Abstract
BackgroundGroup B Streptococcus (GBS) remains a significant cause of neonatal infection, but the maternal risk factors for GBS colonization remain poorly defined. We hypothesized that there may be an association between antibiotic exposure during pregnancy and GBS colonization and/or the presence of inducible clindamycin resistance (iCLI-R) in GBS isolates from GBS-colonized pregnant women.MethodsA retrospective cohort study was performed at Louisiana State University Health Sciences Center – Shreveport including demographic and clinical data from 1513 pregnant women who were screened for GBS between July 1, 2009 and December 31, 2010.ResultsAmong 526 (34.8%) women who screened positive for GBS, 124 (23.6%) carried GBS strains with iCLI-R (GBS-iCLI-R). While antibiotic exposure, race, sexually-transmitted infection (STI) in pregnancy, GBS colonization in prior pregnancy and BMI were identified as risk factors for GBS colonization in univariate analyses, the only independent risk factors for GBS colonization were African–American race (AOR = 2.142; 95% CI = 2.092–3.861) and STI during pregnancy (AOR = 1.309; 95% CI = 1.035–1.653). Independent risk factors for GBS-iCLI-R among women colonized with GBS were non-African–American race (AOR = 2.13; 95% CI = 1.20–3.78) and younger age (AOR = 0.94; 95% CI = 0.91–0.98). Among GBS-colonized women with an STI in the current pregnancy, the only independent risk factor for iCLI-R was Chlamydia trachomatis infection (AOR = 4.31; 95% CI = 1.78–10.41).ConclusionsThis study identified novel associations for GBS colonization and colonization with GBS-iCLI-R. Prospective studies will improve our understanding of the epidemiology of GBS colonization during pregnancy and the role of antibiotic exposure in alterations of the maternal microbiome.
Highlights
Streptococcus agalactiae (Group B Streptococcus (GBS)) is a dynamic colonizer of the gastrointestinal and genitourinary tracts, frequently causing urinary tract infections, chorioamnionitis, postpartum endometritis, and bacteremia in pregnant women [1, 2]
Because of the high rates of sexually-transmitted infections (STIs) in our population and the common resistance mechanisms for inducible clindamycin resistance (iCLI-R) that have been described for GBS and Staphylococcus aureus, we hypothesized that exposure to antibiotics during pregnancy may be a risk factor for colonization with GBS and/or colonization with a GBS strain that displays an iCLI-R phenotype
35% had GBS colonization, 37% had a history of STI, and 55.1%
Summary
Independent risk factors for GBS colonization were STI during pregnancy and AA race as determined by multivariate analysis (Table 2b). Risk factors for iCLI‐R among women with GBS strains Only race and age were significantly associated with iCLR among the GBS colonized women in univariate analyses (Table 4a). Race and age were the independent risk factors for iCLR among GBS positive women as determined by multivariate analysis (Table 4b). The only independent risk factor for colonization with GBS-iCLR among GBSpositive women with STI was CT infection (Table 6b). Adjusted for age and AZ treatment (factors associated with GBS-iCLR by univariate analysis), the odds. ICLI-R Chlamydia trachomatis (CT) Antibiotic exposure AZ treatment AA race Term delivery IAP HIV positive GBS in prior pregnancy Age (years) BMI Gravidity a Calculated from non-missing values.
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