Antimicrobial Resistance Profile and Associated Factors of Group B Streptococci Colonization among Pregnant Women Attending Antenatal Clinics in Jigjiga, Southeast Ethiopia

Vertical Transmission of Group B Streptococcus, Prevalence, Associated Factors, and Antimicrobial Susceptibility Profile among Newborns Delivered at Health Facilities in Jigjiga City, Ethiopia

Background

Group B Streptococcus (GBS) colonizes the rectovaginal area of women and vertically transmitted to neonates. This bacterium has been linked to severe neonatal complications including pneumonia, septicemia, and meningitis. GBS shows an increased resistance to commonly used antibiotics. Thus, we assessed the vertical transmission, contributing factors, and antimicrobial resistance patterns of GBS among newborns delivered at selected Hospitals in Jigjiga City.

Methods

Hospital-based cross-sectional study was conducted from 1st June 2022 to 30th April 2023. A total of 849 pregnant women admitted to delivery wards from two hospitals were screened for GBS colonization. Subsequently, 162 GBS-colonized pregnant women and their newborn babies were included. A semistructured questionnaire and a review of medical records were used to collect the sociodemographic and clinical characteristics of the study participants. Trained nurses collected swab samples from the vaginal-rectal area of pregnant women and the nasal, ear canal, and umbilical areas of newborn babies. Samples were inoculated on Todd Hewitt broth media supplemented with gentamycin and nalidixic acid and then subcultured on blood agar. Colony characteristics, Gram stain, and catalase test were used for identification. All gram-positive cocci, B-hemolytic, and catalase-negative isolates were further identified using Christie-Atkins-Munch-Petersen and a bacitracin test. The modified Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing. Data were analyzed using SPSS version 26. Logistic regression analysis was used to determine the factors associated with vertical transmission of GBS, and statistical significance was set at p values <0.05.

Result

The overall vertical transmission rate was 41.4% (67/162). History of preterm labor (Adjusted odds ratio (AOR) = 2.25; 95% CI: 1.11, 4.59), history of urinary tract infection (UTI) at current pregnancy (AOR = 2.25; 95% CI: 1.11, 4.59), and prolonged rupture of membranes greater than 18 hours (AOR = 2.23; 95% CI: 1.13, 4.4) were significantly associated with vertical transmission of GBS from previously colonized mothers to their newborn babies. Regarding GBS antibiotic susceptibility profile, a significant degree of resistance was observed to penicillin (29.9%), tetracycline (22.4%), ampicillin (20.9%), and clindamycin (19.4%).

Conclusion

Our study documented a high prevalence of vertical transmission rate of GBS from pregnant women to their babies, with an overall transmission rate of 41.4%. The study identified the presence of antimicrobial-resistant GBS to penicillin, ampicillin, clindamycin, ciprofloxacin, and chloramphenicol. The organism was susceptible to vancomycin, followed by azithromycin, ceftriaxone, and erythromycin. Our study also reported MDR at 13.4%. Based on our findings, there is a need for antenatal culture-based GBS screening, maternal vaccination, and large-scale epidemiological and serotype identification studies to be put into practice in the study area.

Antimicrobial Resistance Profile of Group B Streptococci Colonization in a Sample Population of Pregnant Women from Romania

Group B Streptococcus (GBS) represents one of the leading causes of life-threatening invasive disease in pregnant women and neonates. Rates of GBS colonization vary by region, but studies on maternal GBS status are limited in Romania. This study aims to identify the prevalence of colonization with GBS and whether the obstetrical characteristics are statistically associated with the study group's antimicrobial susceptibility patterns of tested GBS strains. This observational study was conducted between 1 May and 31 December 2021 at The Department of Obstetrics and Gynecology at Elias University Emergency Hospital (EUEH) in Bucharest, Romania. A total of 152 samples were positive for GBS and included in the study according to the inclusion criteria. As a result, the prevalence of colonized patients with GBS was 17.3%. GBS isolated in this population had the highest resistance to erythromycin (n = 38; 25%), followed by clindamycin (n = 36; 23.7%). Regarding the susceptibility patterns of tested strains to penicillin, the 152 susceptible strains had MIC breakpoints less than 0.06 μg/μL. The susceptibility patterns of tested strains to linezolid indicated three resistant strains with low levels of resistance (MICs ranging between 2 and 3 μg/μL). Multidrug resistance (at least three antibiotic classes) was not observed. In conclusion, although GBS naturally displays sensitivity to penicillin, the exact bacterial susceptibility testing should be performed in all cases where second-line therapy is taken into consideration for treatment. We acknowledge the need for future actions to limit multidrug-resistant bacteria.

Prevalence, Antimicrobial Susceptibility Pattern and Associated Factors of Group B Streptococcus Among Pregnant Women Attending Antenatal Care at Bule Hora University Teaching Hospital, Southern Ethiopia

Background

In many parts of the world, Group B Streptococcus (GBS) is a major cause of maternal and neonatal illness and mortality. It has a negative impact on neonatal and pregnancy outcomes. A worrisome problem in Ethiopia is the unknown rate of antibiotic resistance and the risk factors connected to GBS infections.

Objective

This study was to determine the prevalence, antibiotic susceptibility pattern, and related variables of Group B Streptococcus among pregnant women receiving prenatal treatment conducted at Bule Hora University Teaching Hospital, Southern Ethiopia, between June 1 and August 30, 2022.

Methods

An institutional-based cross-sectional study was conducted among 213 pregnant women attending antenatal care at Bule Hora University Teaching Hospital. Data on sociodemographic and related factors were gathered using structured questionnaires. The study's participants were selected using the consecutive sampling method. The lower vaginal/rectum area was brushed with a sterile cotton swab to capture the vaginal/rectum swab sample, which was then examined using microbiological techniques. The Kirby-Bauer disc diffusion method was used to assess antibiotic susceptibility in GBS isolates. Logistic regression analysis was performed on the data using SPSS version 26. It was deemed statistically significant when the p-value was 0.05 with a 95% confidence interval (CI).

Results

The overall prevalence of GBS was 16.9% (CI: 0.12-0.23). A history of prematurity of the membrane (AOR: 3.35, 95% CI: 1.19-9.45), a history of stillbirth (AOR: 2.88, 95% CI: 1.07-7.71), and preterm delivery history (AOR: 3.41, 95% CI: 1.31-8.89) (p 0.05) were independent predictors of GBS infection. Cefepime had the highest resistance at 58.3%. Most GBS isolates showed high susceptibility to vancomycin (97.2%) and ampicillin (91.7%). Multidrug resistance was 13.9%.

Conclusion

The prevalence of GBS was considerably high among pregnant women in this study. This finding emphasises the need for routine screening and testing of antimicrobial susceptibility to provide antibiotic prophylaxis and minimise newborn infection and comorbidity.

Intracellular bacterial communities in patient with recurrent urinary tract infection caused by Staphylococcus spp and Streptococcus agalactiae: a case report and literature review

Background

 Urinary tract infections (UTI) are among the most frequent pathologies worldwide. Uropathogenic Escherichia coli (UPEC) is the leading etiological agent; however, depending on the patient's characteristics, the etiology may include some atypical pathogens. Some pathogenic bacteria can internalize in the urothelial and phagocytic cells complicating treatment and timely diagnosis.

Case presentation

We present a clinical case of a married female patient with urological alteration, constant catheterization, and urethral dilation with recurrent UTI for ten years, with five episodes per year and reports of negative urine culture. The microscopic analysis revealed intracellular bacterial communities (IBC) and pyocytes with active bacteria. A protocol was designed for the release of intracellular bacteria in urine samples; without the proposed treatment, the urine culture was negative. However, upon releasing the internalized bacteria, we obtained a polymicrobial urine culture. We isolated and identified Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus simulans, and Streptococcus agalactiae. All microorganisms were sensitive to nitrofurans and sulfas. The patient is under treatment with nitrofurantoin and continuous follow-up by our workgroup.

Conclusions

 It is essential to look for IBC and pyocytes with active bacteria in patients with recurrent UTIs to avoid false-negative urine culture results and provide timely treatment. Polymicrobial culture must be considered depending on the patient and clinical history.