Maternal colonization with Staphylococcus aureus and Group B streptococcus is associated with colonization in newborns

A Roca,A Bojang,B Camara,C Oluwalana,K Lette,P West,U D'Alessandro,C Bottomley

doi:10.1016/j.cmi.2017.04.020

Abstract

ObjectivesAlthough Staphylococcus aureus and Group B streptococcus (GBS) are major causes of neonatal sepsis in sub-Saharan Africa, it is unclear how these bacteria are transmitted to the neonate. MethodsIn a cohort of 377 Gambian women and their newborns, nasopharyngeal swabs were collected at delivery (day 0), and 3, 6, 14 and 28 days later. Breast milk samples and vaginal swabs were collected from the mother. Staphylococcus aureus and GBS were isolated using conventional microbiological methods. ResultsMost women were carriers of S. aureus (264 out of 361 with all samples collected, 73.1%) at some point during follow up and many were carriers of GBS (114 out of 361, 31.6%). Carriage of S. aureus was common in all three maternal sites and GBS was common in the vaginal tract and breast milk. Among newborns, carriage of S. aureus peaked at day 6 (238 out of 377, 63.1%) and GBS at day 3 (39 out of 377, 10.3%). Neonatal carriage of S. aureus at day 6 was associated with maternal carriage in the breast milk adjusted OR 2.54; 95% CI 1.45–4.45, vaginal tract (aOR 2.55; 95% CI 1.32–4.92) and nasopharynx (aOR 2.49; 95% CI 1.56–3.97). Neonatal carriage of GBS at day 6 was associated with maternal carriage in the breast milk (aOR 3.75; 95% CI 1.32–10.65) and vaginal tract (aOR 3.42; 95% CI 1.27–9.22). ConclusionsMaternal colonization with S. aureus or GBS is a risk factor for bacterial colonization in newborns.

Highlights

Among 6 million deaths in the under-fives occurred in 2013, more than half died of infections and approximately 44% occurred during the neonatal period [1]
Roca et al / Clinical Microbiology and Infection 23 (2017) 974e979 this cohort study, we investigate the relationship between maternal colonization at various body sitesdnasopharynx, vagina and breast milkdand nasopharyngeal S. aureus and Group B streptococcus (GBS) colonization in Gambian newborns
This study has shown that carriage of S. aureus and GBS is common among Gambian women and their newborns, and that maternal colonization is an important risk factor for neonatal colonization

Summary

Introduction

Among 6 million deaths in the under-fives occurred in 2013, more than half died of infections and approximately 44% occurred during the neonatal period [1]. In sub-Saharan Africa, Staphylococcus aureus [1] and Group B streptococcus (GBS) are common causes of severe bacterial disease in neonates. Few studies have investigated how neonates become colonizedda necessary step to diseasedwith these bacteria. In sub-Saharan Africa S. aureus colonization peaks during the first week of life (c.80% prevalence), and decreases steadily until reaching a low plateau (c.20% prevalence) 10e20 weeks later [2,3]. The timing of the peak during the neonatal period probably reflects the role of vertical transmission. Studies in developed countries have shown that vaginal colonization in the mother and breastfeeding are risk factors for S. aureus colonization during the neonatal period [4e6]. One study conducted in sub-Saharan Africa showed that mammillary colonization was a risk factor for S. aureus carriage during early infancy [7]

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