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Nielsen SY, Hoffmann-Lücke E, Henriksen TB, Hartvigsen CM, Helmig RB, Khalil MR, Møller JK, Pedersen LH, Murra M, Greibe E. Timing and dosage of intrapartum prophylactic penicillin for preventing early-onset group B streptococcal disease: assessing maternal and umbilical cord blood concentration. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-326986. [PMID: 38729749 DOI: 10.1136/archdischild-2024-326986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Timing of administration of antibiotics and concentrations in maternal blood and the umbilical cord blood are important prerequisites for optimal intrapartum antibiotic prophylaxis (IAP) of neonatal early-onset group B streptococcus (GBS) disease. This cohort study aimed to explore penicillin concentrations in mothers and infants at birth in relation to time elapsed from administration to delivery and to the minimal inhibitory concentration (MIC) for GBS. MAIN OUTCOME MEASURES Penicillin G concentrations in maternal and umbilical cord blood in relation to time and dose from administration to time of delivery. RESULTS In 44 mother-infant dyads, median maternal penicillin G concentration was 0.2 mg/L (IQR 0-0.8 mg/L; range 0-1.6 mg/L). Median infant penicillin G concentration was 1.2 mg/L (IQR 0.5-5.0 mg/L; range 0-12.7 mg/L). In all infants (N=38) born less than 4 hours after the latest IAP administration, penicillin G concentrations far exceeded MIC (0.125 mg/L), even after short time intervals between IAP administration and birth. The highest plasma concentrations were reached in umbilical cord blood within 1 hour from IAP administration to birth.For 44 mother-infant dyads, maternal concentrations were very low compared with their infants'; particularly, very high concentrations were seen in the 20 infants with only one dose of IAP. CONCLUSION High concentrations of penicillin G were found in umbilical cord blood of infants born less than 4 hours after IAP administration, well above the MIC for GBS.
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Affiliation(s)
- Stine Yde Nielsen
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Elke Hoffmann-Lücke
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Tine Brink Henriksen
- Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet Faculty of Health, Aarhus, Denmark
| | | | - Rikke Bek Helmig
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Mohammed Rohi Khalil
- Department of Obstetrics and Gynecology, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
| | | | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine and Biomedicine, Aarhus University, Aarhus, Denmark
| | - May Murra
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Eva Greibe
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus Universitet Faculty of Health, Aarhus, Denmark
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Björklund V, Saxén H, Hertting O, Malchau Carlsen EL, Hoffmann S, Håkansson S, Stefánsson Thors V, Haraldsson Á, Brigtsen AK, Döllner H, Huhtamäki H, Pokka T, Ruuska TS. Early-onset group B streptococcal infections in five Nordic countries with different prevention policies, 1995 to 2019. Euro Surveill 2024; 29:2300193. [PMID: 38240058 PMCID: PMC10797658 DOI: 10.2807/1560-7917.es.2024.29.3.2300193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/30/2023] [Indexed: 01/22/2024] Open
Abstract
BackgroundNeonatal early-onset disease caused by group B Streptococcus (GBS) is a leading cause of infant morbidity. Intrapartum antibiotic prophylaxis (IAP) is effective in preventing early-onset GBS disease, but there is no agreement on the optimal strategy for identifying the pregnant women requiring this treatment, and both risk-based prophylaxis (RBP) and GBS screening-based prophylaxis (SBP) are used.AimThe aim of this study was to evaluate the effect of SBP as a public health intervention on the epidemiology of early-onset GBS infections.MethodsIn 2012, Finland started the universal SBP, while Denmark, Iceland, Norway and Sweden continued with RBP. We conducted an interrupted time series analysis taking 2012 as the intervention point to evaluate the impact of this intervention. The incidences of early- and late-onset GBS infections during Period I (1995-2011) and Period II (2012-2019) were collected from each national register, covering 6,605,564 live births.ResultsIn Finland, a reduction of 58% in the incidence of early-onset GBS disease, corresponding to an incidence rate ratio (IRR) of 0.42 (95% CI: 0.34-0.52), was observed after 2012. At the same time, the pooled IRR of other Nordic countries was 0.89 (95% CI: 0.80-1.0), specifically 0.89 (95% CI: 0.70-1.5) in Denmark, 0.34 (95% CI: 0.15-0.81) in Iceland, 0.72 (95% CI: 0.59-0.88) in Norway and 0.97 (95% CI: 0.85-1.1) in Sweden.ConclusionsIn this ecological study of five Nordic countries, early-onset GBS infections were approximately halved following introduction of the SBP approach as compared with RBP.
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Affiliation(s)
- Verna Björklund
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Harri Saxén
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Olof Hertting
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Emma Louise Malchau Carlsen
- Department of Intensive Care for Newborns and Infants, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Stellan Håkansson
- Department of Clinical Science/Paediatrics, Umeå University, Umeå, Sweden
| | - Valtýr Stefánsson Thors
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Ásgeir Haraldsson
- Children's Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - Anne Karin Brigtsen
- Department of Neonatal Intensive Care, Clinic of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Henrik Döllner
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Children's Clinic, St. Olavs University Hospital, Trondheim, Norway
| | - Heikki Huhtamäki
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Tytti Pokka
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Terhi Susanna Ruuska
- Department of Paediatrics and Adolescent Medicine, Oulu University Hospital, Oulu, Finland
- Biocenter Oulu and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
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Majigo M, Makupa J, Mwazyunga Z, Luoga A, Kisinga J, Mwamkoa B, Kim S, Joachim A. Bacterial Aetiology of Neonatal Sepsis and Antimicrobial Resistance Pattern at the Regional Referral Hospital, Dar es Salam, Tanzania; A Call to Strengthening Antibiotic Stewardship Program. Antibiotics (Basel) 2023; 12:antibiotics12040767. [PMID: 37107129 PMCID: PMC10135403 DOI: 10.3390/antibiotics12040767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The diagnosis of neonatal sepsis in lower-income countries is mainly based on clinical presentation. The practice necessitates empirical treatment with limited aetiology and antibiotic susceptibility profile knowledge, prompting the emergence and spread of antimicrobial resistance. We conducted a cross-sectional study to determine the aetiology of neonatal sepsis and antimicrobial resistance patterns. We recruited 658 neonates admitted to the neonatal ward with signs and symptoms of sepsis and performed 639 automated blood cultures and antimicrobial susceptibility testing. Around 72% of the samples were culture positive; Gram-positive bacteria were predominantly isolated, contributing to 81%. Coagulase-negative Staphylococci were the most isolates, followed by Streptococcus agalactiae. Overall, antibiotic resistance among Gram-positive pathogens ranged from 23% (Chloramphenicol) to 93% (Penicillin) and from 24.7% (amikacin) to 91% (ampicillin) for Gram-negative bacteria. Moreover, about 69% of Gram-positive and 75% of Gram-negative bacteria were multidrug-resistant (MDR). We observed about 70% overall proportion of MDR strains, non-significantly more in Gram-negative than Gram-positive pathogens (p = 0.334). In conclusion, the pathogen causing neonatal sepsis in our setting exhibited a high resistance rate to commonly used antibiotics. The high rate of MDR pathogens calls for strengthening antibiotic stewardship programs.
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Affiliation(s)
- Mtebe Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
| | - Jackline Makupa
- Medipeace Global Health, Dar es Salaam P.O. Box 77978, Tanzania
| | - Zivonishe Mwazyunga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Anna Luoga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Julius Kisinga
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Bertha Mwamkoa
- Mwananyamala Regional Referral Hospital, Dar es Salaam P.O. Box 61665, Tanzania
| | - Sukyung Kim
- Medipeace Global Health, Dar es Salaam P.O. Box 77978, Tanzania
| | - Agricola Joachim
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam P.O. Box 65001, Tanzania
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Khalil MR, Hartvigsen CM, Thorsen PB, Møller JK, Uldbjerg N. Maternal age and body mass index as risk factors for rectovaginal colonization with group B streptococci. Int J Gynaecol Obstet 2023; 161:303-307. [PMID: 36086996 DOI: 10.1002/ijgo.14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the effect of including maternal age and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) as additional risk factors in the traditional risk-based strategy at term pregnancies consisting of previous early-onset group B streptococcus (GBS) disease, GBS bacteriuria during pregnancy, maternal temperature of 38.0°C or more intrapartum, and rupture of membranes of 18 h or longer. METHODS A secondary analysis of a Danish cohort including 902 pregnant women. Exposures were maternal age and pre-pregnancy BMI. Outcome was rectovaginal GBS colonization at the time of labor. The logistic regression analysis adjusted for parity, gestational age, vaginal delivery, and smoking. RESULTS The GBS prevalence was 17% in the entire population, 35% among participants older than 40 years, and 23% among those with a BMI of 25 or greater. Including maternal "age > 40" as an additional risk factor increased the sensitivity of the risk-based strategy from 21% to 26% and decreased the specificity from 90% to 87%. Inclusion of "BMI ≥ 25" increased the sensitivity from 21% to 57% and decreased the specificity from 90% to 59%. CONCLUSIONS Maternal age and BMI might be included as additional risk factors in risk-based programs for identification of GBS-positive laboring women to receive intrapartum antibiotics prophylaxis.
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Affiliation(s)
- Mohammed R Khalil
- Department of Obstetrics and Gynecology, Lillebaelt Hospital, Kolding, Denmark
| | | | - Poul B Thorsen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark.,Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
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5
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Nusman CM, Snoek L, van Leeuwen LM, Dierikx TH, van der Weijden BM, Achten NB, Bijlsma MW, Visser DH, van Houten MA, Bekker V, de Meij TGJ, van Rossem E, Felderhof M, Plötz FB. Group B Streptococcus Early-Onset Disease: New Preventive and Diagnostic Tools to Decrease the Burden of Antibiotic Use. Antibiotics (Basel) 2023; 12:antibiotics12030489. [PMID: 36978356 PMCID: PMC10044457 DOI: 10.3390/antibiotics12030489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/18/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023] Open
Abstract
The difficulty in recognizing early-onset neonatal sepsis (EONS) in a timely manner due to non-specific symptoms and the limitations of diagnostic tests, combined with the risk of serious consequences if EONS is not treated in a timely manner, has resulted in a low threshold for starting empirical antibiotic treatment. New guideline strategies, such as the neonatal sepsis calculator, have been proven to reduce the antibiotic burden related to EONS, but lack sensitivity for detecting EONS. In this review, the potential of novel, targeted preventive and diagnostic methods for EONS is discussed from three different perspectives: maternal, umbilical cord and newborn perspectives. Promising strategies from the maternal perspective include Group B Streptococcus (GBS) prevention, exploring the virulence factors of GBS, maternal immunization and antepartum biomarkers. The diagnostic methods obtained from the umbilical cord are preliminary but promising. Finally, promising fields from the newborn perspective include biomarkers, new microbiological techniques and clinical prediction and monitoring strategies. Consensus on the definition of EONS and the standardization of research on novel diagnostic biomarkers are crucial for future implementation and to reduce current antibiotic overexposure in newborns.
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Affiliation(s)
- Charlotte M. Nusman
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Linde Snoek
- Department of Neurology, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Lisanne M. van Leeuwen
- Department of Paediatrics and Department of Vaccin, Infection and Immunology, Spaarne Hospital, Boerhaavelaan 22, 2035 RC Haarlem, The Netherlands
- Department of Paediatrics, Willem Alexander Children Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Thomas H. Dierikx
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Meibergdreef 69-71, 1105 BK Amsterdam, The Netherlands
| | - Bo M. van der Weijden
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatrics, Tergooi Hospital, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands
| | - Niek B. Achten
- Department of Paediatrics, Erasmus University Medical Centre, Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Merijn W. Bijlsma
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Douwe H. Visser
- Department of Neonatology, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marlies A. van Houten
- Department of Paediatrics and Department of Vaccin, Infection and Immunology, Spaarne Hospital, Boerhaavelaan 22, 2035 RC Haarlem, The Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Willem Alexander Children’s Hospital, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Tim G. J. de Meij
- Department of Pediatric Gastroenterology, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Meibergdreef 69-71, 1105 BK Amsterdam, The Netherlands
| | - Ellen van Rossem
- Department of Paediatrics, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Mariet Felderhof
- Department of Paediatrics, Flevo Hospital, Hospitaalweg 1, 1315 RA Almere, The Netherlands
| | - Frans B. Plötz
- Department of Paediatrics, Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Department of Paediatrics, Tergooi Hospital, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands
- Correspondence: ; Tel.: +31-88-753-3664
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Schilling AL, Rody A, Bossung V. Antibiotic Use During Pregnancy and Childbirth: Prospective Observational Study on Prevalence, Indications, and Prescribing Patterns in a German Tertiary Center. Geburtshilfe Frauenheilkd 2022; 83:192-200. [PMID: 37151734 PMCID: PMC10155238 DOI: 10.1055/a-1934-1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/28/2022] [Indexed: 12/04/2022] Open
Abstract
Abstract
Introduction Antibiotics are powerful drugs to prevent and treat perinatal infections. Overuse of antibiotics leads to antibiotic resistance, has potential side effects and
influences the maternal and neonatal microbiome.
Patients and Methods We performed a prospective observational study on the prevalence, indications, and prescribing patterns of antibiotics during pregnancy and childbirth. We
included women who had given birth after 23+0 weeks of gestation at a single tertiary center in Germany from January 2020 to March 2021. Descriptive statistics and binomial regression were
performed to analyze the factors influencing the prescription of antibiotics.
Results We included 522 postpartum women into our study. 337 (64.6%) were exposed to antibiotics during pregnancy and/or childbirth. 115 women received antibiotics during pregnancy,
291 during birth. Most antibiotics during pregnancy were prescribed for urinary tract infections (UTIs) (56.0%). Most prescriptions were issued by obstetrics and gynecology physicians
(65.8%), followed by hospitals (16.7%) and family medicine physicians (8.8%). Most antibiotics during childbirth were given for a cesarean section (64.3%), followed by preterm rupture of
membranes (41.2%). 95.3% of women who had a preterm birth were exposed to antibiotics. In logistic regression models, lower gestational age at birth, higher maternal body-mass-index and
smoking were independently associated with antibiotic use during pregnancy and childbirth.
Conclusion We found a high rate of antibiotic exposure during pregnancy and childbirth. Our results imply an urgent need for antibiotic stewardship programs in perinatal medicine as
well as further research on the effects of perinatal antibiotic exposure on microbiome development and childhood health.
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Affiliation(s)
- Anna-Lara Schilling
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Achim Rody
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Verena Bossung
- Department of Obstetrics, University Hospital of Zürich, Zürich, Switzerland
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Kugelman N, Kleifeld S, Shaked-Mishan P, Assaf W, Marom I, Cohen N, Gruber M, Lavie O, Waisman D, Kedar R, Bardicef M, Damti A. Group B Streptococcus real-time PCR may potentially reduce intrapartum maternal antibiotic treatment. Paediatr Perinat Epidemiol 2022; 36:548-552. [PMID: 34888893 DOI: 10.1111/ppe.12841] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/30/2021] [Accepted: 11/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Protocols for preventing early-onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real-time polymerase chain reaction (PCR) can provide a result within 30-60 min and has been found to be specific and sensitive for defining intrapartum GBS status. OBJECTIVE To evaluate whether implementation of GBS fast real-time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics. METHODS This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35-37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real-time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration. RESULTS Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real-time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1). CONCLUSIONS Compared with antepartum universal culture screening or intrapartum risk-factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real-time PCR, without compromising the sensitivity of GBS detection.
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Affiliation(s)
- Nir Kugelman
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shiran Kleifeld
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Wisam Assaf
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Inbal Marom
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nadav Cohen
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Maya Gruber
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dan Waisman
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Neonatology, Carmel Medical Center, Haifa, Israel
| | - Reuven Kedar
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Mordehai Bardicef
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Amit Damti
- Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Um S, Her J, Kim SH, Song SA, Kim YN, Shin JH. Performance of BD MAX Group B Streptococcus (GBS) Assay without Enrichment for the Detection of GBS. Ann Lab Med 2022; 42:478-481. [PMID: 35177569 PMCID: PMC8859559 DOI: 10.3343/alm.2022.42.4.478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/29/2021] [Accepted: 12/03/2021] [Indexed: 11/21/2022] Open
Abstract
Group B streptococcus (GBS) is an important pathogen causing neonatal early-onset disease. We evaluated the diagnostic performance of BD Max GBS assay (Becton Dickinson, Franklin Lakes, NJ, USA) without enrichment (direct BDM) for detecting GBS using vaginal and rectal specimens in comparison with culture. In total, 716 specimens collected from 358 pregnant women between June 2018 and May 2020 were included in this study. Bacterial culture was performed using ChromID Strep B agar (bioMérieux, Marcy-l’Étoile, France), and species identification results were confirmed using the VITEK-MS system (bioMérieux). The sensitivity of direct BDM for vaginal and rectal specimens was 75.0% and 100%, respectively. Thirteen specimens showed discrepant results: 10 false-negative results in the vaginal specimens and three false-positive results in the rectal specimens. The overall agreement between direct BDM and culture was 98.9% (354/358). The final sensitivity and specificity of direct BDM were 98.5% and 99.0%, respectively. Discrepant results—one false-negative and three false-positives—were obtained for four specimens. Direct BDM shows a good diagnostic performance and will be useful for GBS screening within a few hours.
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Affiliation(s)
- Sewhan Um
- Inje University College of Medicine, Busan, Korea
| | - Jaeyoung Her
- Inje University College of Medicine, Busan, Korea
| | - Si Hyun Kim
- Department of Clinical Laboratory Science, Semyung University, Jecheon, Korea
| | - Sae Am Song
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea
| | - Young Nam Kim
- Department of Obstetrics and Gynecology, Inje University College of Medicine, Busan, Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine, Inje University College of Medicine, Busan, Korea.,Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Korea
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Piffer S, Rizzello R, Pedron M, Dellanna L, Lauriola AL. Screening of group B Streptococcus infection in pregnancy and neonatal outcomes in the province of Trento, Italy. LE INFEZIONI IN MEDICINA 2022; 30:254-262. [PMID: 35693054 PMCID: PMC9177189 DOI: 10.53854/liim-3002-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
The study analyzes the trend of group B streptococcal (GBS) infection in pregnancy in the province of Trento, Italy, where a universal screening of GBS infection in pregnancy has been active for some time. Data from pregnant women who gave birth at local maternity units between 2015-2019 were obtained from birth attendance certificates (BAC), the main - and mandatory - source of information for monitoring pregnancies, births and neonatal health in Italy. The BAC used in the province of Trento acquires the results of a vast range of infections in pregnancy. The data collected from the BAC were integrated with those provided by the Hospital Information System (SIO). The occurrence of neonatal GBS infection was investigated on 2019 birth cohort, using the hospital discharge archive as an ancillary information source. Between 2015-2019, 20,905 pregnant women received care at maternity units of the province of Trento, Italy, of whom 25.5% were foreigners. The average coverage of GBS testing in pregnancy was 91.8% (95% CI 91.25-92.35) without significant variations from one year to the next. Test coverage varies in relation to maternity units and some socio-demographic characteristics of mothers. The average proportion of GBS positive cases over the study period was 21.0% (95% CI 20.7-21.3), a value that does not show statistically significant changes from one year to the next. The proportion of positive cases appears uneven among the subgroups of pregnant women considered, even if the differences are not statistically significant. In the 2019 birth cohort, newborns to GBS-positive mothers had an excess of stillbirths, of those born with Apgar at 5 minutes <7 and hospitalized at birth. However, these excesses were not statistically significant. Intravenous Antibiotic Prophylaxis (IAP) was performed in 86.8% of births from GBS positive mothers who had an indication for IAP. IAP was inadequate in 7.4% of the GBS positive mothers. Postnatal evaluation of 783 live births to GBS positive mothers identified 3 cases of early neonatal GBS infection. The incidence of neonatal GBS infection over the whole series of live births is 0.71/1,000 (95% CI 0.56-0.86), 0.68/1000 (CI 95% 0.55-0.79) in Italians and 1.07/1000 (95% CI 0.45-1.65) in foreigners. Data collection on infections in pregnancy through BAC allows area-based assessment. The quality of the data recorded in the BAC can be considered satisfactory but it was necessary to access to other information sources. The local availability of various information sources should allow periodic audits and closer monitoring of neonatal GBS infection.
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Affiliation(s)
- Silvano Piffer
- Clinical and Evaluational Epidemiology Service. Provincial Health Agency, Trento, Italy
| | - Roberto Rizzello
- Clinical and Evaluational Epidemiology Service. Provincial Health Agency, Trento, Italy
| | - Mariangela Pedron
- Clinical and Evaluational Epidemiology Service. Provincial Health Agency, Trento, Italy
| | - Laura Dellanna
- Obstetrics and Gynaecology Unit, Ospedale S. Chiara Trento. Provincial Health Agency, Trento, Italy
| | - Anna Lina Lauriola
- Paediatrics Unit, Ospedale S. Maria del Carmine, Rovereto. Provincial Health Agency, Trento, Italy
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Hartvigsen CM, Nielsen SY, Møller JK, Khalil MR. Reduction of intrapartum antibiotic prophylaxis by combining risk factor assessment with a rapid bedside intrapartum polymerase chain reaction testing for group B streptococci. Eur J Obstet Gynecol Reprod Biol 2022; 272:173-176. [PMID: 35334420 DOI: 10.1016/j.ejogrb.2022.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate the impact of administering Intrapartum Antibiotic Prophylaxis (IAP) to laboring women with one or more risk factors for Early Onset Group B Streptococcal neonatal infection (EOGBS) based on the result of a rapid bedside test for Group B Streptococci (GBS). STUDY DESIGN Quality assessment study. METHODS Three-hundred-sixty-six laboring women admitted to our maternity ward, with one or more risk factors for EOGBS, were prospectively included. Rectovaginal swab-samples were examined bedside by the GenomEra® GBS Polymerase Chain Reaction (PCR) assay upon admission. Time from administration of IAP to delivery was registered. According to national guidelines, one-hundred-two women mandatorily received IAP independent of the PCR test result fulfilling one of the following three risk factors: prior infant with EOGBS, preterm labor before 35 gestational week, temperature ≥ 38 °C during labor. Women with GBS bacteriuria during current pregnancy, rupture of membranes ≥ 18 h IAP, and preterm labor between 35 and 37 gestational week, received IAP solely if the PCR test was positive. Predictive values were calculated for each risk factor. RESULTS Previous GBS bacteriuria was strongly associated (PPV = 71%) with a positive GBS PCR test, whilst the corresponding positive percent of ROM > 18 h and of GA 35-37 was only PPV = 16% and 22%, respectively. Seventy-four women, 74/251 (31%), received IAP because they were GBS PCR positive. IAP was thus reduced by about two-thirds compared to the risk-based strategy of offering IAP to all women with one or more risk factors for EOGBS. Two women, 2/254 (0.8%), received inferior care, as they did not receive IAP within the recommended 4 h prior to delivery due to the extra time spend on the test procedure. CONCLUSION Bedside intrapartum PCR testing of women with risk factors for EOGBS effectively diminishes use of IAP during labor compared to the present risk factor-based strategy alone. In this project, the extra time spend on the PCR test procedure did not lead to noticeable delay in IAP.
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Affiliation(s)
- C M Hartvigsen
- Department of Gynecology and Obstetrics, Kolding Sygehus, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark.
| | - S Y Nielsen
- Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; Institute of Biomedicine, Aarhus University, Høegh-Guldbergs Gade 10, 8000 Aarhus C, Denmark
| | - J K Møller
- Department of Clinical Microbiology, Vejle Sygehus, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark
| | - M R Khalil
- Department of Gynecology and Obstetrics, Kolding Sygehus, University Hospital of Southern Denmark, Sygehusvej 24, 6000 Kolding, Denmark
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11
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Slotved HC, Møller JK, Khalil MR, Nielsen SY. The serotype distribution of Streptococcus agalactiae (GBS) carriage isolates among pregnant women having risk factors for early-onset GBS disease: a comparative study with GBS causing invasive infections during the same period in Denmark. BMC Infect Dis 2021; 21:1129. [PMID: 34724923 PMCID: PMC8561911 DOI: 10.1186/s12879-021-06820-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 01/12/2023] Open
Abstract
Background We describe the serotype distribution of Streptococcus agalactiae (GBS) carriage isolates from women in labor and among GBS isolates causing invasive infections during the same period to see if the distribution of carriage serotypes reflects the GBS serotypes causing invasive diseases including early-onset disease (EOGBS). Methods Data on invasive isolates from 2019 including serotype, erythromycin and clindamycin susceptibility was retrieved from the Danish national reference laboratory, Statens Serum Institut. Carriage isolates were collected from women with risk factors for EOGBS enrolled at delivery at the maternity ward at a Danish University Hospital, first half of 2019. Results Among carriage isolates, the dominant serotype was IX (21 %) followed by serotype III (19 %). The resistance to erythromycin and clindamycin was 21 and 26 %, respectively. Among invasive GBS isolates, no case of EOGBS with serotype IX was detected but the distribution of serotypes were otherwise similar to the GBS carrier strains. The corresponding resistance to erythromycin and clindamycin was 23 and 15 %, respectively. Penicillin resistance was not detected among carriage nor invasive isolates. Conclusions The distribution of serotypes among carriage and invasive GBS reflects the assumption that EOGBS occur following transmission of GBS from mother to newborn, with the exception of serotype IX. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06820-2.
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Affiliation(s)
- Hans-Christian Slotved
- Department of Bacteria, Parasites and, Fungi, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen, Denmark.
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Mohammad Rohi Khalil
- Department of Gynecology and Obstetrics, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Stine Yde Nielsen
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
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12
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Beauruelle C, Treluyer L, Pastuszka A, Cochard T, Lier C, Mereghetti L, Glaser P, Poyart C, Lanotte P. CRISPR Typing Increases the Discriminatory Power of Streptococcus agalactiae Typing Methods. Front Microbiol 2021; 12:675597. [PMID: 34349737 PMCID: PMC8328194 DOI: 10.3389/fmicb.2021.675597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/15/2021] [Indexed: 11/25/2022] Open
Abstract
We explored the relevance of a Clustered regularly interspaced short palindromic repeats (CRISPR)-based genotyping tool for Streptococcus agalactiae typing and we compared this method to current molecular methods [multi locus sequence typing (MLST) and capsular typing]. To this effect, we developed two CRISPR marker schemes (using 94 or 25 markers, respectively). Among the 255 S. agalactiae isolates tested, 229 CRISPR profiles were obtained. The 94 and 25 markers made it possible to efficiently separate isolates with a high diversity index (0.9947 and 0.9267, respectively), highlighting a high discriminatory power, superior to that of both capsular typing and MLST (diversity index of 0.9017 for MLST). This method has the advantage of being correlated with MLST [through analysis of the terminal direct repeat (TDR) and ancestral spacers] and to possess a high discriminatory power (through analysis of the leader-end spacers recently acquired, which are the witnesses of genetic mobile elements encountered by the bacteria). Furthermore, this “one-shot” approach presents the benefit of much-reduced time and cost in comparison with MLST. On the basis of these data, we propose that this method could become a reference method for group B Streptococcus (GBS) typing.
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Affiliation(s)
- Clémence Beauruelle
- Département de Bactériologie-Virologie, Hygiène Hospitalière et Parasitologie-Mycologie, Centre Hospitalier Régional Universitaire (CHRU) de Brest, Brest, France.,Inserm, EFS, UMR 1078, GGB, Universitè de Bretagne Occidentale, Brest, France
| | - Ludovic Treluyer
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France
| | - Adeline Pastuszka
- INRAE, ISP, Université de Tours, Tours, France.,Service de Bactériologie-Virologie, CHRU de Tours, Tours, France
| | | | - Clément Lier
- INRAE, ISP, Université de Tours, Tours, France.,Service de Bactériologie-Virologie, CHRU de Tours, Tours, France
| | - Laurent Mereghetti
- INRAE, ISP, Université de Tours, Tours, France.,Service de Bactériologie-Virologie, CHRU de Tours, Tours, France
| | - Philippe Glaser
- Evolution and Ecology of Resistance to Antibiotics (EERA) Unit, Institut Pasteur, Paris, France.,UMR CNRS 3525, Paris, France
| | - Claire Poyart
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris Descartes University, Paris, France.,Department of Bacteriology, University Hospitals Paris Centre-Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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13
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Khalil MR, Thorsen PB, Møller JK, Uldbjerg N. Polymerase chain reaction for Group B Streptococci (GBS) at labor highly correlates with vaginal GBS load. J Matern Fetal Neonatal Med 2021; 35:6782-6786. [PMID: 33969778 DOI: 10.1080/14767058.2021.1922383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore factors associated with a high vaginal GBS load during labor considering (1) the recto-vaginal GBS load at 35-37 weeks' gestation determined by culture and (2) the vaginal GBS colonization determined by a polymerase chain reaction (PCR) assay during labor. METHODS From an unselected cohort of 902 pregnant women, we obtained (1) recto-vaginal swabs for culture of GBS at 35-37 weeks' gestation (GBSrectovag-36), (2) vaginal swabs for GBS PCR detection at labor (PCRvag-labor), and (3) vaginal swabs for culture of GBS at labor (GBSvag-labor). The GBS load was classified semi quantitatively according to a culture protocol without prior broth enrichment of the swab samples: none (0), few (+), some (++), or many (+++) GBS colonies. RESULTS Among 902 unselected pregnant women, 859 (95%) had a vaginal swab culture taken at labor, which was classified semi quantitatively. High load GBSvag-labor (+++) were found in 31 participants. GBSrectovag-36 showed a sensitivity of 90% (28/31) and a PPV of 23% (28/121), whereas PCRvag-labor had a sensitivity of 98% (30/31, non-significant difference) and a PPV of 42% (30/71, p < .01). PCR at labor had a lower sensitivity (78%) for detection of vaginal colonization with GBS at labor (any load) compared to recto/vaginal colonization with GBS at 36 weeks (92%). Vaginal colonization with GBS at 36 weeks seemed to have a lower sensitivity for detecting GBS in vagina at labor for high load (48%) and for any load (39%). CONCLUSION PCR at labor has higher detection rate (non-significant) and PPV in identification of laboring women with a high load of vaginal GBS compared with recto-vaginal culture at 36 weeks' gestation.
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Affiliation(s)
- Mohammed Rohi Khalil
- Department of Gynecology and Obstetrics, University Hospital of Southern Denmark, Lillebaelt Hospital, Kolding, Denmark
| | - Poul Bak Thorsen
- Department of Gynecology and Obstetrics, University Hospital of Southern Denmark, Lillebaelt Hospital, Kolding, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Lillebaelt Hospital, Vejle, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
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14
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Place K, Rahkonen L, Nupponen I, Kruit H. Vaginal streptococcus B colonization is not associated with increased infectious morbidity in labor induction. Acta Obstet Gynecol Scand 2021; 100:1501-1510. [PMID: 33768531 DOI: 10.1111/aogs.14154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 03/14/2021] [Accepted: 03/21/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Labor induction rates are increasing and, in Finland today, one of three labors is induced. Group B streptococcus (GBS) is a bacterium found in 10%-30% of pregnant women and it can be transmitted to the neonate during vaginal delivery. Although GBS is rarely harmful in the general population, it is the leading cause of severe neonatal infections such as sepsis, pneumonia, and meningitis. In addition, GBS can cause maternal morbidity. Labor induction in GBS-positive women has not yet been investigated but concerns of infectious morbidity associated with balloon catheters have been raised. MATERIAL AND METHODS A historical cohort study of 1959 women undergoing labor induction by balloon catheter in Helsinki University Hospital, Finland, between January 1, 2014 and December 31, 2017. Women with viable singleton term pregnancy in cephalic presentation, unfavorable cervix (Bishop score <6), and intact amniotic membranes were included. GBS was screened by rapid qualitative in vitro test (XPert® GBS) from vaginal and perineal culture upon admission for labor induction. All women testing positive received prophylactic antibiotics. RESULTS Of the women, 469 (23.9%) were GBS-positive. The rate of maternal intrapartum infection was 7.4%, being lower in the GBS-positive group compared with the GBS-negative group (4.7% vs 8.3%; p = 0.01). The rate of maternal postpartum infection was 3.9%, and the rate of neonatal infection was 3.3%, both being similar between the groups. Also, no difference in the rates of other adverse neonatal outcomes was seen. No GBS sepses occurred in the study. In multivariable logistic regression, rupture of membranes to delivery interval ≥12 hours was associated with maternal intrapartum and postpartum infection, as well as neonatal infection. Other risk factors for maternal intrapartum infection were GBS-negativity, nulliparity, prolonged pregnancy (≥41 weeks), and Bishop score <3 at the start of induction. Cesarean section was associated with postpartum endometritis, while nulliparity, gestational diabetes, and maternal intrapartum infection were associated with neonatal infection. CONCLUSIONS Regarding maternal and neonatal infectious morbidity, labor induction with balloon catheter appears safe in women colonized with GBS when prophylactic antibiotics are administered at the onset of labor or at membrane rupture.
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Affiliation(s)
- Katariina Place
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Leena Rahkonen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Irmeli Nupponen
- Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heidi Kruit
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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15
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Khalil MR, Uldbjerg N, Thorsen PB, Møller JK. Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35-37 weeks of pregnancy. Int J Gynaecol Obstet 2020; 151:124-127. [PMID: 32521063 DOI: 10.1002/ijgo.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 05/02/2020] [Accepted: 06/06/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate whether systematic antepartum screening for Group B Streptococci (GBS) by urine culture improves the risk factor-based selection of pregnant women for intrapartum GBS screening with a rapid polymerase chain reaction (PCR) assay. METHODS A prospective observational study was conducted between April 2013 and June 2014. GBS colonization judged by urine culture at 35-37 weeks of gestation was compared with the result of a vaginal GBS PCR test at labor as outcome. The results of urine culture were used as exposure variable. The PCR test was performed on intrapartum vaginal samples. RESULTS Screening for urine GBS in 902 unselected pregnant Danish women at 35-37 weeks of gestation predicted intrapartum PCR GBS status with a sensitivity of 33.6%. A positive predictive value of 41.2% was seen among women with low GBS counts (<104 CFU/mL) and 83.3% among women with high GBS counts (≥104 CFU/mL). Systematic GBS screening of urine at 35-37 weeks of gestation added 30.9% extra women for intrapartum GBS PCR screening in the study group. CONCLUSION Systematic antepartum GBS screening of urine should be implemented in order to improve risk stratification for early onset GBS by offering laboring women an intrapartum GBS PCR test.
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Affiliation(s)
- Mohammed R Khalil
- Department of Gynecology and Obstetrics, University Hospital of Southern Denmark, Lillebaelt Hospital, Kolding, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Poul B Thorsen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Vejle Hospital, Vejle, Denmark
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16
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Nielsen SY, Møller JK, Khalil MR. A comparison of GenomEra® GBS PCR and GeneXpert ® GBS PCR assays with culture of GBS performed with and without broth pre-enrichment. Eur J Clin Microbiol Infect Dis 2020; 39:1945-1950. [PMID: 32535806 PMCID: PMC7497322 DOI: 10.1007/s10096-020-03934-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/24/2020] [Indexed: 12/31/2022]
Abstract
This study was designed to compare the performance of GeneXpert® and GenomEra® group B streptococcus (GBS) PCR assays, held up against standard culture of GBS performed with and without broth pre-enrichment. In Denmark, the strategy for preventing early onset GBS infection (EOGBS) is risk factor based. Three hundred and sixty six women fulfilling one or more of the criteria for presence of risk factors for EOGBS were prospectively included. Rectovaginal swab samples were taken intrapartum and tested bed-site by the GenomEra® and the GeneXpert® GBS PCR assays and cultured at the microbiology laboratory using Granada agar plates with and without prior growth of sampling material in selective enrichment broth. Among 366 participants tested intrapartum, 99 were GBS-positive by culture, 95 by GenomEra, and 95 by GeneXpert. Compared with culture, the GenomEra and the GeneXpert performed with a sensitivity of 91.8% and 91.7% and a specificity of 98.1% and 97.3%, respectively. A combined reference standard was established by defining true positives as either culture-positive samples or culture-negative samples where both the GeneXpert and the GenomEra GBS PCR assays were positive. Using this, the sensitivity increased to 92.2% and the specificity to 99.6% for GenomEra and to 92.0% and 96.8% for GeneXpert. The use of selective broth enrichment found only three additional GBS culture-positive samples. The performance of the two PCR methods examined was very similar and close to the findings by culture, and both PCR assays are thus applicable as rapid intrapartum bed-site tests.
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Affiliation(s)
- S Y Nielsen
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Odense, Denmark. .,Department of Clinical Microbiology, Vejle Hospital, Aarhus University Hospital, Aarhus, Denmark.
| | - J K Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Odense, Denmark
| | - M R Khalil
- Department of Clinical Microbiology, University Hospital of Southern Denmark, Odense, Denmark
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17
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Slotved HC, Hoffmann S. The Epidemiology of Invasive Group B Streptococcus in Denmark From 2005 to 2018. Front Public Health 2020; 8:40. [PMID: 32211361 PMCID: PMC7076979 DOI: 10.3389/fpubh.2020.00040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
Previous epidemiology reports on invasive Streptococcus agalactiae (GBS) infections in Denmark did not include all patient age groups. The aim of this study was therefore to analyze the GBS incidence in all age groups during the period 2005-2018 and to present the serotype distribution and the antibiotic susceptibility. Data were retrieved from the Danish laboratory surveillance system, and these included data on typing and susceptibility testing for erythromycin and clindamycin. Early-onset disease (EOD) (mean incidence 0.17 per 1,000 live births) and late-onset disease (LOD) (mean incidence 0.14 per 1,000 live births) showed a low level during the period. The incidence was stable in the age groups 91 days to 4 years, 5-19 years, and 20-64 years. From 2005 to 2018, the incidence in the elderly showed a significantly increasing trend (P < 0.05), that in the 65-74 years increased from 3.23 to 8.34 per 100,000, and that in the 75+ years increased from 6.85 to 16.01 per 100,000. Erythromycin and clindamycin resistance fluctuated over the period; however, the overall trend was increasing. Data showed that EOD and LOD incidence continued to be low, whereas an increasing trend in GBS infections in the elderly was observed. The prevalence of erythromycin and clindamycin resistance increased from 2005 to 2018.
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Affiliation(s)
- Hans-Christian Slotved
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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18
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Johansen NR, Kjærbye-Thygesen A, Jønsson S, Westh H, Nilas L, Rørbye C. Prevalence and treatment of group B streptococcus colonization based on risk factors versus intrapartum culture screening. Eur J Obstet Gynecol Reprod Biol 2019; 240:178-181. [DOI: 10.1016/j.ejogrb.2019.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
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19
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Furfaro LL, Chang BJ, Payne MS. Detection of group B Streptococcus during antenatal screening in Western Australia: a comparison of culture and molecular methods. J Appl Microbiol 2019; 127:598-604. [PMID: 31120589 DOI: 10.1111/jam.14331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/04/2019] [Accepted: 05/18/2019] [Indexed: 11/27/2022]
Abstract
AIM Global screening strategies for Group B Streptococcus (GBS) include risk- or culture-based methods to guide intrapartum prophylaxis. In Western Australia (WA), antenatal culture-based screening is routine; however, numerous culture methods exist, in addition to molecular methods. We aimed to assess the comparability of research and diagnostic screening approaches. METHODS AND RESULTS Vaginal and rectal swabs were self-collected by pregnant women (n = 531) from King Edward Memorial Hospital, WA, in parallel to routine screening (35-37 weeks of gestation). Research methods involved culture (Strep B Carrot Broth™ and StrepB CHROMagar™) and molecular methods (real-time PCR) and were compared to routine diagnostic screening (Lim Broth and Granada agar). Overall, GBS detection was comparable between research and diagnostic approaches (3-5% discrepancy, kappa = 0·76). Specificity/sensitivity of Carrot Broth™ was 100%/89%, while that of CHROMagar™ was 73%/100%, respectively. Direct PCR was unable to detect GBS in ~18% of specimens which were culture positive; however, it exhibited 100% specificity. CONCLUSIONS This clinical evaluation of GBS screening methods provides support for current practice. SIGNIFICANCE AND IMPACT OF THE STUDY Although CHROM was highly sensitive, further testing is recommended due to a high false-positive rate. Molecular assays are useful for rapid detection; however, low-titre samples may require additional enrichment prior to molecular analysis to improve sensitivity.
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Affiliation(s)
- L L Furfaro
- Division of Obstetrics and Gynaecology, The School of Medicine, The University of Western Australia, Crawley, WA, Australia
| | - B J Chang
- The Marshall Centre for Infectious Diseases Research and Training, The School of Biomedical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - M S Payne
- Division of Obstetrics and Gynaecology, The School of Medicine, The University of Western Australia, Crawley, WA, Australia
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20
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Abstract
Invasive disease due to group B Streptococcus infection (Streptococcus agalactiae) results in a wide spectrum of clinical disease. In North America, serotypes Ia, Ib, II, III, and V are most frequently associated with invasive disease. Group B Streptococcus remains a continuing source of morbidity and mortality in high-risk populations, including pregnant women, neonates, and the elderly; an increasing incidence of invasive disease has been observed in nonpregnant adults. Group B Streptococcus remains the most common culture-confirmed neonatal bacterial infection in the United States and is a significant source of neonatal morbidity globally. Intrapartum antibiotic prophylaxis has reduced the incidence of early-onset neonatal disease without a notable impact on the incidence of late-onset neonatal disease. Penicillin G remains the mainstay of therapy, although reduced penicillin susceptibility has been observed in select isolates. Increased frequency of resistance to non-beta-lactam antibiotics, including clindamycin, erythromycin, and fluoroquinolones, has been observed, with some isolates demonstrating resistance to vancomycin. The development and implementation of strategies to identify hosts, treat judiciously with antimicrobials with the narrowest spectra, and prevent invasive disease, with vaccines, are essential to reduce the burden of group B Streptococcus disease.
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Comparison of BD MAX GBS and GenomEra GBS assays for rapid intrapartum PCR detection of vaginal carriage of group B streptococci. PLoS One 2019; 14:e0215314. [PMID: 30990861 PMCID: PMC6467400 DOI: 10.1371/journal.pone.0215314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/29/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the diagnostic performance of BD MAX and GenomEra PCR assays for a rapid PCR detection of vaginal carriage of group B streptococci at delivery. Methods This is a retrospective laboratory analysis of vaginal swab samples taken intrapartum from a randomly selected cohort of pregnant women giving birth at a single childbirth and maternity unit. Results Ninety-one culture-positive and 279 culture-negative vaginal samples were included from a cohort of 902 women. One-hundred-and-two specimens were found positive with the BD MAX and 84 with the GenomEra PCR assay. No statistically significant difference was observed compared to culture, sensitivity of BD MAX 84.6% (77/91) [95%CI 75.5–91.3] and of GenomEra 71.4% (65/91) [95%CI 61.0–80.4]. When compared to a combined reference standard, no statistically significant differences were seen between culture, BD MAX and GenomEra PCR assays. The sensitivities were 82.7% (91/110) [95%CI 74.3–89.3], 87.3% (96/110) [95%CI 79.6–92.9], and 79.1% (87/110) [95%CI 70.3–86.3], respectively. Conclusion Both PCR assays performed comparably to culture of the intrapartum vaginal samples. In particular, the GenomEra assay is potentially an easy and rapid on-site PCR test for intrapartum detection of vaginal carriage of group B streptococci at a maternity ward to identify women who should receive intrapartum antibiotic prophylaxis.
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Khalil MR, Uldbjerg N, Thorsen PB, Møller JK. Risk-based approach versus culture-based screening for identification of group B streptococci among women in labor. Int J Gynaecol Obstet 2018; 144:187-191. [PMID: 30467848 DOI: 10.1002/ijgo.12721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/24/2018] [Accepted: 11/21/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare a risk-based and culture-based screening approach for identification of group B streptococci (GBS) vaginal colonization using an intrapartum rectovaginal culture as the reference standard. METHODS Pregnant women attending the prenatal clinic at Lillebaelt Hospital, Kolding, Denmark, between April 1, 2013, and June 30, 2014, were invited to participate in a prospective observational study. For prepartum culture-based screening, vaginal and rectal culture samples were obtained and, for reference, standard, paired vaginal and rectal culture samples were collected during labor. Risk factors for risk-based screening were previous early-onset GBS, GBS bacteriuria during pregnancy, maternal temperature ≥38.0°C intrapartum, and rupture of membranes for more than 18 hours. RESULTS The intrapartum rectovaginal GBS colonization rate was 30% (32/108) among participants with risk factors and 15% (123/794) among participants without risk factors. Culture-based screening demonstrated a sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio in predicting intrapartum GBS carriage of 78% (95% confidence interval [CI] 71-84), 95% (94-97), 78% (70-84), 95% (94-97), and 17 (12-23), respectively; for risk-based screening, these values were 21% (15-28), 90% (87-92), 30% (22-38), 85% (83-86), and 2 (1-3), respectively. CONCLUSIONS Culture-based screening performed considerably better than a risk-based approach in identifying intrapartum GBS colonization.
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Affiliation(s)
- Mohammed R Khalil
- Department of Obstetrics and Gynecology, Lillebaelt Hospital, Kolding, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Poul B Thorsen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
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Khalil MR, Thorsen PB, Møller JK, Uldbjerg N. Number of colony forming units in urine at 35–37 weeks’ gestation as predictor of the vaginal load of Group B Streptococci at birth. Eur J Obstet Gynecol Reprod Biol 2018; 223:68-71. [DOI: 10.1016/j.ejogrb.2018.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/15/2018] [Indexed: 01/31/2023]
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