Abstract
BackgroundEstimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS.MethodsWe evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017. Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. Interview-administered questionnaires were used to assess risk factors associated with GBS colonization. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin using the disk diffusion method. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization.ResultsA total of 292 women were enrolled. Median age was 30 years (Interquartile range {IQR} 26–35) and a median gestational age of 35 weeks (IQR 30–37). Overall GBS was identified in 60/292 (20.5%) of participants. Among the positive isolates, resistance was detected for penicillin G in 42/58 (72.4%) isolates, ampicillin in 32/58 (55.2%) isolates, clindamycin in 14/46 (30.4%) isolates, and vancomycin in 14/58 (24.1%) isolates. All ten GBS serotypes were isolated, and 37/53 (69.8%) of GBS positive participants were colonized by more than one serotype. None of the risk factors was associated with GBS colonization.ConclusionThe prevalence of GBS colonization was high among antenatal women at KNH. In addition, a high proportion of GBS isolates were resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination is a potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility test performed on GBS positive samples to guide antibiotic prophylaxis.
Highlights
Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya
Our findings agree with observations of Dutra, Alves [27] who reported variations in the regional distribution and occurrence of GBS serotypes as this study found serotype Ia to be the most occurring in this population while Cools et al reported serotype III as the most occurring among pregnant women in Mombasa [16, 27]
Though some of the participants in this study reported having a history of risk factors associated with GBS such as stillbirths, abortions, ectopic pregnancy, history of preterm births, history of neonatal deaths, history of neonatal infection and history of fore water break more than 18 h to labour, no statistically significant association was found between these factors and GBS colonization in this study
Summary
Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya These data are required to inform recommendations for prophylaxis and treatment of infections due to GBS. In the most recent study in Kenya, Seale, Koech [8] reported a GBS prevalence of 12% among expectant mothers in Kilifi county while an earlier study by Salat et al done in 2009, found a high prevalence of 25.2% among pregnant women at KNH [9] Even so, these two studies were limited in their scope to the prevalence and risk factors of GBS colonization but failed to investigate the antimicrobial susceptibility or serotypes of isolated GBS in their populations
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