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Goh KGK, Desai D, Thapa R, Prince D, Acharya D, Sullivan MJ, Ulett GC. An opportunistic pathogen under stress: how Group B Streptococcus responds to cytotoxic reactive species and conditions of metal ion imbalance to survive. FEMS Microbiol Rev 2024; 48:fuae009. [PMID: 38678005 PMCID: PMC11098048 DOI: 10.1093/femsre/fuae009] [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: 08/31/2023] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Group B Streptococcus (GBS; also known as Streptococcus agalactiae) is an opportunistic bacterial pathogen that causes sepsis, meningitis, pneumonia, and skin and soft tissue infections in neonates and healthy or immunocompromised adults. GBS is well-adapted to survive in humans due to a plethora of virulence mechanisms that afford responses to support bacterial survival in dynamic host environments. These mechanisms and responses include counteraction of cell death from exposure to excess metal ions that can cause mismetallation and cytotoxicity, and strategies to combat molecules such as reactive oxygen and nitrogen species that are generated as part of innate host defence. Cytotoxicity from reactive molecules can stem from damage to proteins, DNA, and membrane lipids, potentially leading to bacterial cell death inside phagocytic cells or within extracellular spaces within the host. Deciphering the ways in which GBS responds to the stress of cytotoxic reactive molecules within the host will benefit the development of novel therapeutic and preventative strategies to manage the burden of GBS disease. This review summarizes knowledge of GBS carriage in humans and the mechanisms used by the bacteria to circumvent killing by these important elements of host immune defence: oxidative stress, nitrosative stress, and stress from metal ion intoxication/mismetallation.
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Affiliation(s)
- Kelvin G K Goh
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Devika Desai
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Ruby Thapa
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Darren Prince
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Dhruba Acharya
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
| | - Matthew J Sullivan
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
- School of Biological Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom
| | - Glen C Ulett
- School of Pharmacy and Medical Sciences, and Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD 4222, Australia
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Piazzolla HRW, Modin F, Halkjær SI, Petersen AM, Calum H, Holm A. The association between bacteriuria and adverse pregnancy outcomes: a systematic review and meta-analysis of observational studies. J Antimicrob Chemother 2024; 79:241-254. [PMID: 38073146 DOI: 10.1093/jac/dkad374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/24/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Antibiotics for bacteriuria and urinary tract infection are commonly prescribed during pregnancy to avoid adverse pregnancy outcomes. The aim of this study was to evaluate the association between significant bacteriuria in pregnancy and any of the four pregnancy outcomes: preterm delivery; low birth weight; small for gestational age; and preterm labour. METHODS Systematic review with meta-analysis of observational studies. We searched PubMed, EMBASE, the Cochrane CENTRAL library, and Web of Science for observational studies published before 1 March 2022. The risk of bias was assessed using the Newcastle-Ottawa scale. Study identification, data extraction and risk-of-bias assessment was performed by two independent authors. We combined the included studies in meta-analyses and expressed results as ORs with 95% CIs (Prospero CRD42016053485). RESULTS We identified 58 studies involving 421 657 women. The quality of the studies was mainly poor or fair. The pooled, unadjusted OR for the association between any significant bacteriuria and: (i) preterm delivery was 1.62 (95% CI: 1.30-2.01; 27 studies; I2 = 61%); (ii) low birth weight was 1.50 (95% CI: 1.30-1.72; 47 studies; I2 = 74%); (iii) preterm labour was 2.29 (95% CI: 1.53-3.43; 3 studies; I2 = 0%); and (iv) small for gestational age was 1.33 (95% CI: 0.88-2.02; 7 studies; I2 = 54%). Four studies provided an adjusted OR, but were too diverse to combine in meta-analysis. CONCLUSIONS This systematic review identified an association between significant bacteriuria in pregnancy and the three complications: preterm delivery; low birth weight; and preterm labour. However, the quality of the available evidence is insufficient to conclude whether this association is merely due to confounding factors. There is a lack of high-quality evidence to support active identification and treatment of bacteriuria in pregnancy.
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Affiliation(s)
- Hans R W Piazzolla
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frederikke Modin
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sofie I Halkjær
- Gastrounit, Medical Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Andreas M Petersen
- Gastrounit, Medical Section, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Henrik Calum
- Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Anne Holm
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Cowley ES, Chaves IZ, Osman F, Suen G, Anantharaman K, Hryckowian AJ. Determinants of Gastrointestinal Group B Streptococcus Carriage in Adults. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.17.553755. [PMID: 37645860 PMCID: PMC10462156 DOI: 10.1101/2023.08.17.553755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Background Streptococcus agalactiae (Group B Streptococcus, GBS) is a commensal Gram-positive bacterium found in the human gastrointestinal and urogenital tracts. Much of what is known about GBS relates to the diseases it causes in pregnant people and neonates. However, GBS is a common cause of disease in the general population with 90% of GBS mortality occurring in non-pregnant people. There are limited data about the predisposing factors for GBS and the reservoirs in the body. To gain an understanding of the determinants of gastrointestinal GBS carriage, we used stool samples and associated metadata to determine the prevalence and abundance of GBS in the gut microbiome of adults and find risk factors for GBS status. Methods We used 754 stool samples collected from adults in Wisconsin from 2016-2017 to test for the prevalence and abundance of GBS using a Taqman probe-based qPCR assay targeting two GBS-specific genes: cfp and sip. We compared the microbiome compositions of the stool samples by GBS status using 16S rRNA analysis. We compared associations with GBS status and 557 survey variables collected during sample acquisition (demographics, diet, overall health, and reproductive health) using univariate and multivariate analyses. Results We found 137/754 (18%) of participants had detectable GBS in their stool samples with a median abundance of 104 copies per nanogram of starting DNA. There was no difference in GBS status or abundance based on gender. Beta-diversity, Bray-Curtis and Unweighted UniFrac, was significantly different based on carrier status of the participant. Prior to p-value correction, 59/557 (10.6%) survey variables were significantly associated with GBS carrier status and 11/547 (2.0%) variables were significantly associated with abundance (p-value<0.05). After p-value correction, 2/547 (0.4%) variables were associated with GBS abundance: an increased abundance of GBS was associated with a decreased frequency since last dental checkup (p<0.001) and last dental cleaning (p<0.001). Increased GBS abundance was significantly associated with increased frequency of iron consumption (p=0.007) after p-value correction in multivariate models. Conclusions GBS is found in stool samples from adults in Wisconsin at similar frequencies as pregnant individuals screened with rectovaginal swabs. We did not find associations between risk factors historically associated with GBS in pregnant people, suggesting that risk factors for GBS carriage in pregnancy may differ from those in the general population. We found that frequency of iron consumption and dental hygiene are risk factors for GBS carriage in Wisconsin adults. Given that these variables were not assayed in previous GBS surveys, it is possible they also influence carriage in pregnant people. Taken together, this work serves as a foundation for future work in developing approaches to decrease GBS abundance in carriers.
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Affiliation(s)
- Elise S. Cowley
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Ibrahim Zuniga Chaves
- Department of Bacteriology, University of Wisconsin-Madison
- Microbiology Doctoral Training Program, University of Wisconsin-Madison
| | - Fauzia Osman
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Garret Suen
- Department of Bacteriology, University of Wisconsin-Madison
| | | | - Andrew J. Hryckowian
- Department of Medical Microbiology & Immunology, University of Wisconsin-Madison
- Department of Medicine (Division of Gastroenterology & Hepatology), School of Medicine and Public Health, University of Wisconsin-Madison
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Lewis AL, Gilbert NM. Roles of the vagina and the vaginal microbiota in urinary tract infection: evidence from clinical correlations and experimental models. GMS INFECTIOUS DISEASES 2020; 8:Doc02. [PMID: 32373427 PMCID: PMC7186798 DOI: 10.3205/id000046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mounting evidence indicates that the vagina can harbor uropathogenic bacteria. Here, we consider three roles played by the vagina and its bacterial inhabitants in urinary tract infection (UTI) and urinary health. First, the vagina can serve as a reservoir for Escherichia coli, the most common cause of UTI, and other recognized uropathogens. Second, several vaginal bacterial species are frequently detected upon urine culture but are underappreciated as uropathogens, and other vaginal species are likely under-reported because of their fastidious nature. Third, some vaginal bacteria that are not widely viewed as uropathogens can transit briefly in the urinary tract, cause injury or immunomodulation, and shift the balance of host-pathogen interactions to influence the outcomes of uropathogenesis. This chapter describes the current literature in these three areas and summarizes the impact of the vaginal microbiota on susceptibility to UTI and other urologic conditions.
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Affiliation(s)
- Amanda L. Lewis
- Washington University School of Medicine, Department of Molecular Microbiology, St. Louis, United States
| | - Nicole M. Gilbert
- Washington University School of Medicine, Department of Obstetrics and Gynecology, St. Louis, United States
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Schafer R, Phillippi JC. Group B Streptococcal Bacteriuria in Pregnancy: An Evidence-Based, Patient-Centered Approach to Care. J Midwifery Womens Health 2020; 65:376-381. [PMID: 32096338 DOI: 10.1111/jmwh.13085] [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: 09/19/2017] [Revised: 12/10/2019] [Accepted: 12/17/2019] [Indexed: 11/29/2022]
Abstract
Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence-based, patient-centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.
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Affiliation(s)
- Robyn Schafer
- Rutgers University School of Nursing, Newark, New Jersey
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No. 298-The Prevention of Early-Onset Neonatal Group B Streptococcal Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e665-e674. [PMID: 30103891 DOI: 10.1016/j.jogc.2018.05.032] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review the evidence in the literature and to provide recommendations on the management of pregnant women in labour for the prevention of early-onset neonatal group B streptococcal disease. The key revisions in this updated guideline include changed recommendations for regimens for antibiotic prophylaxis, susceptibility testing, and management of women with pre-labour rupture of membranes. OUTCOMES Maternal outcomes evaluated included exposure to antibiotics in pregnancy and labour and complications related to antibiotic use. Neonatal outcomes of rates of early-onset group B streptococcal infections are evaluated. EVIDENCE Published literature was retrieved through searches of MEDLINE, CINAHL, and The Cochrane Library from January 1980 to July 2012 using appropriate controlled vocabulary and key words (group B streptococcus, antibiotic therapy, infection, prevention). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS The recommendations in this guideline are designed to help clinicians identify and manage pregnancies at risk for neonatal group B streptococcal disease to optimize maternal and perinatal outcomes. No cost-benefit analysis is provided. SUMMARY STATEMENT There is good evidence based on randomized control trial data that in women with pre-labour rupture of membranes at term who are colonized with group B streptococcus, rates of neonatal infection are reduced with induction of labour (I). There is no evidence to support safe neonatal outcomes with expectant management in this clinical situation. RECOMMENDATIONS
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Sullivan MJ, Ulett GC. Evaluation of hematogenous spread and ascending infection in the pathogenesis of acute pyelonephritis due to group B streptococcus in mice. Microb Pathog 2019; 138:103796. [PMID: 31614193 DOI: 10.1016/j.micpath.2019.103796] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/26/2022]
Abstract
Group B streptococcus (GBS) causes pyelonephritis in adults but the mechanisms of infection by which GBS infects the kidneys in vivo are unknown. We investigated GBS infection of the kidneys in mice following experimental challenge via the hematogenous route (transient bacteremia model) or transurethral route (bladder infection and cystitis model). Adult female mice were examined for bacterial dissemination to the kidneys and other organ systems at 24-72 h and tissue samples were assessed for histopathological changes. Comparisons included analysis of different challenge inoculum doses ranging between 107-109 CFU and investigation of several GBS serotypes, including representative strains of serotype V (NEM316), III (BM110, 874391) and Ia (807). Mice with transient, low-level GBS bacteremia routinely developed acute pyelonephritis secondary to high-level kidney infection; infection progressed with high GBS burdens that were sustained in the tissue for days in contrast to bacterial clearance in other organs, including spleen, liver and heart. The histopathological changes of acute pyelonephritis due to GBS were characterized using hematoxylin and eosin, and stains for bacteria, neutrophils, macrophages, mast cells and T lymphocytes; this revealed recruitment of a mixed inflammatory cell population that infiltrated the renal medulla of infected mice in focal areas of discrete micro-abscesses. In contrast, bladder infection leading to cystitis in mice did not result in ascending spread of GBS to the kidneys. We conclude that transient bacteremia, rather than preceding infection of the lower urinary tract, is the predominant condition that leads to GBS kidney infection and subsequent development of acute pyelonephritis.
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Affiliation(s)
- Matthew J Sullivan
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, QLD, Australia
| | - Glen C Ulett
- School of Medical Science, and Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, QLD, Australia.
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Puopolo KM, Lynfield R, Cummings JJ, Hand I, Adams-Chapman I, Poindexter B, Stewart DL, Aucott SW, Goldsmith JP, Mowitz M, Watterberg K, Maldonado YA, Zaoutis TE, Banerjee R, Barnett ED, Campbell JD, Gerber JS, Kourtis AP, Munoz FM, Nolt D, Nyquist AC, O’Leary ST, Sawyer MH, Steinbach WJ, Zangwill K. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics 2019; 144:peds.2019-1881. [PMID: 31285392 DOI: 10.1542/peds.2019-1881] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Group B streptococcal (GBS) infection remains the most common cause of neonatal early-onset sepsis and a significant cause of late-onset sepsis among young infants. Administration of intrapartum antibiotic prophylaxis is the only currently available effective strategy for the prevention of perinatal GBS early-onset disease, and there is no effective approach for the prevention of late-onset disease. The American Academy of Pediatrics joins with the American College of Obstetricians and Gynecologists to reaffirm the use of universal antenatal microbiologic-based testing for the detection of maternal GBS colonization to facilitate appropriate administration of intrapartum antibiotic prophylaxis. The purpose of this clinical report is to provide neonatal clinicians with updated information regarding the epidemiology of GBS disease as well current recommendations for the evaluation of newborn infants at risk for GBS disease and for treatment of those with confirmed GBS infection. This clinical report is endorsed by the American College of Obstetricians and Gynecologists (ACOG), July 2019, and should be construed as ACOG clinical guidance.
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Affiliation(s)
- Karen M. Puopolo
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ruth Lynfield
- Minnesota Department of Health, St Paul, Minnesota; and
| | - James J. Cummings
- Departments of Pediatrics and Bioethics, Alden March Bioethics Institute, Albany Medical College, Albany, New York
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Moorhead R, Daley AJ, Lee L, Gorelik A, Garland SM. Compliance with screening for and recommended management of maternal group B streptococcus carriage in pregnancy. Aust N Z J Obstet Gynaecol 2019; 59:837-842. [DOI: 10.1111/ajo.12977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 02/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Andrew J. Daley
- Department of Microbiology and Infectious DiseaseRoyal Women's Hospital Melbourne Australia
- Department of MicrobiologyRoyal Children's Hospital Melbourne Australia
- Department of PaediatricsUniversity of Melbourne Melbourne Australia
| | - Lai‐yang Lee
- Department of Microbiology and Infectious DiseaseRoyal Women's Hospital Melbourne Australia
- Department of MicrobiologyRoyal Children's Hospital Melbourne Australia
| | | | - Suzanne M. Garland
- Department of Microbiology and Infectious DiseaseRoyal Women's Hospital Melbourne Australia
- Department of MicrobiologyRoyal Children's Hospital Melbourne Australia
- Department of Obstetrics and GynaecologyUniversity of Melbourne Melbourne Victoria Australia
- Infection and ImmunityMurdoch Children's Research Institute Melbourne Australia
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Bacterial Load and Molecular Markers Associated With Early-onset Group B Streptococcus: A Systematic Review and Meta-analysis. Pediatr Infect Dis J 2018; 37:e306-e314. [PMID: 29601454 DOI: 10.1097/inf.0000000000002050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The natural history of neonatal group B Streptococcus (GBS) is poorly understood. Little is known about the bacterial factors influencing the transmission of GBS from mother to neonate, or the development of invasive early-onset GBS disease (EOGBS) in colonized neonates. We reviewed whether bacterial load and molecular markers are associated with GBS vertical transmission and progression to EOGBS. METHODS We searched Medline, Embase, Cochrane and Web of Science from inception to October 10, 2016, for observational studies in English. We also hand-searched reference lists of relevant publications and experts cross-checked included studies. Two reviewers independently screened studies, extracted data and appraised the quality of included studies using the Quality in Prognosis Studies tool. We conducted random-effects meta-analyses where possible and narratively synthesized the evidence in text and tables. RESULTS Seventeen studies were included from 1107 records retrieved from electronic databases and publication references. Meta-analyses of 3 studies showed that neonates colonized by serotype III had a higher risk of developing EOGBS than serotype Ia (pooled risk ratio: 1.51, 95% confidence interval: 1.12-2.03) and serotype II (risk ratio: 1.95, 95% confidence interval: 1.10-3.45). Eleven studies showed that in heavily colonized mothers, 2-3 times more neonates were colonized, and in heavily colonized neonates, up to 15 times more neonates had EOGBS, compared with light colonization. Most evidence was published before 2000 and was at risk of bias. CONCLUSIONS Acknowledging the difficulty of natural history studies, well-controlled studies are needed to assess the predictive value of pathogen subtype and heavy load; they may be useful for better-targeted prevention.
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Money D, Allen VM. No 298 - Prévention de l'infection néonatale à streptocoques du groupe B d'apparition précoce. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:e675-e686. [DOI: 10.1016/j.jogc.2018.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bianchi-Jassir F, Seale AC, Kohli-Lynch M, Lawn JE, Baker CJ, Bartlett L, Cutland C, Gravett MG, Heath PT, Ip M, Le Doare K, Madhi SA, Saha SK, Schrag S, Sobanjo-ter Meulen A, Vekemans J, Rubens CE. Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis 2017; 65:S133-S142. [PMID: 29117329 PMCID: PMC5850429 DOI: 10.1093/cid/cix661] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. METHODS We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (<37 weeks' gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases. RESULTS We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99-1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P < .001). CONCLUSIONS From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials.
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Affiliation(s)
- Fiorella Bianchi-Jassir
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Anna C Seale
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia
| | - Maya Kohli-Lynch
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
- Centre for Child and Adolescent Health, School of Social and Community Medicine, University of Bristol, United Kingdom
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, United Kingdom
| | - Carol J Baker
- Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas;
| | - Linda Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Clare Cutland
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
| | - Michael G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington;
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Paul T Heath
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Margaret Ip
- Department of Microbiology, Faculty of Medicine, Chinese University of Hong Kong
| | - Kirsty Le Doare
- Vaccine Institute, Institute for Infection and Immunity, St George’s Hospital, University of London and St George’s University Hospitals NHS Foundation Trust, United Kingdom
- Centre for International Child Health, Imperial College London, United Kingdom
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, and Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand,Johannesburg, South Africa
- National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | | | - Stephanie Schrag
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
| | | | | | - Craig E Rubens
- Global Alliance to Prevent Prematurity and Stillbirth, Seattle, Washington;
- Department of Global Health, University of Washington, Seattle
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Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract. Microbiol Spectr 2017; 4. [PMID: 27227294 DOI: 10.1128/microbiolspec.uti-0012-2012] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.
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Pérez-Moreno MO, Picó-Plana E, Grande-Armas J, Centelles-Serrano MJ, Arasa-Subero M, Ochoa NC, (led by MO Pérez-Moreno) MOTSGGESSAGTE. Group B streptococcal bacteriuria during pregnancy as a risk factor for maternal intrapartum colonization: a prospective cohort study. J Med Microbiol 2017; 66:454-460. [DOI: 10.1099/jmm.0.000465] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Mar Olga Pérez-Moreno
- Institud d’Investigació Sanitària Père Virgili, Tarragona, España
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
| | - Ester Picó-Plana
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
- Present address: Catlab (Centre d’analítiques Terrassa), Vial Sant, Jordi s/n, Poligon Industrial Can Mitjans, 08232, Viladecavalls, Barcelona, Spain
| | - Jesús Grande-Armas
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
- Present address: Servicio Análisis Clínicos, Hospital San Juan de Dios, Carretera Santa Cruz-La Laguna, 53, 38009, Santa Cruz de Tenerife (Tenerife), España
| | - Mª José Centelles-Serrano
- Laboratori Clínic ICS Terres de l’Ebre, Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona, Spain
- Institud d’Investigació Sanitària Père Virgili, Tarragona, España
| | - Mercé Arasa-Subero
- Servei d’Obstetricia i Ginecologia. Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes,14. 43500 Tortosa, Tarragona, Spain
- ASSIR (Atenció a la salut sexual i reproductiva) Regió Sanitària Terres de l´Ebre Avda. Colom 18-20. 43500 Tortosa, Tarragona, Spain
| | - Núria Colomé- Ochoa
- Servei d’Obstetricia i Ginecologia. Hospital de Tortosa Verge de la Cinta Carrer de les Esplanetes,14. 43500 Tortosa, Tarragona, Spain
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Money D, Allen VM. Prévention de l'infection néonatale à streptocoques du groupe B d'apparition précoce. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S336-S347. [PMID: 28063545 DOI: 10.1016/j.jogc.2016.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIF Analyser les données issues de la littérature et formuler des recommandations sur la prise en charge des parturientes en vue de prévenir l'infection néonatale à streptocoques du groupe B d'apparition précoce. Parmi les révisions clés que renferme la présente directive clinique mise à jour, on trouve des modifications quant aux recommandations en ce qui concerne les schémas posologiques d'antibioprophylaxie, les épreuves de sensibilité et la prise en charge des femmes présentant une rupture prématurée des membranes. ISSUES Parmi les issues maternelles évaluées, on trouvait l'exposition aux antibiotiques au cours de la grossesse et du travail, ainsi que les complications associées à l'administration d'antibiotiques. Les issues néonatales associées aux taux d'infection néonatale à streptocoques du groupe B d'apparition précoce ont été évaluées. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed, CINAHL et The Cochrane Library entre janvier 1980 et juillet 2012, au moyen d'un vocabulaire contrôlé et de mots clés appropriés (« group B streptococcus », « antibiotic therapy », « infection », « prevention »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en mai 2013. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. VALEURS La qualité des résultats est évaluée au moyen des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs (Tableau 1). AVANTAGES, DéSAVANTAGES ET COûTS: Les recommandations que renferme la présente directive clinique sont conçues de façon à aider les cliniciens à identifier et à assurer la prise en charge des grossesses exposées à un risque d'infection néonatale à streptocoques du groupe B, en vue d'optimiser les issues maternelles et périnatales. Aucune analyse de rentabilité n'est fournie. DéCLARATION SOMMAIRE: Nous disposons de bonnes données (issues d'essais comparatifs randomisés) indiquant que, chez les femmes présentant une rupture prématurée des membranes à terme qui sont colonisées par des streptocoques du groupe B, le déclenchement du travail entraîne une baisse des taux d'infection néonatale. (I) Aucune donnée ne permet de soutenir que, dans une telle situation clinique, la prise en charge non interventionniste permet l'obtention de bonnes issues néonatales. RECOMMANDATIONS.
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Money D, Allen VM. The Prevention of Early-Onset Neonatal Group B Streptococcal Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 38:S326-S335. [PMID: 28063544 DOI: 10.1016/j.jogc.2016.09.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To review the evidence in the literature and to provide recommendations on the management of pregnant women in labour for the prevention of early-onset neonatal group B streptococcal disease. The key revisions in this updated guideline include changed recommendations for regimens for antibiotic prophylaxis, susceptibility testing, and management of women with pre-labour rupture of membranes. OUTCOMES Maternal outcomes evaluated included exposure to antibiotics in pregnancy and labour and complications related to antibiotic use. Neonatal outcomes of rates of early-onset group B streptococcal infections are evaluated. EVIDENCE Published literature was retrieved through searches of MEDLINE, CINAHL, and The Cochrane Library from January 1980 to July 2012 using appropriate controlled vocabulary and key words (group B streptococcus, antibiotic therapy, infection, prevention). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS The recommendations in this guideline are designed to help clinicians identify and manage pregnancies at risk for neonatal group B streptococcal disease to optimize maternal and perinatal outcomes. No cost-benefit analysis is provided. SUMMARY STATEMENT There is good evidence based on randomized control trial data that in women with pre-labour rupture of membranes at term who are colonized with group B streptococcus, rates of neonatal infection are reduced with induction of labour (I). There is no evidence to support safe neonatal outcomes with expectant management in this clinical situation. RECOMMENDATIONS
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Nishihara Y, Dangor Z, French N, Madhi S, Heyderman R. Challenges in reducing group B Streptococcus disease in African settings. Arch Dis Child 2017; 102:72-77. [PMID: 27831912 PMCID: PMC5256401 DOI: 10.1136/archdischild-2016-311419] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 09/12/2016] [Accepted: 09/17/2016] [Indexed: 01/06/2023]
Abstract
Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis in high-income settings and is associated with high rates of neonatal mortality and morbidity. There is now increasing evidence to suggest that there is a high GBS disease burden in resource-limited countries, and it is therefore critically important to identify suitable and practical preventive strategies. In Europe and North America, intrapartum antibiotic prophylaxis (IAP) has led to a dramatic reduction of early-onset GBS disease. However, the methods for identifying pregnant women who should receive IAP and how to reduce late-onset GBS disease are not without controversy and are challenging for most sub-Saharan African countries. GBS vaccines are approaching phase III trials but are still under development. This review aims to explore the current evidence related to strategies for reducing invasive GBS disease in an African setting, the development of a GBS vaccine and whether preventative measures against GBS disease can be practically implemented.
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Affiliation(s)
- Yo Nishihara
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ziyaad Dangor
- Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Neil French
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - Shabir Madhi
- Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg-Braamfontein, South Africa
| | - Robert Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
- Division of Infection and Immunity, University College London, London, UK
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Kobayashi M, Vekemans J, Baker CJ, Ratner AJ, Le Doare K, Schrag SJ. Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries. F1000Res 2016; 5:2355. [PMID: 27803803 PMCID: PMC5070600 DOI: 10.12688/f1000research.9363.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/07/2023] Open
Abstract
Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.
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Affiliation(s)
- Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA
| | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Carol J. Baker
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, USA
- Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, USA
| | - Adam J. Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, USA
| | - Kirsty Le Doare
- Centre for International Child Health, Imperial College, London, UK
| | - Stephanie J. Schrag
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
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Ahmad S. Asymptomatic group B streptococcal bacteriuria among pregnant women in Saudi Arabia. Br J Biomed Sci 2015; 72:135-9. [PMID: 26510270 DOI: 10.1080/09674845.2015.11666810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aims to determine the asymptomatic bacteriuria in pregnancy due to GBS and its antimicrobial sensitivity pattern for planning strategy for the management of these cases and also to determine the relationship between asymptomatic bacteriuria and pyuria. A total of 3863 consecutive urine specimens were collected from 3863 pregnant women with asymptomatic bacteriuria attending the obstetrics and gynaecology department of our hospital over a period of two years. Specimens were processed using standard microbiological procedures. All the subjects were evaluated for bacteriuria. The prevalence of asymptomatic bacteriuria due to group B streptococci (GBS) was 82/3863 (2.1%) among pregnant women in Saudi Arabia. Among these, 69/82 patients (84.2%) had clinical and microbiological features consistent with cystitis, versus 13/82 (15.8%) for pyelonephritis. About 51.2% (42/82) of the patients who had urine analysis performed had positive results based on positive urinary leucocyte esterase and pyuria. Disc-diffusion analysis of all 82 GBS isolates showed that they were highly susceptible to Augmentin and linezolid. Screening for bacteriuria in pregnancy and proper treatment must be considered as an essential part of antenatal care in this community. To prevent asymptomatic bacteriuria complications, all pregnant women should be screened at the first antenatal visit. A negative test for pyuria is not a reliable indicator of the absence of asymptomatic bacteriuria in pregnant women. Further, ongoing surveillance and evaluation of outcomes in pregnancies complicated by GBS bacteriuria is required to optimise maternal and newborn care.
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Prevalence of early-onset neonatal infection among newborns of mothers with bacterial infection or colonization: a systematic review and meta-analysis. BMC Infect Dis 2015; 15:118. [PMID: 25886298 PMCID: PMC4364328 DOI: 10.1186/s12879-015-0813-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 02/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although neonatal infections cause a significant proportion of deaths in the first week of life, little is known about the burden of neonatal disease originating from maternal infection or colonization globally. This paper describes the prevalence of vertical transmission--the percentage of newborns with neonatal infection among newborns exposed to maternal infection. METHODS We searched Pubmed, Embase, Scopus, Web of Science, Cochrane Library, and WHO Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection. Studies that measured prevalence of bacterial vertical transmission were included. Random effects meta-analyses were used to pool data to calculate prevalence estimates of vertical transmission. RESULTS 122 studies met the inclusion criteria. Only seven studies (5.7%) were from very high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of infection (lab-confirmed, clinical signs), colonization, and risk factors of infection. The prevalence of early onset neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 17.2% (95%CI 6.5-27.9). The prevalence of neonatal lab-confirmed infection among newborns of colonized mothers was 0% (95% CI 0.0-0.0). The prevalence of neonatal surface colonization among newborns of colonized mothers ranged from 30.9-45.5% depending on the organism. The prevalence of neonatal lab-confirmed infection among newborns of mothers with risk factors (premature rupture of membranes, preterm premature rupture of membranes, prolonged rupture of membranes) ranged from 2.9-19.2% depending on the risk factor. CONCLUSIONS The prevalence of early-onset neonatal infection is high among newborns of mothers with infection or risk factors for infection. More high quality studies are needed particularly in high neonatal mortality settings to accurately estimate the prevalence of early-onset infection among newborns at risk.
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Money D, Allen VM. The prevention of early-onset neonatal group B streptococcal disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:939-948. [PMID: 24165063 DOI: 10.1016/s1701-2163(15)30818-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To review the evidence in the literature and to provide recommendations on the management of pregnant women in labour for the prevention of early-onset neonatal group B streptococcal disease. The key revisions in this updated guideline include changed recommendations for regimens for antibiotic prophylaxis, susceptibility testing, and management of women with pre-labour rupture of membranes. OUTCOMES Maternal outcomes evaluated included exposure to antibiotics in pregnancy and labour and complications related to antibiotic use. Neonatal outcomes of rates of early-onset group B streptococcal infections are evaluated. EVIDENCE Published literature was retrieved through searches of MEDLINE, CINAHL, and The Cochrane Library from January 1980 to July 2012 using appropriate controlled vocabulary and key words (group B streptococcus, antibiotic therapy, infection, prevention). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to May 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. VALUES The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1). BENEFITS, HARMS, AND COSTS The recommendations in this guideline are designed to help clinicians identify and manage pregnancies at risk for neonatal group B streptococcal disease to optimize maternal and perinatal outcomes. No cost-benefit analysis is provided. SUMMARY STATEMENT There is good evidence based on randomized control trial data that in women with pre-labour rupture of membranes at term who are colonized with group B streptococcus, rates of neonatal infection are reduced with induction of labour. (I) There is no evidence to support safe neonatal outcomes with expectant management in this clinical situation. RECOMMENDATIONS 1. Offer all women screening for colonization with group B streptococcus at 35 to 37 weeks' gestation with culture taken from one swab first to the vagina and then to the rectum (through the anal sphincter). (II-1A) This includes women with planned Caesarean delivery because of their risk of labour or ruptured membranes earlier than the scheduled Caesarean delivery. (II-2B) 2. Because of the association of heavy colonization with early onset neonatal disease, provide intravenous antibiotic prophylaxis for group B streptococcus at the onset of labour or rupture of the membranes to: • any woman positive for group B streptococcus by vaginal/rectal swab culture screening done at 35 to 37 weeks' gestation (II-2B); • any woman with an infant previously infected with group B streptococcus (II-3B); • any woman with documented group B streptococcus bacteriuria (regardless of level of colony-forming units) in the current pregnancy. (II-2A) 3. Manage all women who are < 37 weeks' gestation and in labour or with rupture of membranes with intravenous group B streptococcus antibiotic prophylaxis for a minimum of 48 hours, unless there has been a negative vaginal/rectal swab culture or rapid nucleic acid-based test within the previous 5 weeks. (II-3A) 4. Treat all women with intrapartum fever and signs of chorioamnionitis with broad spectrum intravenous antibiotics targeting chorioamnionitis and including coverage for group B streptococcus, regardless of group B streptococcus status and gestational age. (II-2A) 5. Request antibiotic susceptibility testing on group B streptococcus-positive urine and vaginal/rectal swab cultures in women who are thought to have a significant risk of anaphylaxis from penicillin. (II-1A) 6. If a woman with pre-labour rupture of membranes at ≥ 37 weeks' gestation is positive for group B streptococcus by vaginal/rectal swab culture screening, has had group B streptococcus bacteriuria in the current pregnancy, or has had an infant previously affected by group B streptococcus disease, administer intravenous group B streptococcus antibiotic prophylaxis. Immediate obstetrical delivery (such as induction of labour) is indicated, as described in the Induction of Labour guideline published by the Society of Obstetricians and Gynaecologist in September 2013. (II-2B) 7. At ≥ 37 weeks' gestation, if group B streptococcus colonization status is unknown and the 35- to 37-week culture was not performed or the result is unavailable and the membranes have been ruptured for greater than 18 hours, administer intravenous group B streptococcus antibiotic prophylaxis. (II-2B) 8. If a woman with pre-labour rupture of membranes at < 37 weeks' gestation has an unknown or positive group B streptococcus culture status, administer intravenous group B streptococcus prophylaxis for 48 hours, as well as other antibiotics if indicated, while awaiting spontaneous or obstetrically indicated labour. (II-3B).
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Chan GJ, Lee ACC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med 2013; 10:e1001502. [PMID: 23976885 PMCID: PMC3747995 DOI: 10.1371/journal.pmed.1001502] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 07/12/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Neonatal infections cause a significant proportion of deaths in the first week of life, yet little is known about risk factors and pathways of transmission for early-onset neonatal sepsis globally. We aimed to estimate the risk of neonatal infection (excluding sexually transmitted diseases [STDs] or congenital infections) in the first seven days of life among newborns of mothers with bacterial infection or colonization during the intrapartum period. METHODS AND FINDINGS We searched PubMed, Embase, Scopus, Web of Science, Cochrane Library, and the World Health Organization Regional Databases for studies of maternal infection, vertical transmission, and neonatal infection published from January 1, 1960 to March 30, 2013. Studies were included that reported effect measures on the risk of neonatal infection among newborns exposed to maternal infection. Random effects meta-analyses were used to pool data and calculate the odds ratio estimates of risk of infection. Eighty-three studies met the inclusion criteria. Seven studies (8.4%) were from high neonatal mortality settings. Considerable heterogeneity existed between studies given the various definitions of laboratory-confirmed and clinical signs of infection, as well as for colonization and risk factors. The odds ratio for neonatal lab-confirmed infection among newborns of mothers with lab-confirmed infection was 6.6 (95% CI 3.9-11.2). Newborns of mothers with colonization had a 9.4 (95% CI 3.1-28.5) times higher odds of lab-confirmed infection than newborns of non-colonized mothers. Newborns of mothers with risk factors for infection (defined as prelabour rupture of membranes [PROM], preterm <37 weeks PROM, and prolonged ROM) had a 2.3 (95% CI 1.0-5.4) times higher odds of infection than newborns of mothers without risk factors. CONCLUSIONS Neonatal infection in the first week of life is associated with maternal infection and colonization. High-quality studies, particularly from settings with high neonatal mortality, are needed to determine whether targeting treatment of maternal infections or colonization, and/or prophylactic antibiotic treatment of newborns of high risk mothers, may prevent a significant proportion of early-onset neonatal sepsis. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Grace J Chan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Tan CK, Ulett KB, Steele M, Benjamin WH, Ulett GC. Prognostic value of semi-quantitative bacteruria counts in the diagnosis of group B streptococcus urinary tract infection: a 4-year retrospective study in adult patients. BMC Infect Dis 2012; 12:273. [PMID: 23101431 PMCID: PMC3514254 DOI: 10.1186/1471-2334-12-273] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 10/23/2012] [Indexed: 11/10/2022] Open
Abstract
Background Semi-quantitative bacteruria counts (s-QBC) are important in the diagnosis of urinary tract infection (UTI) due to most uropathogens. The prognostic value of s-QBC for diagnosis of UTI due to group B streptococcus (GBS) is unknown. In this study, we assessed the value of s-QBC for differentiating acute GBS UTI from asymptomatic bacteruria (ABU), independent of other potential prognostic indicators. Methods Medical record review and urinalysis (UA) values for 1593 patients who had urinary GBS isolated (103 to ≥105 CFU/ml) during a four-year period were analyzed using binary logistic regression to determine the predictive values of s-QBC, age, and gender for infection category (acute UTI, ABU) based on the clinical diagnosis. Results s-QBC alone had a strong predictive value for infection category but only for ABU. Multivariate logistic regression showed similar predictive power of s-QBC for infection category using age as a co-predictor, which was also independently associated with infection category. Typical s-QBC cut-off values that are commonly used in diagnostic settings had no significant power in predicting infection category. Among other UA measures, proteinuria and hematuria were significantly associated with acute infection. Conclusions Together, these data show that s-QBC is not useful in the differential diagnosis of GBS UTI. Among the patients in this study, age was an equally effective prognostic indicator compared to s-QBC for identifying high- and low-risk patients for acute GBS UTI. Collectively, these findings indicate that age-based associations may be equally as useful as s-QBC for predicting infection category in the setting of adult patients with GBS-positive urine cultures.
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Affiliation(s)
- Chee K Tan
- School of Medical Sciences, Centre for Medicine and Oral Health, Griffith University, Gold Coast Campus, Queensland, Australia
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Genome-wide mapping of cystitis due to Streptococcus agalactiae and Escherichia coli in mice identifies a unique bladder transcriptome that signifies pathogen-specific antimicrobial defense against urinary tract infection. Infect Immun 2012; 80:3145-60. [PMID: 22733575 DOI: 10.1128/iai.00023-12] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The most common causes of urinary tract infections (UTIs) are Gram-negative pathogens such as Escherichia coli; however, Gram-positive organisms, including Streptococcus agalactiae, or group B streptococcus (GBS), also cause UTI. In GBS infection, UTI progresses to cystitis once the bacteria colonize the bladder, but the host responses triggered in the bladder immediately following infection are largely unknown. Here, we used genome-wide expression profiling to map the bladder transcriptome of GBS UTI in mice infected transurethrally with uropathogenic GBS that was cultured from a 35-year-old women with cystitis. RNA from bladders was applied to Affymetrix Gene-1.0ST microarrays; quantitative reverse transcriptase PCR (qRT-PCR) was used to analyze selected gene responses identified in array data sets. A surprisingly small significant-gene list of 172 genes was identified at 24 h; this compared to 2,507 genes identified in a side-by-side comparison with uropathogenic E. coli (UPEC). No genes exhibited significantly altered expression at 2 h in GBS-infected mice according to arrays despite high bladder bacterial loads at this early time point. The absence of a marked early host response to GBS juxtaposed with broad-based bladder responses activated by UPEC at 2 h. Bioinformatics analyses, including integrative system-level network mapping, revealed multiple activated biological pathways in the GBS bladder transcriptome that regulate leukocyte activation, inflammation, apoptosis, and cytokine-chemokine biosynthesis. These findings define a novel, minimalistic type of bladder host response triggered by GBS UTI, which comprises collective antimicrobial pathways that differ dramatically from those activated by UPEC. Overall, this study emphasizes the unique nature of bladder immune activation mechanisms triggered by distinct uropathogens.
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Alós Cortés JI, Andreu Domingo A, Arribas Mir L, Cabero Roura L, de Cueto López M, López Sastre J, Melchor Marcos JC, Puertas Prieto A, de la Rosa Fraile M, Salcedo Abizanda S, Sánchez Luna M, Sanchez Pérez MJ, Torrejon Cardoso R. [Prevention of Neonatal Group B Sreptococcal Infection. Spanish Recommendations. Update 2012. SEIMC/SEGO/SEN/SEQ/SEMFYC Consensus Document]. Enferm Infecc Microbiol Clin 2012; 31:159-72. [PMID: 22658283 DOI: 10.1016/j.eimc.2012.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 03/23/2012] [Indexed: 12/18/2022]
Abstract
Group B streptococci (GBS) remain the most common cause of early onset neonatal sepsis. In 2003 the Spanish Societies of Obstetrics and Gynaecology, Neonatology, Infectious Diseases and Clinical Microbiology, Chemotherapy, and Family and Community Medicine published updated recommendations for the prevention of early onset neonatal GBS infection. It was recommended to study all pregnant women at 35-37 weeks gestation to determine whether they were colonised by GBS, and to administer intrapartum antibiotic prophylaxis (IAP) to all colonised women. There has been a significant reduction in neonatal GBS infection in Spain following the widespread application of IAP. Today most cases of early onset GBS neonatal infection are due to false negative results in detecting GBS, to the lack of communication between laboratories and obstetric units, and to failures in implementing the prevention protocol. In 2010, new recommendations were published by the CDC, and this fact, together with the new knowledge and experience available, has led to the publishing of these new recommendations. The main changes in these revised recommendations include: microbiological methods to identify pregnant GBS carriers and for testing GBS antibiotic sensitivity, and the antibiotics used for IAP are updated; The significance of the presence of GBS in urine, including criteria for the diagnosis of UTI and asymptomatic bacteriuria in pregnancy are clarified; IAP in preterm labour and premature rupture of membranes, and the management of the newborn in relation to GBS carrier status of the mother are also revised. These recommendations are only addressed to the prevention of GBS early neonatal infection, are not effective against late neonatal infection.
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Kessous R, Weintraub AY, Sergienko R, Lazer T, Press F, Wiznitzer A, Sheiner E. Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes? J Matern Fetal Neonatal Med 2012; 25:1983-6. [DOI: 10.3109/14767058.2012.671872] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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El Malek BA, Embleton ND, Loughney AD. Group B streptococcal disease: screening and treatment in pregnancy. ACTA ACUST UNITED AC 2011. [DOI: 10.1576/toag.7.1.034.27040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Centelles-Serrano MJ, Pérez-Moreno MO, Llovet-Lombarte MI, Cortell-Ortolá M, Jardí-Baiges AM, Buj-González JI. Impacto de la investigación sistemática de estreptococo del grupo B en orina en la identificación de gestantes colonizadas. Enferm Infecc Microbiol Clin 2009; 27:394-8. [DOI: 10.1016/j.eimc.2008.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 10/08/2008] [Indexed: 10/20/2022]
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Koenig JM, Keenan WJ. Group B streptococcus and early-onset sepsis in the era of maternal prophylaxis. Pediatr Clin North Am 2009; 56:689-708, Table of Contents. [PMID: 19501699 PMCID: PMC2702484 DOI: 10.1016/j.pcl.2009.04.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite an era of marked success with universal screening, Group B Streptococcus (GBS) continues to be an important cause of early-onset sepsis, and thus remains a significant public health issue. Improved eradication of GBS colonization and disease may involve universal screening in conjunction with rapid diagnostic technologies or other novel approaches. Given the complications and potential limitations associated with maternal intrapartum prophylaxis, however, vaccines may be the most effective means of preventing neonatal GBS disease. The global utility of conjugated GBS vaccines may be hampered by the variability of serotypes in diverse populations and geographic locations. Modern technologies, such as those involving proteomics and genomic sequencing, are likely to hasten the development of a universal vaccine against GBS.
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Affiliation(s)
- Joyce M Koenig
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Saint Louis University, Saint Louis, MO 63104, USA.
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Diversity of group B streptococcus serotypes causing urinary tract infection in adults. J Clin Microbiol 2009; 47:2055-60. [PMID: 19439533 DOI: 10.1128/jcm.00154-09] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Serotypes of group B streptococcus (GBS) that cause urinary tract infection (UTI) are poorly characterized. We conducted a prospective study of GBS UTI in adults to define the clinical and microbiological characteristics of these infections, including which serotypes cause disease. Patients who had GBS cultured from urine over a 1-year period were grouped according to symptoms, bacteriuria, and urinalysis. Demographic data were obtained by reviewing medical records. Isolates were serotyped by latex agglutination and multiplex PCR-reverse line blotting (mPCR/RLB). Antibiotic susceptibilities were determined by disc diffusion. GBS was cultured from 387/34,367 consecutive urine samples (1.1%): 62 patients had bacteriuria of >10(7) CFU/liter and at least one UTI symptom; of these patients, 31 had urinary leukocyte esterase and pyuria (others not tested), 50 (81%) had symptoms consistent with cystitis, and 12 (19%) had symptoms of pyelonephritis. Compared with controls (who had GBS isolated without symptoms), a prior history of UTI was an independent risk factor for disease. Increased age was also significantly associated with acute infection. Serotyping results were consistent between latex agglutination and mPCR/RLB for 331/387 (85.5%) isolates; 22 (5.7%) and 7 (1.8%) isolates were nontypeable with antisera and by mPCR/RLB, respectively; and 45/56 (80.4%) isolates with discrepant results were typed by mPCR/RLB as belonging to serotype V. Serotypes V, Ia, and III caused the most UTIs; serotypes II, Ib, and IV were less common. Nontypeable GBS was not associated with UTI. Erythromycin (39.5%) and clindamycin (26.4%) resistance was common. We conclude that a more diverse spectrum of GBS serotypes causes UTI than previously recognized, with the exception of nontypeable GBS.
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Anderson BL, Simhan HN, Simons KM, Wiesenfeld HC. Untreated asymptomatic group B streptococcal bacteriuria early in pregnancy and chorioamnionitis at delivery. Am J Obstet Gynecol 2007; 196:524.e1-5. [PMID: 17547879 DOI: 10.1016/j.ajog.2007.01.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 11/21/2006] [Accepted: 01/02/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the study was to determine the frequency of adverse pregnancy outcomes in women with untreated asymptomatic group B beta-hemolytic streptococcal (GBS) bacteriuria during pregnancy. STUDY DESIGN In this retrospective cohort, all women with antepartum GBS bacteriuria in a research registry were included. Controls were women with negative urine cultures. The frequency of chorioamnionitis was compared between groups. Chorioamnionitis was defined as intrapartum fever, fetal tachycardia, and histologic inflammation of the membranes. RESULTS One hundred twenty-two women with bacteriuria (study group) and 183 women with negative antepartum cultures (controls) were included. There were no differences in demographic characteristics between the groups. Thirty-one women (10.2%) had chorioamnionitis. Untreated GBS bacteriuria was associated with chorioamnionitis after controlling for confounding variables, adjusted odds ratio 7.2 (95% confidence interval 2.4 to 21.2). There was also a significant positive rank correlation between increasing colony count of GBS bacteriuria and increasing grade of chorioamnionitis (P = .02). CONCLUSION Untreated antepartum GBS bacteriuria is associated with chorioamnionitis.
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Affiliation(s)
- Brenna L Anderson
- Division of Reproductive Infectious Diseases and Immunology, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Abstract
Clinicians need information on the risk of Early Onset Group B Streptococcal disease (EOGBS) for counselling pregnant women and to decide who would benefit most from antibiotic treatment during labour. We carried out a systematic review of the research literature and conducted meta-analyses to obtain estimates for the natural history of EOGBS that are representative of the UK population. The mean rate of colonisation for the UK was 14% and we found weak evidence that the prevalence is increasing over time. Maternal GBS colonisation was more likely in women who delivered preterm compared with at term. Just over one-third of babies born to colonised mothers become colonised with GBS at birth (36%), and 3% of colonised babies develop EOGBS bacteraemia. In the UK, EOGBS constitutes one-third of all early onset bacteraemia due to pathogens, in contrast to one-half in the USA.
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Affiliation(s)
- Tim Colbourn
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guildford Street, WC1N 1EH, London, United Kingdom.
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Tamayo J, Gómez-Garcés JL, Alós JI. Evaluation of Granada agar plate for detection of Streptococcus agalactiae in urine specimens from pregnant women. J Clin Microbiol 2004; 42:3834-6. [PMID: 15297542 PMCID: PMC497650 DOI: 10.1128/jcm.42.8.3834-3836.2004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Granada agar plate (GAP; Biomedics SL, Madrid, Spain) was evaluated for the detection of group B streptococci (GBS) in urine specimens from pregnant women submitted for testing for asymptomatic bacteriuria and was compared with blood agar (BA [Columbia agar with 5% sheep blood]; bioMérieux, Marcy l'Etoile, France). The GAP detected 103 out of 105 GBS, whereas BA detected only 50. Use of the GAP could be a good method for the detection of GBS in urine specimens from pregnant women.
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Affiliation(s)
- Javier Tamayo
- Servicio de Microbiología, Hospital de Móstoles, 28935 Móstoles, Madrid, Spain.
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Money DM, Dobson S. The Prevention of Early-Onset Neonatal Group B Streptococcal Disease. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004; 26:826-40. [PMID: 15361281 DOI: 10.1016/s1701-2163(16)30157-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.
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Archivée: Prévention de l’infection néonatale à streptocoques du groupe B à début précoce. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2004. [DOI: 10.1016/s1701-2163(16)30158-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hernáiz C, Antón N, Alós JI, Orden B, Orellana MA, Colomina J, Redondo J, Gómez-Garcés JL. [Clinical significance of Streptococcus agalactiae isolation from urine samples of outpatients from health care centers]. Enferm Infecc Microbiol Clin 2004; 22:89-91. [PMID: 14756990 DOI: 10.1016/s0213-005x(04)73040-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Streptococcus agalactiae is a well-recognized pathogen in the obstetric population and is a cause of invasive infection in adults with underlying diseases. Nevertheless, the role of S. agalactiae in urinary tract infections in the adult non-pregnant population treated in outpatient health care centers has been less extensively studied. METHODS The clinical significance of S. agalactiae isolation in urine samples from health care center patients was studied in five areas of Spain over a period of six months. The study protocol included the collection of personal, epidemiological and clinical data. A total of 85 patients were studied; 79 were women (17 pregnant) and 6 men. RESULTS Pyuria was found in 72.9% of the cases. A total of 26.4% (n = 18) of non-pregnant women and all the men had some type of chronic underlying disease and 35.3% (n = 24) had urinary disease. Among the pregnant women, 53% had asymptomatic bacteriuria and 35.3% had vaginal and/or urethral colonization. Among the group of men and non-pregnant women, the most frequent entity was non-complicated cystitis, seen in 66.1% (45 of 68) of cases, followed by complicated infection in 19.1% and asymptomatic bacteriuria in 11.8%. Of the 45 patients with non-complicated cystitis, 35 (77.7%) were over 40 years old and 19 (42.2%) were over 60 years old. CONCLUSIONS Among the population of non-pregnant adults treated in outpatient health care centers, S. agalactiae isolation from urine was found mainly in women over 40 years old and was the cause of non-complicated urinary tract infection in more than half of cases.
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Affiliation(s)
- Carmen Hernáiz
- Servicio de Microbiología, Hospital de Móstoles, Móstoles, Madrid, España
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Riley L, Appollon K, Haider S, Chan-Flynn S, Cohen A, Ecker J, Rein M, Lieberman E. "Real World" compliance with strategies to prevent early-onset group B streptococcal disease. J Perinatol 2003; 23:272-7. [PMID: 12774132 DOI: 10.1038/sj.jp.7210895] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the "real-world" compliance with risk- and culture-based strategies to prevent early-onset group B streptococcal disease. STUDY DESIGN We retrospectively reviewed the medical records of consecutive term pregnancies delivered at three institutions (a subset of practices at an academic hospital using the culture-based strategy, an academic hospital using the risk-based strategy, and a community hospital using both) between January and March 1998. We abstracted demographic data and risk factors for group B streptococcus, group B streptococcal culture information, documentation of intrapartum antibiotic prophylaxis, and adverse drug reactions. We compared intrapartum compliance with the intended strategy. RESULTS There were a total of 505 women managed with the risk-based strategy. Of those, 79 had a risk factor for group B streptococcal disease and 72/79 (91.1%) received intrapartum antibiotic prophylaxis. There were a total of 428 women managed with the culture-based strategy. Of those, 70 had positive cultures and 67 (95.7%) received intrapartum antibiotic prophylaxis. An additional 39 women in the culture-based group had no documentation that cultures had been done. Of those, eight (20.5%) had risk factors and all eight received intrapartum antibiotic prophylaxis. Compliance with the risk-based strategy was 91.1 versus 96.2% with the culture-based strategy (p=0.3). Among women managed using the risk-based strategy, 5/426 (1.2%) received intrapartum antibiotic prophylaxis without an identifiable risk factor. Among women in the culture-based strategy, 5/359 (1.4%) received intrapartum antibiotic prophylaxis with documented negative group B streptococcal cultures (p=0.5). When examined by site, compliance with the intended strategy was 91.2% at the academic hospital using the risk-based strategy, 100% at the academic hospital using the culture-based strategy, 90.9% at the community practices using the risk-based strategy, and 82.4% at the community practices using the culture-based strategy. CONCLUSION Overall, intrapartum compliance with the risk-based approach was similar to the culture-based approach. However, there were more cultures not done and cultures done at inappropriate gestations at the community hospital practice.
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Affiliation(s)
- Laura Riley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
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Prevención de la infección perinatal por estreptococo del grupo B. Recomendaciones españolas revisadas. Enferm Infecc Microbiol Clin 2003. [DOI: 10.1016/s0213-005x(03)72979-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Larsen B, Monif GR. Understanding the bacterial flora of the female genital tract. Clin Infect Dis 2001; 32:e69-77. [PMID: 11181139 DOI: 10.1086/318710] [Citation(s) in RCA: 134] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2000] [Revised: 06/26/2000] [Indexed: 11/03/2022] Open
Abstract
The microbiological flora of the lower female genital tract provides a dynamic, complex example of microbial colonization, the regulation of which is not fully understood. When an exogenous bacterial species, with its array of virulence factors, is introduced into the host, disease does not always occur. Conversely, under selected conditions, commensal endogenous bacteria-for example, Gardnerella vaginalis and group B streptococci-can participate in disease processes. Disease caused by both exogenous and endogenous bacteria correlates positively with a markedly increased level of bacterial replication. The key question is what determines the quantity of a given bacterium at any given time. For disease to occur, exogenous or endogenous bacteria that possess pathogenic prerequisites must attain replicative dominance. Their ability to do so is potentially governed by inhibitory or synergistic interrelationships with other microbes.
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Affiliation(s)
- B Larsen
- Des Moines UniversityOsteopathic Medical Center, IA 50312-4198, USA.
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Benitz WE, Gould JB, Druzin ML. Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 1999; 103:e77. [PMID: 10353974 DOI: 10.1542/peds.103.6.e77] [Citation(s) in RCA: 177] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To identify and to establish the prevalence of ORs factors associated with increased risk for early-onset group B streptococcal (EOGBS) infection in neonates. streptococcal (EOGBS) infection in neonates. STUDY DESIGN Literature review and reanalysis of published data. RESULTS Risk factors for EOGBS infection include group B streptococcal (GBS)-positive vaginal culture at delivery (OR: 204), GBS-positive rectovaginal culture at 28 (OR: 9.64) or 36 weeks gestation (OR: 26. 7), vaginal Strep B OIA test positive at delivery (OR: 15.4), birth weight </= 2500 g (OR: 7.37), gestation <37 weeks (OR: 4.83), gestation <28 weeks (OR: 21.7), prolonged rupture of membranes (PROM) >18 hours (OR: 7.28), intrapartum fever >37.5 degrees C (OR: 4.05), intrapartum fever, PROM, or prematurity (OR: 9.74), intrapartum fever or PROM at term (OR: 11.5), chorioamnionitis (OR: 6.43). Chorioamnionitis is reported in most (88%) cases in which neonatal infection occurred despite intrapartum maternal antibiotic therapy. ORs could not be estimated for maternal GBS bacteriuria during pregnancy, with preterm premature rupture of membranes, or with a sibling or twin with invasive GBS disease, but these findings seem to be associated with a very high risk. Multiple gestation is not an independent risk factor for GBS infection. CONCLUSIONS h Mothers with GBS bacteriuria during pregnancy, with another child with GBS disease, or with chorioamnionitis should receive empirical intrapartum antibiotic treatment. Their infants should have complete diagnostic evaluations and receive empirical treatment until infection is excluded by observation and negative cultures because of their particularly high risk for EOGBS infection. Either screening with cultures at 28 weeks gestation or identification of clinical risk factors, ie, PROM, intrapartum fever, or prematurity, may identify parturients whose infants include 65% of those with EOGBS infection. Intrapartum screening using the Strep B OIA rapid test identifies more at-risk infants (75%) than any other method. These risk identifiers may permit judicious selection of patients for prophylactic interventions.
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Affiliation(s)
- W E Benitz
- Department of Pediatrics, Stanford University, School of Medicine, Stanford, California 94305, USA.
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Abstract
Urinary tract infections remain some of the most common infections observed in community- and hospital-based practices. Although most infections continue to be caused by enteric bacteria, a growing proportion of these infections are caused by pathogens often associated with sexually transmitted diseases, including those of nonbacterial and viral etiologies. Consequently, multiresistant strains have become more prevalent, and the clinician must respond with a rational approach to therapy, based on the selection of an effective and well-tolerated antibiotic. The emergence of the newer antibiotic classes, including the second and third-generation cephalosporins and the fluoroquinolones, has provided the clinician with agents that offer a broad spectrum of activity, good patient acceptance, a well-tolerated safety profile, and convenient dosage regimens due to their unique pharmacokinetic profiles. These drugs may be effective in single- or multiple-dose regimens, depending on the condition being treated, and these should be considered important drugs in the treatment of uncomplicated and complicated adult urinary tract infections.
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Affiliation(s)
- S Faro
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
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Lorentzon S, Hovelius B, Miörner H, Tendler M, Aberg A. The diagnosis of bacteriuria during pregnancy. Scand J Prim Health Care 1990; 8:81-3. [PMID: 2218158 DOI: 10.3109/02813439008994935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Three diagnostic tests, Nitur, Urobact, and Uricult, were evaluated in the detection of bacteriuria in 865 pregnant women. As reference method agar culture was performed. Heavy growth (greater than 10(5) CFU/ml) of urinary tract bacteria was considered a true positive result and demonstrated in 58 (6.7%) of the women, 14 of whom had gram-negative rods. The sensitivity of the nitrite test was extremely low (0.13). The test gave negative results in eight of 17 specimens yielding heavy growth of Escherichia coli or Proteus mirabilis. Although the Urobact test was highly sensitive as regards gram-negative infection, it had an unacceptably low (0.27) predictive value in positive tests. The sensitivity of the Uricult test was low (0.35) in this study. The predictive value (0.50) of a positive test result may be acceptable, since just over half of the false positive results were explainable by moderate growth of urinary tract pathogens (10(4)-10(5) CFU/ml). It is argued that semi-quantitative urine culture may be preferable to the rapid diagnostic methods studied for the screening of bacteriuria in pregnant women.
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Affiliation(s)
- S Lorentzon
- Södertull Community Health Centre, Lund, Sweden
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Carstensen H, Christensen KK, Grennert L, Persson K, Polberger S. Early-onset neonatal group B streptococcal septicaemia in siblings. J Infect 1988; 17:201-4. [PMID: 3063756 DOI: 10.1016/s0163-4453(88)96426-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
At each of two consecutive deliveries, a woman gave birth to a baby that developed early-onset group B streptococcal (GBS) septicaemia. A low titre of serum antibodies to the type of the infecting GBS and persistence of the organism in the mother were demonstrated. This case confirms that mothers of GBS infected infants are at high risk of their future babies being similarly infected.
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Affiliation(s)
- H Carstensen
- Department of Paediatrics, University of Lund, Malmö General Hospital, Sweden
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Persson KM, Grabe M, Kristiansen P, Forsgren A. Significance of group B streptococci in urine cultures from males and non-pregnant females. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1988; 20:47-53. [PMID: 3283922 DOI: 10.3109/00365548809117216] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Over a 2-year period, 1% of 24,000 urine cultures with possible relevant bacteria from males and non-pregnant females greater than or equal to 15 years of age were found to harbour group B streptococci (GBS) in quantities greater than or equal to 10(5) colony forming units (cfu)/ml; a further 0.9% harboured GBS in quantities greater than or equal to 10(4) but less than 10(5) cfu/ml. Patients with GBS in urine were evenly distributed by age. Those with greater than or equal to 10(5) cfu GBS/ml in voided urine more frequently had true bacteriuria (i.e. bacteria in the urine bladder) than did patients with less amounts (p = 0.01) as determined by suprapubic aspiration of 23 patients. One third (3/9) of the aspirated patients with greater than or equal to 10(5) cfu GBS/ml in simultaneously voided urine, had contaminated urine only and no true bacteriuria. The acute symptoms and clinical conditions of 128 patients with greater than or equal to 10(5) cfu GBS/ml urine were studied by matching 128 patients with negative urine cultures (less than 10(2) cfu/ml) and 128 patients with comparable quantity of Escherichia coli. The incidence of acute lower urinary tract symptoms in patients with GBS was greater than that in patients with negative urine cultures (p less than 0.01), and the same as that in patients with E. coli. The incidence of fever was lower in patients with GBS than in those with E. coli (p less than 0.01). The incidence of urinary tract abnormalities was greatest in patients with GBS in urine. No GBS serotype seems to have particular affinity to the urinary tract.
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Affiliation(s)
- K M Persson
- Department of Medical Microbiology, University of Lund, Malmö General Hospital, Sweden
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Persson K, Bjerre B, Elfström L, Forsgren A. Longitudinal study of group B streptococcal carriage during late pregnancy. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1987; 19:325-9. [PMID: 3303305 DOI: 10.3109/00365548709018478] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
152 women were cultured for group B streptococci (GBS) weekly from the 37th week of gestation and at admission to hospital for delivery. Matched rectal, urethral and urine specimens were collected for study (mean 4 times). In the 37th week of gestation, 33 women (22%) harboured GBS in rectal specimens, 28 women (18%) in urethral specimens, 16 women (11%) in urine specimens, and 37 women (24%) in at least one of the 3 specimens. All cultures considered, a total of 46 women (30%) yielded GBS in at least one culture. In the 37th week of gestation, women subsequently found to be GBS colonized at labour (positive in at least one site) had a higher rate of positive cultures in rectal specimens (77%) than in either urethral (67%) or urine specimens (41%). Chronic GBS carriage was more frequent in rectum than in urethra or urine. The results of the present investigation support the gastrointestinal tract as being the predominant source of GBS.
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