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

Burden of Invasive Group B Streptococcus Infection Among Omani Infants Less Than 90 Days Old: A Multicenter Study

BACKGROUND

Group B Streptococcus (GBS) infection is the leading cause of neonatal morbidity and mortality worldwide. This study aims to investigate the incidence of invasive GBS disease among infants less than 90 days old in Oman and to describe their risk factors, clinical presentations and clinical outcomes.

METHODS

We retrospectively collected the data of less than 90-day-old Omani infants with culture-positive GBS from sterile samples. This study was conducted in 3 tertiary hospitals in Oman from 2009 to 2018.

RESULTS

Over 10 years, we identified 92 cases of culture-confirmed invasive GBS infection from 178,285 live births in the 3 hospitals, giving an overall incidence of 0.53 per 1000 live births [95% confidence interval (CI): 0.4-0.7)]. Of those, 59 (64.1%) had early-onset neonatal GBS disease and 33 (35.9%) had late-onset neonatal GBS disease. The incidence of invasive GBS disease was significantly higher in the last 5 years from 2014 to 2018 (0.69 per 1000 live births, 95% CI: 0.5-0.9) compared to the previous years from 2009 to 2013 (0.36 per 1000 live births, 95% CI: 0.2‒0.5), (P = 0.004). Infants with late-onset neonatal GBS disease had a higher risk of meningitis compared to infants with early-onset neonatal GBS disease (30.3% vs. 10.2%, P = 0.021). The mortality rate was 13.5%.

CONCLUSIONS

The incidence of invasive GBS disease in Oman is similar to what was reported worldwide, however, the burden of the disease in terms of mortality is high. In addition, a significant increase in the annual incidence of invasive GBS disease in Omani infants was found over the study period.

Factors Affecting Awareness of Pregnancy Screening for Group B Streptococcus Infection Among Women of Reproductive Age in Jazan Province, Saudi Arabia

Background

Group B streptococcus (GBS) infection is one of the leading causes of neonatal sepsis and meningitis. GBS screening and intrapartum antibiotic prophylaxis can effectively prevent early-onset GBS disease. This study aimed to assess the awareness of the risks of GBS infection and screening in Jazan Province, Saudi Arabia.

Methodology

A cross-sectional study was conducted using a survey of 995 women aged 18-45 in Jazan, Saudi Arabia. Data were collected between January to April 2023 and included information on sociodemographic characteristics, awareness of GBS infection, and perspectives on GBS screening.

Results

The response rate was 97.45%, and the mean age of the participants was 31.50 ± 9.80 years. Most were married (60.2%), had a university education (81.11%), and 59% were pregnant or had a pregnancy history. Only 23% had heard of GBS, associated with age, marital status, job, pregnancy status, awareness of GBS risk factors, and pregnancy follow-up (p < 0.05). Women most aware were students (55.9%), married (55.46%), pregnant or had a pregnancy history (51.09%), knew risk factors of GBS (38.86%), and were followed by a specialist (88.14%). Regarding GBS screening preferences, 40% preferred universal screening without consent, 31% with consent, 16% for high-risk pregnancies with consent, and 13% for high-risk pregnancies without consent.

Conclusion

The study found low awareness of GBS among women residing in Jazan, Saudi Arabia. Factors related to demographic details and obstetric follow-up were associated with better understanding. Most women preferred universal screening for GBS, with or without consent. Effective health education is needed to raise women's awareness of screening benefits and risks. This education can help women make informed decisions and improve prevention and care. Future studies may evaluate healthcare providers' awareness of GBS.

Population genetics of group B Streptococcus from maternal carriage in an ethnically diverse community in London

Introduction

Maternal immunization against Group B Streptococcus (GBS) has the potential to significantly reduce the burden of neonatal GBS infections. Population genetics of GBS from maternal carriage can offer key insights into vaccine target distribution.

Methods

In this study we characterized the population structure of GBS isolates from maternal carriage (n = 535) in an ethnically diverse community in London, using whole genome sequencing.

Results

The isolates clustered into nine clonal complexes (CCs) but the majority (95%) belonged to five lineages: CC1 (26%), CC19 (26%), CC23 (20%), CC17 (13%) and CC8/10 (10%). Nine serotypes were identified, the most common were serotypes III (26%), V (21%), II (19%) and Ia (19%). Other serotypes (Ib, IV, VI, VII, IX) represented less than 10% of all isolates each. Intra-lineage serotype diversity was observed in all major CCs but was highest in CC1, which revealed nine serotypes. Nearly all isolates (99%) carried at least one of the four alpha family protein genes (alpha, alp1, alp23, and rib). All isolates were susceptible to penicillin. We found 21% and 13% of isolates to be resistant to clarithromycin and clindamycin, respectively. Prevalence of macrolide-lincosamide-streptogramin B (MLS_B) resistance genes was 22% and they were most common in CC19 (37%) and CC1 (28%), and isolates with serotypes V (38%) and IV (32%). We identified some associations between maternal ethnicity and GBS population structure. Serotype Ib was significantly less common among the South Asian compared to Black women (S. Asian: 3/142, Black: 15/135, p = 0.03). There was also a significantly lower proportion of CC1 isolates among the White other (24/142) in comparison to Black (43/135) and S. Asian (44/142) women (p = 0.04). We found a significantly higher proportion of CC17 isolates among the White other compared to S. Asian women (White other: 32/142, S. Asian: 10/142, p = 0.004).

Conclusion

Our study showed high prevalence of GBS vaccine targets among isolates from pregnant women in London. However, the observed serotype diversity in CC1 and high prevalence of MLS_B resistance genes in CC19 demonstrates presence of high risk lineages, which might act as a reservoir of non-vaccine strains and antimicrobial resistance determinants.

Adherence to screening and management guidelines of maternal Group B Streptococcus colonization in pregnancy

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.

Incidence of Vaginal Colonization of Group B Streptococci among Pregnant Women Attending a Tertiary Care Hospital – Chennai, India

Streptococcus agalactiae or Group B Streptococcus (GBS) is an important pathogen, which can cause serious illness and sometimes death especially in newborns, pregnant women and in people with compromised immune system. The major risk factor for neonatal disease is vaginal colonization of GBS during pregnancy and delivery. 1) To study the incidence of vaginal colonization of Group B Streptococcus (GBS) among pregnant women. 2) To compare the efficacy of sheep blood agar vs selective medium like HiCHROME Strep B Selective agar (HIMEDIA) in the isolation of GBS. Vaginal swabs were collected from 150 antenatal women at 35-37 weeks of gestation or at any gestational age if additional risk factors were present. The swabs were cultured on non-selective medium like Blood agar and a chromogenic medium (HiCHROME Strep B Agar, HiMedia). GBS was identified by standard microbiological techniques. Bluish, purple-colored colonies were confirmed as GBS by CAMP test and latex agglutination test. Only 3 out of 150 women (2%) of the screened antenatal women were colonized with GBS. Incidence was quite low, compared to the literature from the West. All the 3 babies born to the three women colonized with GBS were healthy with no indication of invasive GBS disease. The chromogenic medium supported the growth of Group B Streptococcus and Enterococcus spp. only and was a useful selective medium for isolation of GBS.

Group B Streptococci Vaginal-Recto Colonization, Vertical Transmission to Newborns, Antimicrobial Susceptibility Profile and Associated Factors in Selected Health Facilities of Bahir Dar City: A Cross-Sectional Study

BACKGROUND

Group B streptococci (GBS) is an important pathogen involved in stillbirths, neonatal deaths and neurological defects, and the occurrence of multi-drug resistance (MDR) is an alarming issue. This study determined the prevalence of GBS colonization in pregnant women and newborns, the proportion of vertical transmission, antimicrobial susceptibility profiles of isolates, and the factors associated with colonization and vertical transmission.

METHODS

A cross-sectional study was conducted from March 1, 2021 to June 30, 2021, at selected health facilities of Bahir Dar city. Vaginal-recto swabs from 292 pregnant women and pooled ear, nasal and umbilical swabs from 292 newborns were collected. GBS were identified following standard microbiological protocols. Antimicrobial susceptibility testing was performed using modified Kirby-Bauer disk diffusion method and interpreted by the accepted 2020 CLSI M100 guidelines. Logistic regression analysis was computed.

RESULTS

Overall, 54 (18.5%) of pregnant women and 22 (7.5%) of newborns had GBS colonization. The proportion of GBS vertical transmission was 22 (40.7%). Group B Streptococcus isolates scored susceptibility to penicillin, ampicillin and vancomycin with 88.9%, 90.7%, and 96.3% for pregnant women and 86.4%, 90.9% and 95.9% for newborns, respectively. A high percentage of non-susceptibility was found for clindamycin and erythromycin with 33.3% and 25.9% for pregnant women and 31.8% and 22.7% from newborns, respectively. Besides, 19 (35.2%) GBS from pregnant women and 8 (36.4%) from newborns were MDR. Group B streptococci colonization was significantly associated with delivery before 37th week of gestation (AOR=2.77, 95% CI 1.14-6.68) and history of stillbirth (AOR=3.13, 95% CI 1.13-8.70).

CONCLUSION

Pregnant women vaginal-recto GBS colonization and transmission to newborns connected with MDR are a matter of concerns. Although non-susceptible GBS isolates are obtained, penicillin and vancomycin are relatively effective. The use of clindamycin, erythromycin and ceftriaxone should be guided by antimicrobial susceptibility testing. Genetic analysis is recommended to exactly identify the epidemiology of GBS strains, vertical transmission and antimicrobial resistance at the country level.

Effects of group B streptococcus infection on vaginal micro-ecology and pregnancy outcomes of pregnant women in late pregnancy

BACKGROUND

Invasive infection with group B streptococcus (GBS) can lead to intrauterine infection, and GBS can also spread via vertical transmission between mother and infant, resulting in adverse pregnancy outcomes. This study aimed to investigate the effects of GBS colonization in late gestation on vaginal micro-ecology, pregnancy outcomes and neonatal outcome.

METHODS

One hundred and twenty pregnant women in the third trimester infected with GBS and 120 healthy counterparts who underwent a prenatal examination in the obstetrics department of the study hospital from June 2019 to December 2020 were selected for inclusion in the study. Vaginal micro-ecological index, mode of delivery, adverse pregnancy outcomes and neonatal Apgar score were compared between the two groups.

RESULTS

The incidence rates of vaginal micro-ecological disorders, intrauterine infection and neonatal infection were significantly higher in the GBS group compared with the control group. The incidence rates of neonatal fetal distress and pathological jaundice were much higher in the GBS group compared with the control group. The neonatal Apgar score was markedly lower in the GBS group compared with the control group.

CONCLUSIONS

GBS infection is correlated with the vaginal micro-environment. GBS colonization in late pregnancy has adverse effects on vaginal micro-ecology and pregnancy outcome.

Awareness of Pregnancy Screening for Group B Streptococcus Infection Among Women of Reproductive Age and Physicians in Jeddah, Saudi Arabia

Background Group B Streptococcus is part of the normal flora of the female urogenital tract and rectum. Vaginal colonization and transmission of this bacteria during delivery can lead to neonatal life-threatening complications, which can be prevented by screening and the administration of intrapartum antibiotics. This study's aim was to assess the level of awareness of antenatal screening of Group B Streptococcus among women and physicians in Jeddah, Saudi Arabia. Methods A cross-sectional study using an online survey from a previously published study was distributed among 767 participants in Jeddah from June to August 2020. The participants were family medicine or obstetrics and gynecology physicians and women of reproductive age. Results Our results revealed a good level of knowledge of the physicians, although almost half of them reported the need for training to correctly perform screenings. The level of the women's knowledge was relatively poor, their mean knowledge was 50.7%, and the majority were unaware of this infection (85.3%). Conclusions This study found a low level of knowledge of Group B Streptococcus among women of reproductive age and physicians in obstetrics and gynecology and family medicine. These findings confirm the importance of increasing the awareness of Group B Streptococcus among these populations to avoid complications associated with this infection.

Emergence of Multi-Drug Resistance and Its Association With Uncommon Serotypes of Streptococcus agalactiae Isolated From Non-neonatal Patients in Thailand

Group B streptococcus (GBS) or Streptococcus agalactiae is an opportunistic pathogen that causes serious illness in newborns, pregnant women, and adults. However, insufficient detection methods and disease prevention programs have contributed to an increase in the incidence and fatality rates associated with this pathogen in non-neonatal patients. This study aimed to investigate factors of the observed increased incidence by investigation of serotype distribution, virulence factors, and antimicrobial susceptibility patterns from invasive GBS disease among non-neonatal patients in Thailand. During 2017–2018, a total of 109 S. agalactiae isolates were collected from non-pregnant patients. There were 62 males and 47 females, with an average age of 63.5 years (range: 20 – 96). Serotypes were determined by latex agglutination assay and multiplex polymerase chain reaction (PCR)-based assay. Among those isolates, seven virulence genes (rib, bca, pavA, lmb, scpB, cylE, and cfb) were detected by PCR amplification, and were determined for their susceptibility to 20 antimicrobial agents using a Sensititre^TM Streptococcus species STP6F AST plate. Among the study isolates, serotype III was predominant (52.3%), followed by serotype V and serotype VI (13.8% for each), serotype Ib (11.9%), and other serotypes (8.2%). Of the seven virulence genes, pavA was found in 67.0%. Except for one, there were no significant differences in virulence genes between serotype III and non-serotype III. Study isolates showed an overall rate of non-susceptibility to penicillin, the first-line antibiotic, of only 0.9%, whereas the resistance rates measured in tetracycline, clindamycin, azithromycin, and erythromycin were 41.3, 22.0, 22.0, and 22.0%, respectively. Strains that were resistant to all four of those drugs were significantly associated with non-serotype III (p < 0.001). Using multi-locus sequence typing (MLST), 40.0% of the four-drug-resistant isolates belonged to serotype VI/ST1, followed by serotype Ib/ST1 (35.0%). Cluster analysis with global GBS isolates suggested that the multiple drug-resistant isolates to be strongly associated with the clonal complex (CC) 1 (p < 0.001). Compared to the 2014 study of 210 invasive GBS isolates conducted in 12 tertiary hospitals in Thailand, the proportion of serotype III has dramatically dropped from nearly 90% to about 50%. This suggests that resistances to the second-line antibiotics for GBS might be the selective pressure causing the high prevalence of non-serotype III isolates.

Urinary Bacterial Profile and Antibiotic Susceptibility in Pregnant Adolescents and Pregnant Low Obstetric Risk Adult Women

Introduction

Significant bacteriuria is associated with clinical and obstetric complications. The existing studies on the profile of urinary pathogens in pregnant women have widely divergent results and they hardly include data on pregnant adolescents.

Methods

This observational retrospective study was conducted in a tertiary hospital in the city of São Paulo with 388 pregnant adolescents and 2547 pregnant low-risk obstetric care adults who began prenatal care between January 2010 and January 2016. They were compared in terms of urine sediment, urine culture, and antibiogram results.

Results

The prevalence of bacteriuria was 17.01% (66/388) among adolescents and 10.13% (258/2547) among adults. Adolescence was a risk factor for bacteriuria in pregnancy (OR=1.82, CI95%=1.35–2.44, p=0.08). The most frequently isolated pathogen in urine culture was Escherichia coli, both in adolescents (49%) and in adults (42.18%). In positive urine cultures, urinary leukocytes were present in greater numbers in adolescents than in adults (p<0.001). Resistance to quinolones in general was more frequent among adults (OR=5.86, CI95%=0.78–44.20, p<0.001), but the tendency was not statistically significant.

Conclusion

Escherichia coli and the less frequent Streptococcus agalactiae were the etiologic agents most often found in the urine cultures both of adolescents and adults. Higher rates of bacteriuria and of abnormal urine sediments prevailed among adolescents.

Group B Streptococcus Screening Guidelines in Pregnancy: A Critical Review of Compliance

INTRODUCTION

Colonization with Group B Streptococcus in pregnancy is a major risk factor for neonatal infection. Universal screening for maternal streptococcal colonization and the use of intrapartum antibiotic prophylaxis has resulted in substantial reductions of neonatal early-onset Group B Streptococcus disease. To achieve the best neonatal outcomes, it is imperative for maternity healthcare providers to adhere to screening and management guidelines.

AIM

This literature review uses a systematic approach and aims to provide a synthesis of what is known about compliance with Group B Streptococcus screening protocols in a variety of global settings, including maternity homes, private obstetric practice, and hospital clinical environments.

METHODS

The review was carried out using electronic databases as well as hand-searching of reference lists. Included papers reported primarily on compliance with Group B Streptococcus screening guidelines, potential factors which influence compliance rates, and implementations and outcomes of interventions.

RESULTS

Six international studies have been retained which all focused on adherence to Group B Streptococcus screening guidelines and demonstrated that different factors might have an influence on adherence to GBS screening protocols such as financial aspects and high caesarean section rates. Findings of relatively low compliance rates led to recognizing the need of developing improved strategies for optimising antenatal GBS screening adherence.

CONCLUSION

Adhering to Group B Streptococcus screening guidelines to prevent neonatal infection is crucial. Various factors influence compliance rates such as financial aspects and high proportions of caesarean sections. The implementation of strategies and different forms of education can result in improved compliance rates.

Differences in maternal group B Streptococcus screening rates in Latin American countries

OBJECTIVE

To determine rates and results of maternal Group B streptococcus (GBS) screening during pregnancy and identify sociodemographic characteristics associated with GBS screening in Latin American countries.

BACKGROUND

GBS is a primary cause of morbidity and mortality in neonates and is prevented by screening pregnant women for GBS before delivery and intrapartum antibiotic treatment. Yet, data regarding national GBS screening practices and the epidemiology of maternal GBS colonization in Latin America are limited.

METHODS

We conducted a retrospective observational study using de-identified records of pregnant women in six Latin American countries from a regional database. 460,328 collected from January 1, 2009 through December 31, 2012 met study criteria and were included. Maternal screening rates for GBS were determined, association of demographic variables (ethnicity, age, education level, and civil status) with maternal GBS screening was determined using logistic regression, odds ratios were calculated comparing incidence of adverse neonatal outcomes (sepsis, pneumonia, and meningitis) between countries with high and low rates of GBS screening, maternal GBS colonization prevalence was determined by year and association of demographic variables with maternal GBS colonization was determined using logistic regression.

RESULTS

Maternal GBS screening was less than 15% in each country, except Uruguay which screened greater than 65% of women. The final regression model examining maternal screening rates and demographic variables included the covariates ethnicity, maternal age group, education level and civil status. Countries with lower rates of maternal GBS screening had increased odds of neonatal sepsis [OR 23.3; 95% CI (15.2-35.9)] and pneumonia [OR 19.9; 95% CI (12.1-32.6)]. In Uruguay, GBS prevalence over the study period was 18.5%. Black women, older women and women without a primary education had higher rates of GBS colonization (21.3%, 20.4% and 21.9% respectively).

CONCLUSIONS

Our study highlights the need for national policy and investments to increase maternal GBS screening and better understand the prevalence of maternal GBS colonization in Latin America. Further research on the burden of neonatal GBS disease within Latin America is needed to inform the introduction of a maternal GBS vaccine, when available.

To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

Streptococcus agalactiae, also known as Group B streptococcus (GBS) is the commonest cause of early onset sepsis in newborns in developed high-income countries. Intrapartum antimicrobial (antibiotic) prophylaxis (IAP) is recognized to be highly effective in preventing early onset Group B sepsis (EOGBS) in newborns. The key controversy is about the strategy that should be used to identify mothers who should receive IAP. There are two strategies that are followed in developed countries: screening-based or risk-factor-based identification of women requiring IAP. The debate regarding which of the two approaches is better has intensified in the recent years with concerns about antimicrobial resistance, effect on newborn’s microbiome and other adverse effects. In this review, we have discussed some of the key research papers published in the period 2015–2019 that have addressed the relative merits and disadvantages of screening versus risk-factor-based identification of women requiring IAP. Although screening-based IAP appears to be more efficacious than risk-based IAP, IAP-based prevention has several limitations including ineffectiveness in prevention of late-onset GBS infection in babies, premature and still births, impact of IAP on neonatal microbiota, emergence of antimicrobial resistance and difficulties in implementing IAP-based strategies in middle and low income countries. Alternative strategies, principally maternal immunization against GBS would circumvent use of IAP. However, no licensed vaccines are currently available for use.

Association Between Maternal Obesity and Group B Streptococcus Colonization in a National U.S. Cohort

Objective: To investigate the association between maternal obesity as measured by prepregnancy body mass index (BMI) and group B streptococcus (GBS) colonization. Methods: We conducted a secondary analysis from the Consortium on Safe Labor Study (CSL) in the United States cohort study (2002-2008). Pregnant women with deliveries at ≥37 weeks of gestation who attempted labor were included (115,070 assessed deliveries). The association between maternal prepregnancy BMI, categorized as normal weight or below (<25 kg/m²), overweight (25 to <30 kg/m²), class I obesity (30 to <35 kg/m²), class II obesity (35 to <40 kg/m²), and class III obesity (≥40 kg/m²), and GBS colonization was modeled using logistic regression with generalized estimating equations. Models adjusted for maternal age, parity, race, pregestational diabetes, insurance status, study site/region, and year of delivery. Results: The overall prevalence of GBS colonization was 20.5% (23,625/115,070), which increased with rising maternal BMI, normal weight 19.3% (13,543/70,098), overweight 20.8% (5,353/25,733), class I obesity 23.0% (2,596/11,275), class II obesity 26.1% (1,270/4,850), and class III obesity 27.7% (863/3,114). In multivariable analysis, increasing maternal obesity severity was associated with higher odds of GBS colonization, namely overweight (adjusted odds ratio [AOR]: 1.09, 95% confidence interval [CI]: 1.05-1.13), class I obesity (AOR: 1.20, 95% CI: 1.15-1.26), class II obesity (AOR: 1.42, 95% CI: 1.33-1.51), and class III obesity (AOR: 1.50; 95% CI: 1.38-1.62) compared with normal weight. In secondary analyses, these associations persisted when stratified by maternal race. Conclusions: In a national U.S. sample, increasing maternal obesity severity as assessed by prepregnancy BMI was associated with a higher likelihood of maternal GBS colonization during pregnancy.

Changes in incidence and etiology of early-onset neonatal infections 1997-2017 - a retrospective cohort study in western Sweden

Background

The objective of the study was to evaluate data on early-onset neonatal invasive infections in western Sweden for the period 1997–2017. To identify changes in incidence, etiology and mortality and compare to previous studies from the same area starting from 1975.

Methods

Observational epidemiological, retrospective study on infants 0–6 days of age with a positive culture in blood and/or cerebrospinal fluid between 1997 and 2017. A comparison was made of the incidence between 2008 and 2017 compared to 1997–2007. Changes in the incidence of infections due to Group B streptococci, Staphylococcus aureus and aerobic Gram-negative rods were assessed from 1975.

Results

The total incidence, including both recognized pathogens and commensals as causative agents, was 1.1/1000 live births. The incidence declined from 1.4/1000 LB in 1997–2007 to 0.9/1000 LB in 2008–2017 but the case-fatality rate remained unchanged, (8/119 vs 7/90), at 7%. Among the 209 patients identified during 1997–2017 with sepsis or meningitis the most common organisms were Group B streptococci (40%, 84/209), S. aureus (16%, 33/209) and E. coli (9%, 18/209). The incidence of Group B streptococci infections went from 0.9/1000 live births 1987–1996 to 0.45/1000 live births 1997–2017 and all cases were within 72 h. The proportion of extremely preterm infants (< 28 weeks gestation) rose steadily during the study period but there was no rise in infections due to Gram-negative organisms. The spectrum of cultured organisms changed after 72 h as commensal organisms started to emerge.

Conclusion

There has been a decrease in the incidence of neonatal early-onset infections compared to previous studies in western Sweden. The incidence of GBS infections was not as low as in other reports. Further studies are needed to assess if screening-based intra partum antimicrobial prophylaxis instead of a risk factor-based approach for identifying candidates for intrapartum antimicrobial prophylaxis would be a better option for this study area.

Key notes

This study is one of the longest running follow-ups in the world, a follow-up of 43 years of early-onset neonatal infections.

The incidence of early-onset GBS infections is higher in Western Sweden compared to other local reports.

No difference in the incidence of early-onset GBS depending on the definition of early-onset being within 72 h or 7 days of life.

Differential rates of group B streptococcus (GBS) colonisation in pregnant women in a racially diverse area of London, UK: a cross-sectional study

OBJECTIVE

To describe the epidemiology of maternal group B streptococcus (GBS) colonisation by racial group.

DESIGN

Cross-sectional study.

SETTING

Antenatal clinics in London North West University Healthcare NHS Trust.

POPULATION

Pregnant women.

METHODS

Group B streptococcus (GBS) colonisation status was recorded during a screening programme for the prevention of invasive early-onset GBS infection. Information regarding age, address, ethnicity, parity, mode of delivery, body mass index (BMI), and diabetes was routinely collected. Data were analysed by multivariable analysis.

MAIN OUTCOME MEASURES

Association between GBS colonisation and putative risk factors.

RESULTS

Overall, 29.1% (1836/6309) of the women were colonized with GBS. Multivariable analysis showed significantly higher colonisation among women of black African origin (39.5%; OR = 1.57) compared with white British women (27.4%), and lowest colonisation in women of South Asian origin (23.3%; OR = 0.8). Higher parity (≥2) was associated with higher colonisation (35.3%), with the odds of colonisation over 40% higher than for nulliparous women. Increasing BMI was associated with an incremental rise in colonisation from 23 to 35%. Colonisation was not associated with age, season or mode of testing.

CONCLUSION

This study identified high maternal GBS colonisation rates in a racially and socially diverse population. The highest rates were seen in women of black African origin and also with higher parity and BMI. Further research is needed to understand the relationship between these factors and rectovaginal colonisation.

TWEETABLE ABSTRACT

Study of group B streptococcus colonisation in pregnant women in London shows highest rates in black African women and those with high BMI and parity.

Prolonged Rupture of Membranes, Neonatal Outcomes and Management Guidelines

BACKGROUND

Prolonged rupture of membranes (PROM) is a risk factor for early-onset neonatal sepsis (EOS). In the absence of early specific and sensitive diagnostic tools, management of asymptomatic infants is difficult. This study was conducted to investigate clinical outcomes of newborns born to mothers with PROM.

METHODS

A retrospective study of neonates ≥ 34 weeks admitted due to PROM was conducted. Medical charts were reviewed. Neonates were classified into three categories based on their status at birth: ill appearing, well, and equivocal. Sepsis risk calculator was retrospectively applied.

RESULTS

A total of 176 neonates were included. All mothers had unknown group B streptococcus (GBS) status. Of them, 74.4% were asymptomatic. Nine infants (5%) had positive cultures, and 23 infants (13%) had culture-negative sepsis. The newborns with sepsis fit into the "ill appearing" category with a significantly higher proportion (12.5% vs. 0.0%, P value < 0.0).

CONCLUSIONS

Reliable early diagnostic tools for neonatal sepsis are lacking. Adopting a protocol that utilizes multiple methods and follow-up for the clinical condition of these infants are the key factors to avoid missing neonates with true sepsis and decreasing the use of antibiotics in those without infection.

Streptococcus agalactiae from Ethiopian pregnant women; prevalence, associated factors and antimicrobial resistance: alarming for prophylaxis

Background

Maternal Streptococcus agalactiae (Group B Streptococcus, GBS) colonization rates and its antibiotic resistance patterns provide important information useful in guiding prevention strategies. There is a paucity of evidence about GBS in the Amhara National Regional State, Ethiopia.

Objective

To determine colonization prevalence, associated risk factors, and antibiotics resistance including inducible clindamycin resistance patterns of GBS among Ethiopian pregnant women.

Methods

A prospective cross-sectional study was conducted from 1st December 2016 to 30th November 2017 at the University of Gondar Referral hospital delivery ward. Combined recto-vaginal swabs were collected from 385 pregnant women and analyzed at the University of Gondar Bacteriology Laboratory by using LIM broth and 5% defibrinated sheep blood agar culture methods. Isolates were identified by using colony morphology, gram reaction, hemolysis, and CAMP test. Antibiotic susceptibility test was done using the disc diffusion method. Double disc diffusion method was used to identify inducible clindamycin resistance isolates. Data were analyzed by SPSS version 20 software. p ≤ 0.05 was considered as statistically significant.

Results

The overall prevalence of maternal GBS colonization was 25.5% (95% CI 21–29.5%). Experiencing meconium stained amniotic fluid (AOR = 3.018, 95% CI 1.225, 7.437), and longer duration of premature rupture of membrane (AOR = 1.897, 95% CI 1.014, 3.417) were statistically significant to maternal colonization. Furthermore, GBS resistant to 0 (8.2%), 1 (25.5%) and 3 (39.8%) or more antibiotics were identified. A D-test showed 15.2% inducible clindamycin resistant GBS. Constitutive macrolide lincosamide–streptogramin_B, L-, and M-phenotypes were also detected.

Conclusions

Maternal GBS colonization rate in this study was higher compared to the previous reports in Ethiopia. This much prevalence and antibiotics resistance results are the clue to which attention shall be given to this bacterium during management of pregnant women and the newborns.

Early-onset group B Streptococcus (EOGBS) infection subsequent to cessation of screening-based intrapartum prophylaxis: findings of an observational study in West London, UK

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.