pooled proportion of antibiotic resistance to GBS was observed in gentamicin (45.58%, 95% CI [4.12%, 91.23]), followed by erythromycin, (25.11%, 95% CI [16.70, 34.49]). The lowest antibiotic resistance was observed in vancomycin (3.84%, 95% CI [0.48, 9.22]). Our findings indicate that serotypes Ia/Ib/II/ III/and V cover almost 88.6% of serotypes in SSA. CONCLUSIONS The estimated high prevalence and resistance to different antibiotic classes observed in GBS isolates from SSA suggests the need for implementation of effective intervention efforts.
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Affiliation(s)
- Fiseha Wadilo
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia; Woliata Sodo University, Wolaita Sodo, South West Ethiopia Peoples' Region, Ethiopia; Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Elifaged Hailemeskel
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia; Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Kiya Kedir
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Ziad El-Khatib
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Montreal, Québec, Canada; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Tamrayehu Seyoum
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | | | - Rawliegh Howe
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia; Ethiopian Evidence Based Health Care Center, A Joanna Briggs Institute's Center of Excellence, Institute of Health, Jimma University, Ethiopia.
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Bramugy J, Mucasse H, Massora S, Vitorino P, Aerts C, Mandomando I, Paul P, Chandna J, Seedat F, Lawn JE, Bardají A, Bassat Q. Short- and Long-term Outcomes of Group B Streptococcus Invasive Disease in Mozambican Children: Results of a Matched Cohort and Retrospective Observational Study and Implications for Future Vaccine Introduction. Clin Infect Dis 2022; 74:S14-S23. [PMID: 34725690 PMCID: PMC8776307 DOI: 10.1093/cid/ciab793] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Invasive group B Streptococcus disease (iGBS) in infancy, including meningitis or sepsis, carries a high risk of mortality and neurodevelopmental impairment (NDI). We present data on iGBS from 2 decades of surveillance in Manhiça, Mozambique, with a focus on NDI. METHODS Morbidity surveillance databases in a rural Mozambican district hospital were screened for iGBS cases. From February 2020 to March 2021, surviving iGBS patients (n = 39) plus age- and sex-matched children without iGBS (n = 119) were assessed for neurocognitive development, vision, and hearing. The role of GBS in stillbirths and infant deaths was investigated using minimally invasive tissue sampling (MITS). RESULTS Ninety iGBS cases were included, with most children being <3 months of age (85/90). The in-hospital case fatality rate was 14.4% (13/90), increasing to 17.8% (3 additional deaths) when considering mortality during the 6 months postdiagnosis. Fifty percent of the iGBS exposed infants and 10% of those unexposed showed any NDI. Surviving GBS conferred a 11-fold increased adjusted odds of moderate/severe NDI (odds ratio, 2.8 [95% confidence interval, .92-129.74]; P = .06) in children aged 0-5 years. For older children (6-18 years), no differences in NDI were found between exposed and unexposed. Motor domain was the most affected among young GBS survivors. Three stillbirths and 4 early neonatal deaths (of the 179 MITS performed) were attributed to iGBS. CONCLUSIONS In absence of preventive strategies, such as intrapartum antibiotics, iGBS remains a significant cause of perinatal and infant disease and death. GBS also causes major longer-term neurodevelopmental sequelae, altogether justifying the need for maternal GBS vaccination strategies to increase perinatal and infant survival.
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Affiliation(s)
- Justina Bramugy
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | | | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Pio Vitorino
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
| | - Céline Aerts
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | - Proma Paul
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jaya Chandna
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Farah Seedat
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Joy E Lawn
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Azucena Bardají
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça, Maputo, Mozambique
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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Makinde O, Okusanya BO, Osanyin G. Group B Streptococcus vaginal colonization in pregnant women living with HIV infection: prevalence and antibiotic susceptibility at HIV referral centers in Lagos, Nigeria. J Matern Fetal Neonatal Med 2021; 35:9098-9104. [PMID: 34894995 DOI: 10.1080/14767058.2021.2015575] [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: 10/19/2022]
Abstract
OBJECTIVES Group B Streptococcus (GBS) colonization of the genital tract is often asymptomatic yet associated with increased risks of maternal and neonatal morbidity especially amongst women living with HIV infection. The objectives of this study were to determine the prevalence of GBS colonization of the genital tract in women living with HIV infection and antibiotic susceptibility of GBS in the genital tract. METHOD This cross-sectional study recruited 244 pregnant women (122 women living with HIV infection and 122 HIV-uninfected women) between 35 and 37 weeks of gestation. GBS colonization was determined by collecting lower vaginal and anal swabs at recruitment. Swabs were cultured in Todd Hewitt's broth and confirmed by Christie, Atkins, and Munch-Peterson (CAMP) test. Most recent CD4 count and viral load estimates were retrieved from the women's records. Maternal and neonatal outcomes and antibiotic susceptibility were assessed. Statistical analysis was performed at 95% confidence interval at a statistical significance of p < .005. RESULTS The prevalence of GBS colonization of the genital tract in all participants was 3.3%; GBS was isolated in 4 (3.3%) of 122 pregnant women living with HIV. No woman with a GBS-colonized genital tract developed puerperal sepsis and no neonatal infection occurred in neonates born to GBS-positive women, irrespective of HIV infection status. In women living with HIV, GBS isolate was resistant to Ampicillin (100%), Ceftriaxone (100%), Vancomycin (100%), yet partially sensitive to Ciprofloxacin (50%). CONCLUSION Pregnant women living with HIV do not have an increased risk of genital GBS colonization. Vaginal GBS colonization was not associated with an adverse perinatal outcome. Antibiotic use for GBS colonization should be based on sensitivity pattern and not empiric.
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Affiliation(s)
- O Makinde
- SouthShore Women's Clinic, Victoria Island, Lagos, Nigeria
| | - B O Okusanya
- Department of Obstetrics and Gynaecology College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
| | - G Osanyin
- Department of Obstetrics and Gynaecology College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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A systematic review and meta-analysis on the prevalence of Escherichia coli and extended-spectrum β-lactamase-producing Escherichia coli in pregnant women. Arch Gynecol Obstet 2021; 303:363-379. [PMID: 33386957 DOI: 10.1007/s00404-020-05903-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/17/2020] [Indexed: 01/05/2023]
Abstract
PROPOSE The aim of the present study was to determine the prevalence of E. coli and extended-spectrum β-lactamase-producing (ESBL) E. coli in pregnant women in a systematic review and meta-analysis study. METHODS We searched important databases, including Medline (PubMed), Embase, Scopus, Web of sciences, Cochrane library, Ovid, and CINHAL to retrieve all articles reporting the prevalence of ESBL E. coli in pregnant women that published from January 1990 to June 2020. RESULTS The pooled prevalence of E. coli in pregnant women with and without symptoms of UTI after combining 82 studies with a sample size of 33,118 was 29% (29%; %95 CI 23, 36%). The prevalence based on urine, Feacal, and vagina samples was 26% (% 95 CI 19-34%), 77% (% 95 CI 22-98%), and 32% (% 95 CI 17-48%), respectively. Also, 19 studies with a sample size of 9,200 reported ESBL E. coli prevalence in pregnant women. After combining the results of these studies, the pooled prevalence of ESBL E. coli in pregnant women was 34% (34%; %95 CI 24, 43%). The pooled prevalence of E. coli in pregnant women with HIV was 9%(9%; %95 CI 7, 11%). CONCLUSION According to the results of this study, the prevalence of E. coli and ESBL E. coli is high in pregnant women. Also, the overuse of antibiotics was higher in European and Asian pregnant women than other continents.
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Emerging serotype III sequence type 17 group B streptococcus invasive infection in infants: the clinical characteristics and impacts on outcomes. BMC Infect Dis 2019; 19:538. [PMID: 31216993 PMCID: PMC6585028 DOI: 10.1186/s12879-019-4177-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Group B Streptococcus (GBS) is an important pathogen that causes high mortality and morbidity in young infants. However, data on clinical manifestations between different GBS serotypes and correlation with molecular epidemiology are largely incomplete. The aim of this study was to determine the serotype distribution, antimicrobial resistance, clinical features and molecular characteristics of invasive GBS isolates recovered from Taiwanese infants. METHODS From 2003 to 2017, 182 non-duplicate GBS isolates that caused invasive disease in infants less than one year of age underwent serotyping, multilocus sequence typing (MLST) and antibiotic susceptibility testing. The clinical features of these infants with GBS disease were also reviewed. RESULTS Of the 182 patients with invasive GBS disease, 41 (22.5%) were early-onset disease, 121 (66.5%) were late-onset disease and 20 (11.0%) were late late-onset disease (> 90 days of age). All these patients were treated with effective antibiotics on time. Among them, 51 (28.0%) had meningitis, 29 (16.0%) had neurological complications, 12 (6.6%) died during hospitalization, and 15 (8.8%) out of 170 patients who survived had long-term neurological sequelae at discharge. Serotype III GBS strains accounted for 64.8%, followed by serotype Ia (18.1%) and Ib (8.2%). MLST analysis revealed 11 different sequence types among the 182 isolates and ST-17 was the most dominant sequence type (56.6%). The correlation between serotype III and ST17 was evident, as ST17 accounted for 87.3% of all serotype III isolates. There was an obvious increasing trend of type III/ST-17 GBS that caused invasive disease in infants. All isolates were susceptible to penicillin, cefotaxime, and vancomycin, while 68.1 and 65.9% were resistant to erythromycin and clindamycin, respectively. CONCLUSIONS Despite timely and appropriate antibiotic treatment, a significant proportion of invasive GBS disease still inevitably causes adverse outcomes. Further study to explore preventive strategies and development of serotype-based vaccines will be necessary in the future.
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Gizachew M, Tiruneh M, Moges F, Tessema B. Streptococcus agalactiae maternal colonization, antibiotic resistance and serotype profiles in Africa: a meta-analysis. Ann Clin Microbiol Antimicrob 2019; 18:14. [PMID: 30922308 PMCID: PMC6437888 DOI: 10.1186/s12941-019-0313-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/15/2019] [Indexed: 12/31/2022] Open
Abstract
Background Maternal rectovaginal colonization with Streptococcus agalactiae (Group B Streptococcus or GBS) is the most common route for the GBS disease in the perinatal period. The knowledge of maternal colonization, antibiotic resistance and serotype profiles is substantially needed to formulate the broad vaccine. However, it has not been estimated in Africa. This meta-analysis was aimed to determine the pooled prevalence of colonization, antibiotic resistance and serotype profiles of GBS reported in Africa. Methods Potentially relevant studies from 1989 to 31th January, 2019 were retrieved from the Medline/PubMed, EMBASE, HINARI online databases, periodicals and by requesting authors. Unpublished studies retrieved from grey literature through Google and Google Scholar. Pooled estimates were calculated using the random effect model. Subgroup analysis was done to investigate the burden of colonization across sub-regions, sampling site and countries. Summary estimates were presented using words, Forest plots and Tables. Heterogeneity was assessed using the I2 statistic. Results Eighty-three articles were assessed, of which 57 studies conducted in five sub-regions with 21 countries (22,206 pregnant women) met pre-specified inclusion criteria. The overall estimate of recto-vaginal colonization was 19.3% (95% CI 16.9, 21.7). The highest estimate was observed in Southern Africa, 23.8% (95% CI 18.7, 28.9), followed by Northern Africa, 22.7% (95% CI 18.2, 27.2) while the lowest was driven from the Eastern Africa, 15.4% (95% CI 12.1, 18.7). Considerable heterogeneity across and within regions, sampling site, screening methods and countries (I2 > 75%); and the publication bias were observed (p = 0.031). GBS showed the highest resistance to tetracycline. Resistance to penicillin, amoxicillin, chloramphenicol, ampicillin, ceftriaxone, ciprofloxacin, erythromycin, vancomycin and clindamycin also observed. The V, III, Ia, Ib, and II serotypes altogether were accounted 91.8% in the African studies. Conclusions The pooled estimate of the maternal colonization with GBS was 19.3% which is equivalent with other many primary and review reports worldwide. The most antibiotic resistance estimate was recorded in the tetracycline followed by penicillin. Five serotypes were the most prevalent in Africa and more data on the antibiotic résistance and serotype distribution patterns are needed from developing countries to devise the effective preventive measures. In addition, the antibiotic susceptibility test methods used in the Africa shall be assessed for its quality. Trial registration Prospero Registration Number CRD42018094525
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Affiliation(s)
- Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Moges Tiruneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belay Tessema
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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