High prevalence of Group B Streptococcus colonization among pregnant women in Amman, Jordan

Kate Clouse,Natasha Halasa,Najwa Khuri-Bulos,Abel Mani Suleimat,Tara M Randis,Samir Faouri,Kimberly B Fortner,David M Aronoff,Abeer Al Jammal,Asem Shehabi,Adam J Ratner,James Chappell,Anna B Chamby

doi:10.1186/s12884-019-2317-4

Abstract

BackgroundLittle is known of the burden of Group B Streptococcus (GBS) colonization among pregnant women in Jordan. We conducted a pilot study to determine the prevalence of GBS among pregnant women in Amman, Jordan, where GBS testing is not routine. We also explored GBS serotypes and the performance of a rapid GBS antigen diagnostic test.MethodsWe collected vaginal-rectal swabs from women who presented for labor and delivery at Al-Bashir Hospital. Three methods were used to identify GBS: Strep B Rapid Test (Creative Diagnostics), blood agar media (Remel) with confirmed with BBL Streptocard acid latex test (Becton Dickinson), and CHROMagar StrepB (Remel). Results were read by a senior microbiologist. We defined our gold standard for GBS-positive as a positive blood agar culture confirmed by latex agglutination and positive CHROMagar. PCR testing determined serotype information. Demographic and clinical data were also collected.ResultsIn April and May 2015, 200 women were enrolled with a median age of 27 years (IQR: 23–32); 89.0% were Jordanian nationals and 71.9% completed secondary school. Median gestational age was 38 weeks (IQR: 37–40); most women reported prenatal care (median 9 visits; IQR: 8–12). Median parity was 2 births (IQR: 1–3). Pre-pregnancy median BMI was 24.1 (IQR: 21.5–28.0) and 14.5% reported an underlying medical condition. Obstetric complications included gestational hypertension (9.5%), gestational diabetes (6.0%), and UTI (53.5%), of which 84.5% reported treatment. Overall, 39 (19.5%) of women were GBS-positive on blood agar media and CHROMagar, while 67 (33.5%) were positive by rapid test (36% sensitivity, 67% specificity). Serotype information was available for 25 (64%) isolates: III (48%), Ia (24%), II (20%), and V (8%). No demographic or clinical differences were noted between GBS+ and GBS-negative women.ConclusionsNearly one in five women presenting for labor in Jordan was colonized with GBS, with serotype group III as the most common. The rapid GBS antigen diagnostic had low sensitivity and specificity. These results support expanded research in the region, including defining GBS resistance patterns, serotyping information, and risk factors. It also emphasizes the need for routine GBS testing and improved rapid GBS diagnostics for developing world settings.

Highlights

Little is known of the burden of Group B Streptococcus (GBS) colonization among pregnant women in Jordan
We found many reports from the Middle East and North African (MENA) region estimating the frequency of GBS in pregnant mothers, with estimates ranging from 1.6 to 32% (Table 1), nearly half of these studies were conducted in only two countries – Iran and Israel – and over one-third of the studies were published more than 10 years ago
Intrapartum antibiotic prophylaxis (IAP) for suspected GBS colonization was provided per clinician discretion based on maternal risk factors and other indications for suspected infection

Summary

Introduction

Little is known of the burden of Group B Streptococcus (GBS) colonization among pregnant women in Jordan. In the United States, recommendations for routine screening for GBS in women between 35 and 37 weeks pregnant, followed by antibiotic prophylaxis 4h prior to delivery for colonized patients, led to a dramatic decrease in the incidence of early-onset GBS disease in neonates [8], with no change in the incidence of late-onset GBS. This screen-and-treat paradigm, has not been widely adopted outside of the United States, and policy decisions have been challenged by the absence of solid estimates of the number of at-risk mothers and babies in many parts of the world [9]. One barrier to obtaining reliable epidemiological data from low- and middle-income countries has been the absence of accurate point-of-care tests to determine GBS colonization without the need for time-consuming and expensive, laboratory-based cultivation practices [10]

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Discussion

Conclusion