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Kwatra G, Izu A, Cutland C, Akaba G, Ali MM, Ahmed Z, Beck MM, Barsosio HC, Berkley JA, Chaka TE, Cossa A, Chakraborty S, Dhar N, Dorji P, Islam M, Keita AM, Mwakio S, Mwarumba S, Medugu N, Mucavele H, Mabombo V, Obaro S, Sigaúque B, Sow SO, Saha SK, Santhanam S, Sharma R, Simoes EAF, Sahni RD, Tapia MD, Veeraraghavan B, Madhi SA. Prevalence of group B Streptococcus colonisation in mother-newborn dyads in low-income and middle-income south Asian and African countries: a prospective, observational study. THE LANCET. MICROBE 2024; 5:100897. [PMID: 39178870 PMCID: PMC11464403 DOI: 10.1016/s2666-5247(24)00129-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/26/2024] [Accepted: 05/09/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Rectovaginal group B Streptococcus (GBS) colonisation in pregnant individuals at the time of labour is a major risk factor for invasive GBS disease by age 7 days (early-onset disease). We aimed to investigate the prevalence of rectovaginal GBS colonisation at the time of labour among pregnant women and vertical transmission to their newborns across selected low-income and middle-income African and south Asian countries. METHODS This prospective, observational study was undertaken at 11 maternity and obstetric care facilities based in Ethiopia, Kenya, Mozambique, Nigeria, Mali, South Africa, Bangladesh, India, and Bhutan. HIV-negative pregnant women aged 18-45 years who were in the early stages of labour and at least 37 weeks' gestation were eligible for inclusion. Lower vaginal and rectal swabs and urine were collected from the women, and swabs of the umbilicus, outer ear, axillary fold, rectum, and throat were obtained from their newborns, for GBS culture. Standardised sampling and culture using direct plating and selective media broth for detection of GBS colonisation was undertaken at the sites. Serotyping of GBS isolates was done in South Africa. The primary outcome was the prevalence of rectovaginal GBS among pregnant women, analysed in participants with available data. This study is registered with the South African National Clinical Trials Register, number DOH-27-0418-4989. FINDINGS 6922 pregnant women were enrolled from Jan 10, 2016, to Dec 11, 2018, of whom 6514 (94·1%; 759-892 per country) were included in the analysis; data from Bhutan were not included in the study due to issues with specimen collection and processing. Overall, the prevalence of maternal GBS colonisation was 24·1% (95% CI 23·1-25·2; 1572 of 6514); it was highest in Mali (41·1% [37·7-44·6]; 314 of 764) and lowest in Ethiopia (11·6% [9·5-14·1]; 88 of 759). The overall rate of vertical transmission of GBS from women with rectovaginal GBS colonisation was 72·3% (70·0-74·4; 1132 of 1566); it was highest in Mozambique (79·2% [73·3-84·2]; 168 of 212) and lowest in Bangladesh (55·8%, 47·5-63·8; 77 of 138). The five most common GBS colonising serotypes were Ia (37·3% [34·9-39·7]; 586 of 1572), V (28·5% [26·3-30·8]; 448 of 1572), III (25·1% [23·0-27·3]; 394 of 1572), II (9·2% [7·8-10·7]; 144 of 1572), and Ib (6·5% [5·4-7·8]; 102 of 1572). There was geographical variability in serotype proportion distribution; serotype VII was the third most common serotype in India (8·6% [5·3-13·7]; 15 of 174) and serotype VI was mainly identified in Bangladesh (5·8% [3·0-11·0]; eight of 138) and India (5·7% [3·2-10·3]; ten of 174). INTERPRETATION Our study reported a high prevalence of GBS colonisation in most settings, with some geographical variability even within African countries. Our findings suggest that serotypes not included in current multivalent capsular-polysaccharide GBS vaccines prevail in some regions, so vaccine efficacy and post-licensure effectiveness studies should assess the effect of vaccination on maternal GBS colonisation given the potential for replacement by non-vaccine serotypes. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Gaurav Kwatra
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Alane Izu
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare Cutland
- African Leadership in Vaccinology Expertise, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Godwin Akaba
- Department of Obstetrics and Gynaecology, The University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Musa Mohammed Ali
- Hawassa University College of Medicine and Health Sciences, School of Medical Laboratory Sciences, Hawassa, Ethiopia
| | - Zabed Ahmed
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | | | | | | | - Tolossa E Chaka
- Department of Pediatrics and Child Health, Adama Hospital Medical College, Adama City, Ethiopia
| | - Anélsio Cossa
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Sowmitra Chakraborty
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Nisha Dhar
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Phurb Dorji
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Maksuda Islam
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Adama Mamby Keita
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Stella Mwakio
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Nubwa Medugu
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria; Department of Medical Microbiology and Immunology, Nile University of Nigeria, Abuja, Nigeria
| | - Helio Mucavele
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Viviana Mabombo
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Stephen Obaro
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Betuel Sigaúque
- Centro de Investigação em Saúde da Manhiça (CISM), Manhica, Mozambique
| | - Samba O Sow
- Le Centre pour le Développement des Vaccins du Mali (CVD-Mali), Bamako, Mali
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh; Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College, Vellore, India
| | - Ragunath Sharma
- Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Eric A F Simoes
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado School of Public Health, Aurora, CO, USA
| | - Rani Diana Sahni
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Milagritos D Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Shabir A Madhi
- South Africa Medical Research Council Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; African Leadership in Vaccinology Expertise, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; Wits Infectious Diseases and Oncology Research Institute, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
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Tesfaye A, Fekede M, Getu F, Mekuria S, Abebe T, Tollosa D, Barsenga S, Tahir B, Kedir Roble A, Tesfaye S, Walle M. Vertical Transmission of Group B Streptococcus, Prevalence, Associated Factors, and Antimicrobial Susceptibility Profile among Newborns Delivered at Health Facilities in Jigjiga City, Ethiopia. Int J Microbiol 2024; 2024:5673366. [PMID: 39129911 PMCID: PMC11316908 DOI: 10.1155/2024/5673366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 06/09/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
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.
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Affiliation(s)
- Addisu Tesfaye
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Mahlet Fekede
- Department of PediatricsCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Fasil Getu
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Surafel Mekuria
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Tigist Abebe
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Daniel Tollosa
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Shamil Barsenga
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Bawlah Tahir
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Abdurahman Kedir Roble
- Department of MidwiferySchool of NursingCollege of Medicine and Health ScienceJigjiga University, Jigjiga, Ethiopia
| | - Sara Tesfaye
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
| | - Muluken Walle
- Department of Medical Laboratory ScienceCollege of Medicine and Health SciencesJigjiga University, Jigjiga, Ethiopia
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Mercado-Evans V, Zulk JJ, Hameed ZA, Patras KA. Gestational diabetes as a risk factor for GBS maternal rectovaginal colonization: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2024; 24:488. [PMID: 39033123 PMCID: PMC11264770 DOI: 10.1186/s12884-024-06694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 07/12/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Maternal rectovaginal colonization by group B Streptococcus (GBS) increases the risk of perinatal GBS disease that can lead to death or long-term neurological impairment. Factors that increase the risk of rectovaginal GBS carriage are incompletely understood resulting in missed opportunities for detecting GBS in risk-based clinical approaches. There is a lacking consensus on whether gestational diabetes mellitus (GDM) is a risk factor for rectovaginal GBS. This systematic review and meta-analysis aims to address current conflicting findings and determine whether GDM should be clinically considered as a risk factor for maternal GBS colonization. METHODS Peer-reviewed studies that provided GDM prevalence and documented GBS vaginal and/or rectal colonization in women with and without GDM were included in this analysis. From study inception to October 30, 2023, we identified 6,275 relevant studies from EMBASE and PUBMED of which 19 were eligible for inclusion. Eligible studies were analyzed and thoroughly assessed for risk of bias with a modified Newcastle-Ottawa Scale that interrogated representativeness and comparability of cohorts, quality of reporting for GDM and GBS status, and potential bias from other metabolic diseases. Results were synthesized using STATA 18 and analyzed using random-effects meta-analyses. RESULTS Studies encompassed 266,706 women from 10 different countries, with study periods spanning from 1981 to 2020. Meta-analysis revealed that gestational diabetes is associated with a 16% increased risk of rectovaginal GBS carriage (OR 1.16, CI 1.07-1.26, P = 0.003). We also performed subgroup analyses to assess independent effects of pregestational vs. gestational diabetes on risk of maternal GBS carriage. Pregestational diabetes (Type 1 or Type 2 diabetes mellitus) was also associated with an increased risk of 76% (pooled OR 1.76, CI 1.27-2.45, P = 0.0008). CONCLUSIONS This study achieved a consensus among previously discrepant observations and demonstrated that gestational diabetes and pregestational diabetes are significant risk factors for maternal rectovaginal carriage of GBS. Recognition of GDM as a risk factor during clinical decisions about GBS screening and intrapartum antibiotic prophylaxis may decrease the global burden of GBS on maternal-perinatal health.
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Affiliation(s)
- Vicki Mercado-Evans
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS 385, Houston, TX, 77030, USA
- Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jacob J Zulk
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS 385, Houston, TX, 77030, USA
| | - Zainab A Hameed
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS 385, Houston, TX, 77030, USA
| | - Kathryn A Patras
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, One Baylor Plaza, MS 385, Houston, TX, 77030, USA.
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, 77030, USA.
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Lee KW, Yap SF, Murdan S, Zainudin Z, Abdul Hamid H, Emamjomeh M, Mohd Desa MN, Sither Joseph NM, Azmai Amal MN, Amin-Nordin S. Maternal and neonatal group B streptococcus colonisation: A systematic review and the meta-analysis of matched-pair studies. Acta Paediatr 2024; 113:892-911. [PMID: 38351491 DOI: 10.1111/apa.17152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 04/11/2024]
Abstract
AIM To determine the prevalence of group B Streptococcus (GBS) carriage among parturient women and neonates, and the relative risk of vertical transmission, the relative risk of early and late-onset GBS and the pooled incidence of early-late-onset GBS infection. METHODS A systematic search of relevant cohort studies from three electronic databases to identify all relevant studies published up to 7 November 2022. The review was conducted in accordance with PRISMA guidelines. Estimates were pooled using random-effects meta-analyses. RESULTS A total of 54 articles with 355 787 matched pairs of parturient women and neonates from 30 countries were included in the analysis. The pooled prevalence of GBS colonisation was 17.1% among the pregnant women and 1.0% among neonates. The pooled prevalence of vertical transmission of GBS was 4.5% and the pooled relative risk of GBS colonisation of neonates born to mothers with GBS was 9.9. CONCLUSION We support the implementation of targeted intrapartum antibiotic prophylaxis for all women who are positive for GBS as well as women with risks factors for early onset GBS in their infants regardless of their GBS colonisation status.
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Affiliation(s)
- Kai Wei Lee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sook Fan Yap
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Centre for Research on Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, UK
| | - Zurina Zainudin
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Obstetric and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohsen Emamjomeh
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Nasir Mohd Desa
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Narcisse Mary Sither Joseph
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohammad Noor Azmai Amal
- Department of Biology, Faculty of Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Kharrat R, Ben Ayed N, Ktari S, Regaieg C, Mezghani S, Hmida N, Mahjoubi F, Gargouri A, Hammami A. Group B Streptococcus and Perinatality in the South of Tunisia: Epidemiology, Serotype Distribution, and Antibiotic Susceptibility. Fetal Pediatr Pathol 2024; 43:21-32. [PMID: 38069499 DOI: 10.1080/15513815.2023.2287519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION In the lack of updated Tunisian epidemiological data, we sought to describe the epidemiology of Group B Streptococcus (GBS) in pregnant women and newborns. MATERIALS AND METHODS A retrospective analysis of GBS neonatal invasive infections and a cross-sectional study evaluating the prevalence of maternal GBS colonization were conducted. GBS isolates were tested for antimicrobial susceptibility, serotyped, and assessed for the appurtenance to the hypervirulent ST17 clone. RESULTS Of 98 neonates with GBS, early-onset GBS disease (EOD) comprised 83.7 and 16.3% were late-onset GBS disease (LOD). The prevalence of maternal GBS colonization was 27%. All GBS isolates were susceptible to penicillin. Serotype III predominated (42.6%) for neonatal invasive infections. GBS isolates belonging to the ST17 sequence type were found only as serotype III. CONCLUSION This study documents the frequency of GBS EOD, the high rate of maternal GBS colonization, and the predominance of the hypervirulent clone type III/ST17 in infants.
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Affiliation(s)
- Rim Kharrat
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nourelhouda Ben Ayed
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Ktari
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Chiraz Regaieg
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sonda Mezghani
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nedia Hmida
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Faouzia Mahjoubi
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Abdellatif Gargouri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Adnene Hammami
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Liu Y, Liu W, Zhuang G, Liu W, Qiu C. Colonisation of Group B Streptococcus and its effects on pregnancy outcomes in pregnant women in Guangzhou, China: a retrospective study. BMJ Open 2023; 13:e078759. [PMID: 38011982 PMCID: PMC10685966 DOI: 10.1136/bmjopen-2023-078759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/10/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES This study was to investigate the colonisation rate of Group B Streptococcus (GBS) during pregnancy, and to evaluate the influence of GBS colonisation on pregnancy outcomes. DESIGN A retrospective cohort study. SETTING Data of 47 380 pregnant women from 2016 to 2022 were collected from the Maternal and Child Health Hospital of Huadu District, Guangzhou City, China. PARTICIPANTS A total of 15 040 pregnant women were eligible for this study, of which 32 340 were excluded due to non-native pregnant women, in vitro fertilization infants, malformed fetuses, habitual abortion, abortions due to poor reproductive or obstetrical history, artificial insemination, umbilical cord torsion, and other diseases during pregnancy. PRIMARY OUTCOME MEASURES The incidence rates of GBS colonisation and premature delivery, fetal distress, premature rupture of membranes (PROM), low birth weight (LBW), abortion and stillbirth. RESULTS Of the 15 040 pregnant women included in this study, 1445 developed GBS colonisation, with a prevalence of 9.61% (95% CI, 9.15 to 10.09). Advanced maternal age (≥35 years) predisposed women to GBS colonisation, and the occurrence of GBS colonisation varied among different ethnic groups. Our data revealed that fetal distress, PROM and LBW were more common in pregnant women colonised with GBS than in pregnant women not colonised with GBS. The incidence for premature delivery, fetal distress, PROM and LBW in infants of pregnant women colonised with GBS was 41.0% (OR=1.410, 95% CI, 1.134 to 1.753), 282.5% (OR=3.825, 95% CI, 3.185 to 4.593), 14.9% (OR=1.149, 95% CI, 1.005 to 1.313), and 29.7% (OR=1.297, 95% CI, 1.010 to 1.664), respectively. CONCLUSIONS GBS colonisation was relatively low in pregnant women in Guangzhou. Women of advanced maternal age were more prone to GBS colonisation, and pregnant women colonised with GBS were more predisposed to fetal distress, PROM and LBW.
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Affiliation(s)
- Yanxia Liu
- Department of Clinical Laboratory, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
| | - Weiling Liu
- Department of Clinical Laboratory, Foshan Fosun Chancheng Hospital, Foshan, Guangdong, China
| | - Guiying Zhuang
- Department of Neonatology, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
| | - Weiqi Liu
- Department of Clinical Laboratory, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
| | - Cuiqing Qiu
- Medical Information Office, The Maternal and Children Health Care Hospital (Huzhong Hospital) of Huadu, Guangzhou, Guangdong, China
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Clinical Profile and Risk Factors of Group B Streptococcal Colonization in Mothers from the Eastern District of China. J Trop Med 2022; 2022:5236430. [PMID: 36211624 PMCID: PMC9534697 DOI: 10.1155/2022/5236430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The main aim of this study was to determine the prevalence, capsular genotyping, antimicrobial susceptibility, and associated factors of colonizing Group B Streptococcus (GBS) in pregnant women admitted to a hospital in Jinan, East China. Methods Demographic data, clinical characteristics, and vaginal and rectal swabs were obtained from a group of expecting mothers subjected to GBS screening at the late stage of pregnancy who went into labor over the period from November 2019 to October 2020. Identification of GBS and determination of antimicrobial resistance patterns were performed using a BD Phoenix-100 system. Capsular genotypes were analyzed using polymerase chain reaction and the associated factors were evaluated via logistic regression. Result A total of 2761 pregnant women were recruited for this study. The GBS colonization rate was 6.70% (185/2761). Among the 172 GBS strains examined, all were susceptible to vancomycin and linezolid. Resistance was the highest for erythromycin (80.2%), followed by clindamycin (75.0%), levofloxacin (65.1%), and tetracycline (57.6%). The most common serotype identified was Ia (61.0%), followed by III (29.7%), VI (4.6%), II (3.5%), VII (0.6%), and a nontypeable strain. Risk factors for maternal GBS colonization included maternal age (older than 30 years) (OR = 1.913 (1.662, 2.478)), gestational age at birth (average gestational age) (OR = 1.992 (1.445, 2.746)), and prelabor rupture of membrane (OR = 3.838 (1.619, 9.099)). Conclusion The prevalence of GBS was relatively low. The maternal age was a factor associated with GBS colonization. Subjects showing GBS positivity during late pregnancy were prone to prolonged rupture of the membrane (PROM) and birth at lower a gestation age than the GBS-negative group. Penicillin could still be used as the first agent of choice for intrapartum antibiotic prophylaxis (IAP).
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Antimicrobial Resistance Profile and Associated Factors of Group B Streptococci Colonization among Pregnant Women Attending Antenatal Clinics in Jigjiga, Southeast Ethiopia. Int J Microbiol 2022; 2022:9910842. [PMID: 35401756 PMCID: PMC8989580 DOI: 10.1155/2022/9910842] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/13/2022] [Indexed: 12/05/2022] Open
Abstract
Background Streptococcus agalactiae (group B Streptococcus, GBS) is one of the causes of maternal and neonatal morbidity and mortality in many parts of the world. It is associated with severe maternal and neonatal outcomes. The colonization rate, associated factors, and antimicrobial sensitivity (AST) profile of GBS among pregnant women in Eastern Ethiopia is less studied. Methods A cross-sectional study was conducted from 1st March to 30th May, 2021 in Jigjiga. A total of 182 pregnant women with a gestational period of ≥36 weeks were included. A structured questionnaire was used to collect data on the participants' demographic and clinical history. Vaginal-rectal samples were collected by brushing the lower vagina and rectum with a sterile cotton swab for bacteriological culture. An antimicrobial sensitivity test (AST) was performed using the Kary-Bauer disk diffusion method. Data were entered and analyzed using SPSS version 25. The logistic regression model was used to find out factors associated with GBS colonization. Results GBS colonization among pregnant women attending antenatal care was at 15.9% (29/182). The AST result showed that the majority of the isolates were sensitive to vancomycin (96.6%), chloramphenicol (96.6%), ampicillin (93.1%) azithromycin (89.7%), and penicillin (86.2%). In contrast, the isolates were found to be resistant to ceftriaxone, erythromycin, ciprofloxacin, clindamycin, and tetracycline at 17.2%, 20.7%, 27.6%, 27.6%, and 34.5%, respectively. Multidrug resistance (MDR) was noted in 4 isolates (13.79%). GBS colonization was significantly associated a with history of preterm labor (<37 weeks of gestation) (AOR = 3.87, 95% CI = 1.36–10.9) and a history of prolonged ruptured membrane (>18 hr.) (AOR = 3.44, 95% CI = 1.34–8.83). Conclusions The colonization rate of GBS was considerably high among pregnant women attending antenatal care in the present study area. The observed antimicrobial resistance for the common drugs and the reported MDR level calls for routine screening of pregnant women for GBS and actions to minimize antimicrobial resistance (AMR) should be strengthened.
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Leykun Y, Genet C, Mulu W. 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. Infect Drug Resist 2021; 14:5457-5472. [PMID: 34949929 PMCID: PMC8691132 DOI: 10.2147/idr.s343429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/09/2021] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- Yasabe Leykun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Genet
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Biochemistry and Microbiology, Faculty of Sciences, Ghent University, Ghent, Belgium
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AlZuheiri STS, Dube R, Menezes G, Qasem S. Clinical Profile and Outcome of Group B Streptococcal Colonization in Mothers and Neonates in Ras Al Khaimah, United Arab Emirates: A Prospective Observational Study. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:235-240. [PMID: 34667470 PMCID: PMC8474000 DOI: 10.4103/sjmms.sjmms_213_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/29/2021] [Accepted: 06/24/2021] [Indexed: 11/24/2022]
Abstract
Background: Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE). Objective: The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome. Methods: This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35–37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP). Results: A total of 2295 women were included, of which 158 (6.9%) had positive cultures for GBS colonization. The carriage rate was higher in women without any risk factors for early-onset GBS disease (EOGBS) (P < 0.01). The GBS isolates were about 97% susceptible to linezolid and vancomycin, 90% to benzyl penicillin and 95% to ampicillin. Resistance to trimethoprim/sulfamethoxazole, clindamycin, erythromycin, and levofloxacin were about 77%, 57%, 57%, and 10%, respectively. Urinary tract infection in GBS colonized women were more common in those aged ≤30 years (P = 0.009). Fetal outcome was favorable in women receiving IAP for GBS colonization. No neonate had culture proven EOGBS. Conclusion: The prevalence of GBS colonization in pregnant women as well as the overall maternal and neonatal complications is low in Ras Al Khaimah, UAE. IAP is effective in preventing early-onset sepsis in newborn, and thus should be initiated in those with GBS colonization. The cultured GBS showed sensitivity to most antibiotics.
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Affiliation(s)
- Shatha Taher Salman AlZuheiri
- Department of Obstetrics and Gynecology, Abdulla Bin Omran Hospital for Obstetrics and Gynecology, Ras Al-Khaimah, UAE
| | - Rajani Dube
- Department of Obstetrics and Gynecology, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Godfred Menezes
- Department of Microbiology, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Samar Qasem
- Department of Obstetrics and Gynecology, Abdulla Bin Omran Hospital for Obstetrics and Gynecology, Ras Al-Khaimah, UAE
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Wang Y, Zhao Y, Zou L, Qiao J, Benitz WE. Regional Variation of Early-onset Neonatal Group B Streptococcal Disease Prevention Strategies in Mainland China. Pediatr Infect Dis J 2021; 40:663-668. [PMID: 34097659 DOI: 10.1097/inf.0000000000003089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prevention strategies can reduce the incidence of early-onset group B Streptococcus (GBS) neonatal sepsis (EOGBS). Rates of GBS colonization and infection vary among regions within China. China has not adopted a unified prevention strategy. METHODS To assess strategies to reduce EOGBS in China, models were developed to quantify residual EOGBS rates with intrapartum antibiotic prophylaxis in infants ≥ 35 weeks' gestation in risk factor-based and antepartum screening-based strategies. Maternal GBS colonization rates and EOGBS incidence in 3 regions of China (A: Xiamen of Fujian province, B: Shanghai and C: Liuzhou of Guangxi province) were estimated from published data. RESULTS Estimates for GBS colonization and attack rates were 21.6%, 11.7% and 6.1% and 1.79, 1.79 and 0.58 per 1000 live births for regions A, B and C, respectively. Modeling predicted that strategies including screening cultures beginning at 36 weeks' gestation and intrapartum antibiotic prophylaxis in 90% of eligible parturients could reduce EOGBS incidence to 0.44, 0.50 and 0.16 per 1000 live births in these regions. In region C, the expected EOGBS rate could be reduced to 0.28 per 1000 using a risk factor-based strategy. CONCLUSIONS Different strategies for preventing EOGBS may be needed in different regions of mainland China. Screening strategies may be most appropriate in regions with higher attack rates, even with moderate levels of maternal GBS colonization. In areas with low attack rates, risk factor strategies that reduce morbidity by at least one-third may suffice.
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Affiliation(s)
- Yan Wang
- From the Department of Obstetrics and Gynecology, Peking University Third Hospital
| | - Yangyu Zhao
- From the Department of Obstetrics and Gynecology, Peking University Third Hospital
| | - Liying Zou
- Department of Obstetrics and Gynecology, Beijing Obstetrics and Gynecology Hospital, Beijing, People's Republic of China
| | - Jie Qiao
- From the Department of Obstetrics and Gynecology, Peking University Third Hospital
| | - William E Benitz
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Gao K, Deng Q, Huang L, Chang CY, Zhong H, Xie Y, Guan X, Liu H. Diagnostic Performance of Various Methodologies for Group B S treptococcus Screening in Pregnant Woman in China. Front Cell Infect Microbiol 2021; 11:651968. [PMID: 34109134 PMCID: PMC8183470 DOI: 10.3389/fcimb.2021.651968] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Maternal vaginal/rectal colonization of group B streptococcus (GBS) is a main risk for neonatal invasive infection. Efficient determination of GBS colonization in pregnant women is crucial. This study aimed to investigate the prevalence of GBS carriage and evaluate the diagnostic performance of six methodologies for GBS screening conducted in China, including blood agar plate, liquid chromogenic medium, and loop-mediated isothermal amplification (LAMP) without pre-enrichment, chromogenic agar plate with pre-enrichment, and GBS antigen detection without and with pre-enrichment in comparison with the standard reference method (Lim broth-enriched subculture with plating on 5% sheep blood agar). Vaginal/rectal swabs were collected from 1,281 pregnant women at 35–37 weeks of gestation. Of them, 309 were taken in triplicate, one for Lim broth-enriched subculture, one for blood agar plate, and the third for GBS antigen detection (Reagent W); 177 were acquired in duplicate, one for Lim broth-enriched subculture and the other for GBS antigen detection (Reagent H); 502 were obtained in duplicate, one for Lim broth-enriched subculture and the other for liquid chromogenic medium; 158 were collected in duplicate, one for Lim broth-enriched subculture and the other for LAMP; and 135 were inoculated in Lim broth-enriched for GBS antigen detection (Reagent W) and subculture with chromogenic agar plate and 5% blood agar plate. The overall prevalence of GBS carriage was 10.1% (130/1,281, 95% CI: 8.5–12.1%) according to the standard reference method. Compared with the standard reference method, the LAMP had excellent performance of sensitivity (100%, 95%CI: 83.4–100%), specificity (94%, 95%CI: 88.1–97.1%), and Yoden index (0.940); as well as the blood agar plate with sensitivity (81.5%, 95%CI: 61.3–93.0%), specificity (100%, 95%CI: 98.3–100.0%), and Yoden index (0.815). The other four methods were not sufficient to reach the threshold in terms of sensitivity or specificity compared to the standard reference method. Furthermore, for LAMP, results can be obtained within 0.5–1 h, while for blood agar plate, which needed 24–48 h, and further identification was required. Our data suggested that the performance of LAMP was highly comparable to the standard Lim broth-enriched subculture and LAMP is considered as an alternative for fast and accurate GBS screening.
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Affiliation(s)
- Kankan Gao
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Qiulian Deng
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lianfen Huang
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Chien-Yi Chang
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Huamin Zhong
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yongqiang Xie
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoshan Guan
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haiying Liu
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.,Clinical Laboratory, Guangzhou Brain Hospital, Guangzhou Medical University, Guangzhou, China
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Prevalence of group B streptococcal colonization in the healthy non-pregnant population: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:968-980. [PMID: 33813109 DOI: 10.1016/j.cmi.2021.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/17/2021] [Accepted: 03/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Colonization and transmission precede invasive group B streptococcal (GBS) disease. Data on GBS colonization prevalence, detection methods and risk factors for carriage are relevant for vaccine development and to understand GBS pathogenesis. OBJECTIVES To evaluate GBS colonization prevalence after the first week of life in the healthy non-pregnant population. DATA SOURCES Pubmed/Medline, Embase, Latin American and Caribbean Health Sciences Literature, World Health Organization Library Information System, and Scopus. Search performed 12 January 2021 with search terms related to 'GBS' and 'colonization, epidemiology, prevalence or screening' without restrictions. STUDY ELIGIBILITY CRITERIA All studies that reported prevalence of GBS colonization (any site) in the healthy population. PARTICIPANTS All individuals (>6 days of age), with no indication of pregnancy, invasive disease or severe underlying immunological co-morbidities. METHODS Logit transformation and a random effects model (DerSimonian and Laird) were used to pool colonization estimates. Subgroup analysis and meta-regression on a priori determined subgroups were performed. RESULTS We included 98 studies with 43 112 participants. Our search identified 9309 studies of which 8831 were excluded based on title and abstract and 380 after reading the full text. Colonization rates varied considerably between studies (I2 = 97%), which could be partly explained by differences in culture methods (R2 = 27%), culture sites (R2 = 24%), continent (R2 = 10%) and participant's age (R2 = 6%). Higher prevalence was found with selective culture methods (19%, 95% CI 16%-23% versus non-selective methods 8%, 95% CI 6%-9%; p < 0.0001). Colonization rates were highest in rectum (19%, 95% CI 15%-24%), vagina (14%, 95% CI 12%-17%) and urethra (9%, 95% CI 5%-18%). In participants with negative rectal cultures, 7% (95% CI 5%-9%) had GBS cultured from another niche. Colonization prevalence was lower in children (6 months to 16 years; 3%, 95% CI 2%-5%) compared with adults (16%, 95% CI 14%-20%; p < 0.0001). Using selective culture methods in adults resulted in a prevalence of 26% (95% CI 19%-33%) rectal, 21% (95% CI 17%-25%) vaginal and 9% (95% CI 6%-14%) urethral colonization. CONCLUSION The rectum is the most common body site colonized by GBS. The best approach to screen for any GBS colonization is to screen multiple body sites using selective culture methods.
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Bathing or Not Bathing: Which Is Better for Umbilical Cord Separation Time and Bacterial Colonization in Neonates? ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2020. [DOI: 10.5812/pedinfect.104100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Sepsis is the third cause of death in the first month of life, and the umbilical cord is an important source for sepsis Objectives: We compared the effects of bathing or not bathing on bacterial colonization and cord separation time. Methods: A quasi-experimental study assessed term newborns at Golestan hospital, Tehran, Iran, from 2019 to 2020 in three groups. Bath (B) group included neonates who were bathed with tub water every two days (n = 90). Clean product (CP) group neonates were bathed with cleaners every two days (n = 87). Dry care cord (D) group neonates were not bathed during the first 10 days (n = 63). Periumbilical cord swabs were collected on the 10th day and cultured in blood agar and Eosin methylene blue agar. Bacterial sensitivity tests were done by disk diffusion. Results: The average time to cord separation was 8.2 ± 1.74 days (group B: 9.1 ± 2.1 days, group CP: 8.7 ± 1.82 days, group D: 6.8 ± 1.3 days), which was shorter in group D (P= 0.048). The positive culture rates were 77.8% in group B, 78.1% in group CP, and 74.6% in group D, which were not significantly different between the groups (P = 0.073). Staphylococcus aureus was the most common isolated species. Staphylococcus epidermis and Escherichia coli were the other most common species. Conclusions: Bathing with or without cleaners is safe. No-bath and water bath with or without cleaners had no difference in the rate and type of bacterial culture in umbilical cord but the cord separation time was shorter in the no-bath group. Therefore, in the first week, if a mother does not believe in bathing her baby, she should not be denounced and told that she did something wrong with cord hygiene.
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15
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Kum-Nji P, Meloy L, Pierce J, Ritter A, Wheeler R. Group B streptococcal colonization: Prevalence and impact of smoking in women delivering term or near term neonates in a large tertiary care hospital in the southern United States. PLoS One 2020; 15:e0239294. [PMID: 32941502 PMCID: PMC7498066 DOI: 10.1371/journal.pone.0239294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS The role of smoking as a risk factor for group B streptococcal (GBS) colonization in women during pregnancy has not been previously adequately explored. We hypothesized that women of term or near term neonates who smoked during pregnancy were more likely to have GBS colonization than their non-smoking counterparts. METHODS The electronic health records (EHRs) of a convenience sample of women delivering in an inner-city university tertiary care center were reviewed. The outcome variable of interest was maternal GBS colonization during pregnancy. The primary independent variable of interest was tobacco smoking during pregnancy, determined from the EHRs by the number of cigarettes smoked during gestation. Descriptive statistics were conducted and categorical data were compared by the Fischer's exact test. Multiple logistic regression analysis was further conducted to determine the independent impact of tobacco smoke exposure on GBS colonization. RESULTS The prevalence of maternal GBS colonization was 35% among the study population. In the univariate analyses, factors associated with maternal GBS colonization were tobacco smoking during pregnancy (P of trend <0.001), Race (P<0.001), maternal age <20 years (P = 0.006), low birthweight <2500 gm (P = 0.020), maternal drug use (P = 004), and gestational age <37 (P = 0.041). In a multiple logistic regression analysis, tobacco smoking during pregnancy remained the most significant predictor of GBS colonization. Women who smoked during pregnancy were more than twice more likely to be colonized than their non-smoking counterparts (OR = 2.6; 95% CI = 1.5-4.6; p<0.001). Maternal age was the only other significant predictor with younger mothers more than one and a half time more likely to be colonized than their older counterparts (OR = 1.65; 95% CI = 1.02-2.68; P = 0.04). CONCLUSION The prevalence of GBS colonization in this institution was consistent with recent national rates. Smoking and maternal age were identified as two independent risk factors for GBS colonization during pregnancy. Further studies are needed to confirm these findings.
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Affiliation(s)
- Philip Kum-Nji
- Children’s Hospital of Richmond at the Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Linda Meloy
- Children’s Hospital of Richmond at the Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - John Pierce
- Lynchburg Women’s Health, Lynchburg, Virginia, United States of America
| | - Amanda Ritter
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | - Rachel Wheeler
- Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
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Goel N, Wattal C, Gujral K, Dhaduk N, Mansukhani C, Garg P. Group B Streptococcus in Indian pregnant women: Its prevalence and risk factors. Indian J Med Microbiol 2020; 38:357-361. [PMID: 33154247 DOI: 10.4103/ijmm.ijmm_20_333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Purpose To study the prevalence of group B streptococci (GBS) in Indian pregnant women and associated risk factors. Methods Four hundred and fifty pregnant women attending antenatal outpatient/inpatient department between 35-38 weeks of gestation were enrolled in the study. All enrolled subjects were assessed by a predefined proforma for their demographics, socio-economic characteristics, education, toilet habits, obstetric history and clinical outcome. Two cotton swabs each from lower vagina and rectum were collected and plated on selective solid media CHROM agar Strept B (CHROMagarTM) and selective Enrichment Broth LIM RambaQUICK StreptB broth (CHROMagarTM). Presumptive identification of GBS was growth of 1-3 mm grayish white β-hemolytic colonies on BAP or mauve coloured colonies on CHROM agar Strept B. All presumptively identified GBS were confirmed as group B streptococcus by automated identification system-Vitek MS (Bio Merieux). Results The recto vaginal colonization rate of GBS in this study was observed as 3.3% (n=15). GBS colonization was significantly associated with nulliparous women (p= 0.026) and use of western style toilet (p=0.017). GBS urinary tract infections was also seen more commonly in women with GBS rectovaginal colonization (p=0.002). Conclusion Due to the low GBS prevalence and no significant association with major risk factors, we recommend to institute universal screening of GBS in pregnant women, instead of risk based screening. Since this was a single centric study with low prevalence of GBS, its applicability may be limited, therefore further larger multi-centric prospective studies are required to understand the true GBS prevalence in Indian society.
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Affiliation(s)
- Neeraj Goel
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Chand Wattal
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Kanwal Gujral
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Nehal Dhaduk
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Chandra Mansukhani
- Institute of Obstetrics and Gynaecology, Sir Ganga Ram Hospital, New Delhi, India
| | - Pankaj Garg
- Institute of Neonatology, Sir Ganga Ram Hospital, New Delhi, India
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Proportion of Streptococcus agalactiae vertical transmission and associated risk factors among Ethiopian mother-newborn dyads, Northwest Ethiopia. Sci Rep 2020; 10:3477. [PMID: 32103109 PMCID: PMC7044167 DOI: 10.1038/s41598-020-60447-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/12/2020] [Indexed: 12/03/2022] Open
Abstract
Group B Streptococcus (GBS) vertical transmission causes fetal and neonatal colonization and diseases. However, there is scarcity of data in low-income countries including Ethiopia. We conducted a cross-sectional study on 98 GBS positive mothers, and their newborns to find proportion of vertical transmission. GBS was identified from swabs by using recommended methods and vertical transmission at birth was confirmed by the culture of body surface swabs of newborns within 30 minutes following birth. GBS positivity among swabbed specimens collected for other purposes was 160/1540 (10.4%); 98 were from 385 recto-vaginal swabs of pregnant women, and 62 were from 1,155 swabs of the 385 births. Of the 98 GBS positive cases, 62 newborns were GBS colonized with vertical transmission proportion of 63.3%(95% CI: 54.1–72.4%). We identified that the proportion of vertical transmission in this study was within the range of other many global studies, but higher than recently published data in Ethiopia. Maternal educational level, employment and lower ANC visit were significantly associated risk factors to GBS vertical transmission. Efforts need to be made to screen pregnant women during antenatal care and to provide IAP to GBS positive cases to reduce mother to newborn vertical transmission.
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Szylit NA, Malburg FL, Piccinato CDA, Ferreira LADP, Podgaec S, Zlotnik E. Prevalence of rectovaginal colonization by group B Streptococcus in pregnant women seen at prenatal care program of a health organization. EINSTEIN-SAO PAULO 2019; 18:eAO4920. [PMID: 31826077 PMCID: PMC6905166 DOI: 10.31744/einstein_journal/2020ao4920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the prevalence of group B
Streptococci
in pregnant women of a corporate health program, as well as the epidemiological correlations. Methods This retrospective study used medical records of patients who participated of the prenatal care program at a private hospital in the city of São Paulo (SP), Brazil, from 2015 to 2016. Those who abandoned the program or had incomplete data in their medical records were excluded. Quantitative variables were described by means, standard deviations, median, minimal and maximal values. Parity and socioeconomic status were described by absolute frequency and percentages. We used logistic regression models in the software (SPSS) to analyze correlations of variables according to vaginal-rectal culture, considering a 95%CI and p-values. Variables were age, number of pregnancies, weight gain in pregnancy and gestational age at delivery. Results A total of 347 medical records were included, and after applying the exclusion criteria, 287 medical records composed the final sample. Patients’ age ranged between 17 and 44 years. Mean age was 30.6 years, 67 patients had positive result for group B
Streptococcus
(prevalence of 23.3%; 95%CI: 18.7-28.5). Conclusion Considering the high prevalence of group B
Streptococcus
in our service, the antibiotic prophylaxis strategy based on rectovaginal culture screening approach seems to be cost-effective.
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Affiliation(s)
| | | | | | | | - Sérgio Podgaec
- Hospital Israelita Albert Einstein , São Paulo , SP , Brazil
| | - Eduardo Zlotnik
- Hospital Israelita Albert Einstein , São Paulo , SP , Brazil
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Szylit NA, Malburg FL, Piccinato CDA, Ferreira LADP, Podgaec S, Zlotnik E. Prevalence of rectovaginal colonization by group B
Streptococcus
in pregnant women seen at prenatal care program of a health organization. EINSTEIN-SAO PAULO 2019. [DOI: 10.31744/einstein_journal/2019ao4920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Huang J, Lin XZ, Lai JD, Fan YF. [Group B streptococcus colonization in pregnant women and group B streptococcus infection in their preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:567-572. [PMID: 31208511 PMCID: PMC7389577 DOI: 10.7499/j.issn.1008-8830.2019.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the incidences of group B streptococcus (GBS) colonization in pregnant women and GBS infection in their preterm infants, and to investigate the risk factors for GBS colonization in preterm infants. METHODS A total of 859 women who delivered before term from January 2017 to January 2018 were enrolled in this prospective cohort study. Bacterial culture was performed for GBS using the swabs collected from the rectum and the lower 1/3 of the vagina of the pregnant women on admission. A total of 515 of the above cases underwent real-time PCR assay for testing of GBS DNA. Bacterial culture was performed for GBS using the oropharyngeal secretion, gastric fluid or blood samples in preterm infants born to the 859 pregnant women. Peripheral blood samples from the pregnant women and umbilical cord blood samples from their preterm infants were collected to determine the level of anti-GBS capsular polysaccharide antibody. The incidence of GBS infection and perinatal risk factors for GBS colonization in the preterm infants were examined. RESULTS The positive rate for GBS in the rectal and vaginal cultures was 14.8% (127/859) among the 859 pregnant women, and the positive rate in the GBS DNA testing was 15.1% (78/515). There were 976 live-birth preterm infants delivered by 859 pregnant women, and 4.4% (43/976) of whom were GBS positive. Four preterm infants had early-onset GBS diseases, including pneumonia in two cases and sepsis in two cases. In 127 preterm infants delivered by 127 GBS-positive pregnant women, the preterm infant group with a gestational age between 34 and 37 weeks had a significantly lower GBS positive rate and a significantly higher level of anti-GBS capsular polysaccharide antibody compared with the preterm infant group with a gestational age of less than 34 weeks (P=0.013 and 0.001 respectively). A multivariate logistic regression analysis revealed that premature rupture of membranes time >18 hours and chorioamnionitis were independent risk factors for GBS colonization in preterm infants (OR=6.556 and 6.160 respectively; P<0.05). CONCLUSIONS GBS positive rate and anti-GBS capsular polysaccharide antibody level in preterm infants are correlated with gestational age. premature rupture of membranes time >18 hours and chorioamnionitis may increase the risk of GBS colonization in preterm infants.
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Affiliation(s)
- Jing Huang
- Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University/Xiamen Maternal and Child Care Hospital, Xiamen, Fujian 361001, China.
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Affiliation(s)
- Richard A Stein
- Department of Biochemistry and Molecular Pharmacology, NYU Langone Health, New York, NY
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