Abstract
BackgroundGroup B Streptococcus (GBS) is the leading cause of neonatal sepsis in the developed world. Little is known about its epidemiology in the developing world, where the majority of deaths from neonatal infections occur. Maternal carriage of GBS is a prerequisite for the development of early onset GBS neonatal sepsis but there is a paucity of carriage data published from the developing world, in particular South East Asia.MethodsWe undertook a cross sectional study over a 13 month period in a remote South East Asian setting on the Thai-Myanmar border. During labour, 549 mothers had a combined vaginal rectal swab taken for GBS culture. All swabs underwent both conventional culture as well as PCR for GBS detection. Cultured GBS isolates were serotyped by latex agglutination, those that were negative or had a weak positive reaction and those that were PCR positive but culture negative were additionally tested using multiplex PCR based on the detection of GBS capsular polysaccharide genes.ResultsThe GBS carriage rate was 12.0% (95% CI: 9.4-15.0), with 8.6% positive by both culture and PCR and an additional 3.5% positive by PCR alone. Serotypes, Ia, Ib, II, III, IV, V, VI and VII were identified, with II the predominant serotype. All GBS isolates were susceptible to penicillin, ceftriaxone and vancomycin and 43/47 (91.5%) were susceptible to erythromycin and clindamycin.ConclusionsGBS carriage is not uncommon in pregnant women living on the Thai-Myanmar border with a large range of serotypes represented.
Highlights
Group B Streptococcus (GBS) is the leading cause of neonatal sepsis in the developed world
The introduction of intrapartum antibiotics in the developing world could reduce the number of infants who die from neonatal sepsis each year
A standard proforma was completed after delivery to determine ethnic group, past obstetric history, recent antibiotic exposure, and complications occurring during labour, concentrating on the risk factors for neonatal GBS infection (fever > 38C, prolonged rupture of membranes, prematurity (< 37 weeks) that are included in risk based strategy for the prevention of GBS neonatal sepsis [16]
Summary
Group B Streptococcus (GBS) is the leading cause of neonatal sepsis in the developed world. Infection with GBS has been reported to be rare in the developing world; its importance as a cause of neonatal sepsis in these countries is being increasingly recognised [4,5,6,7,8,9]. To determine the likely impact and the optimal strategy of antibiotic administration the colonization prevalence and neonatal infection rate for GBS in the target population should be known. Another potential strategy for GBS prevention is the introduction of a GBS vaccine. Current candidates are polysaccharide protein conjugates so knowledge of the serotype distribution of GBS in different geographical areas will be important in planning their implementation
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