Group B Streptococcus Bacteriuria Research Articles

Neonatal Group B Streptococcus infection at a single center in Al-Madinah Al-Munawarah, Saudi Arabia.

To determine the occurrence of Group B Streptococcus (GBS) infection in neonates and its associated risk factors in Al-Madinah Al-Munawarah, Saudi Arabia. This retrospective study was carried out at the Maternity and Child Hospital in Al-Madinah Al-Munawarah, between 2017-2022. The laboratory and clinical data of 64 neonates were collected and analyzed using GraphPad Prism 7 software. Out of 16,022 neonates admitted to the nursery, 64 infants were diagnosed with GBS infection. Approximately 53.1% were male, 46.9% female, 15.6% were preterm, and 84.4% were full-term. Vaginal births accounted for 71.9%. The mean onset age was 10±12.4 days. Among the GBS patients, 53.1% had early-onset disease (EOD, 0-6 days), while 46.9% had late-onset disease (LOD, 7-90 days). Unexamined mothers had a higher incidence of GBS and EOD newborns (p=0.05). Meningitis was more common in LOD than EOD patients and correlated with illness onset (p=0.05). Early-onset disease patients had a higher incidence of sepsis. The mortality rate was 10.9%, while 89.1% were discharged from the hospital. Neonatal GBS infection is prevalent in Al-Madinah Al-Munawarah. Several risk factors may contribute to the occurrence of GBS infection including preterm labor, higher body temperature during delivery, prolonged premature rupture of membranes for more than 18 hours, and GBS bacteriuria. We recommend that larger multi-centric studies are needed in Al-Madinah Al-Munawarah, to study the magnitude of neonatal GBS infection and risk factors to develop a screening protocol in maternity and children's hospital.

Maternal age and body mass index as risk factors for rectovaginal colonization with group B streptococci.

To examine the effect of including maternal age and body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) as additional risk factors in the traditional risk-based strategy at term pregnancies consisting of previous early-onset group B streptococcus (GBS) disease, GBS bacteriuria during pregnancy, maternal temperature of 38.0°C or more intrapartum, and rupture of membranes of 18 h or longer. A secondary analysis of a Danish cohort including 902 pregnant women. Exposures were maternal age and pre-pregnancy BMI. Outcome was rectovaginal GBS colonization at the time of labor. The logistic regression analysis adjusted for parity, gestational age, vaginal delivery, and smoking. The GBS prevalence was 17% in the entire population, 35% among participants older than 40 years, and 23% among those with a BMI of 25 or greater. Including maternal "age > 40" as an additional risk factor increased the sensitivity of the risk-based strategy from 21% to 26% and decreased the specificity from 90% to 87%. Inclusion of "BMI ≥ 25" increased the sensitivity from 21% to 57% and decreased the specificity from 90% to 59%. Maternal age and BMI might be included as additional risk factors in risk-based programs for identification of GBS-positive laboring women to receive intrapartum antibiotics prophylaxis.

Evaluation of Sysmex UF-1000i® flow cytometer as a screening method for asymptomatic bacteriuria and detection of Group B Streptococcus in pregnancy

RESUMENObjetivos. Aunque se ha generalizado el uso de la citometría de flujo como método automatizado de cribado previo al urocultivo, los puntos de corte óptimos para cada grupo poblacional no están homogéneamente establecidos. El objetivo del presente estudio ha sido determinar el rendimiento del sistema Sysmex UF-1000i® en la detección de bacteriuria asintomática (BA) y la colonización por estreptococo grupo B (EGB) en la población gestante.Material y métodos. Las orinas recibidas entre enero y julio de 2019 se analizaron mediante Sysmex UF-1000i® y paralelamente se cultivaron. Se recogieron variables demográficas, parámetros del citómetro y el resultado del urocultivo. El análisis del rendimiento del citómetro se realizó mediante curvas receiver operating characteristic (ROC) para la variable BACT/ µL respecto a la detección de BA y EGB.ResultadosDe 33.687 muestras de orina recibidas, 1.443 (4,3%) correspondían a embarazadas. El urocultivo fue positivo en 82 (5,7%) muestras, 1.295 (89,7%) negativas y 66 (4,6%) contaminadas. El EGB se identificó en 69 (4,8%) gestantes, siendo el recuento inferior a 104 UFC/mL en 46 (66,7%) casos. Utilizando el punto de corte de 550 BACT/μL (sensibilidad, 91,5%; valor predictivo negativo, 99,3%) en la detección de la BA se evitaría sembrar el 74,1% de las muestras. Sin embargo, no se pudo establecer ningún punto de corte para EGB.ConclusionesAunque Sysmex UF-1000i® es una herramienta válida para el cribado de BA en la mujer embarazada en nuestro medio, no es útil para detectar EGB; por lo que continúa siendo necesario realizar el urocultivo convencional en este subgrupo poblacional.

Group B Streptococcal Bacteriuria in Pregnancy: An Evidence‐Based, Patient‐Centered Approach to Care

Screening and management of group B streptococcus (GBS) bacteriuria in pregnancy aims to reduce the incidence of pyelonephritis and GBS-related neonatal morbidity and mortality. Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. This article uses a case study approach to discuss evidence-based, patient-centered care for GBS bacteriuria in pregnancy as well as ethical incorporation of individual patient preferences and values.

771: Evaluating the cost effectiveness of the latest recommendations for Group B Streptococcus screening

To evaluate whether Group B Streptococcus (GBS) screening at 35 0/7 to 37 6/7 weeks of gestation versus screening at 36 0/7 to 37 6/7 weeks of gestation with re-screening of GBS negative women five weeks later was most cost-effective. We constructed a decision-analysis model to compare the outcome of GBS early onset disease (EOD) in a hypothetical cohort of 3,614,049 women at ≥ 35 0/7 weeks of gestation (the number of live births in 2017 excluding births from 23 0/7 to 34 6/7 weeks of gestation, GBS bacteriuria during the current pregnancy, and history of previous infant with GBS disease). We took both a health care and societal perspective and all costs were expressed in 2017 U.S. dollars. Effectiveness was based on neonatal quality-adjusted life years (QALYs) gained. An incremental cost-effectiveness ratio was estimated with a willingness to pay threshold set at $100,000/QALY. All model inputs were derived from the literature. One-way probability and cost sensitivity analysis were performed to investigate model assumptions. Screening at 36 0/7 to 37 6/7 weeks of gestation with re-screening of GBS negative women if five weeks passed from the culture-to-delivery interval resulted in a 6.2% increase in neonatal QALYs gained (2,162 versus 2,037), 11.6% fewer cases of neonatal death due to GBS EOD (30 versus 34), and a 9.6% reduction in total societal health care expenditures ($639 versus $707 million) when compared to the past strategy of only screening at 35 0/7 to 37 6/7 weeks of gestation, respectively. This new approach was cost-effective with an incremental cost-effectiveness ratio of $43,205 per neonatal QALY gained. Screening at 36 0/7 to 37 6/7 weeks of gestation with 5 week re-screening of GBS negative results is more cost-effective than past strategies used in the United States.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study

Purpose: Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcus (GBS) early-onset disease (EOD). No European study evaluates the relative impact of risk factors (RFs) for EOD after a screening-based strategy and widespread IAP use We aimed to evaluate the risks of EOD in an Italian region where a screening-based strategy for preventing EOD was implemented.Materials and methods: Cases of EOD born at or above 35 weeks’ gestation were reviewed and matched with controls.Results: There were 109 cases of EOD among 532,154 live births. Most cases had negative GBS prenatal screening (56/91, 61.5%) and were unexposed to IAP (86/109, 78.9%). At multivariate analysis, GBS bacteriuria (OR = 6.99), positive prenatal screening (OR = 13.7) and maternal intrapartum fever (OR = 188.3) were associated with an increased risk of EOD, whereas intrapartum beta-lactam antibiotics were associated with a decreased risk of EOD (≥4 h: OR = 0.008; <4 h: OR = 0.04). Neonates born to nonfebrile, GBS positive pregnant women, receiving beta-lactam antibiotics had very low probability of EOD, particularly if IAP was adequate.Conclusions: GBS positive prenatal screening, GBS bacteriuria and intrapartum fever are associated with EOD. Intrapartum beta-lactam antibiotics reduce the probability of EOD in neonates born to nonfebrile mothers.

No. 276-Management of Group B Streptococcal Bacteriuria in Pregnancy.

To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. The outcomes considered were neonatal GBS disease, preterm birth, pyelonephritis, chorioamnionitis, and recurrence of GBS colonization. Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). Low colony counts refer to <100 000 CFU/mL, and high (significant) colony counts refer to ≥100 000 CFU/mL. Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to February 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Recommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table). The recommendations in this guideline are designed to help clinicians identify pregnancies in which it is appropriate to treat GBS bacteriuria to optimize maternal and perinatal outcomes, to reduce the occurrences of antibiotic anaphylaxis, and to prevent increases in antibiotic resistance to GBS and non-GBS pathogens. No cost-benefit analysis is provided.

Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses.

Preterm birth complications are the leading cause of deaths among children <5 years of age. Studies have suggested that group B Streptococcus (GBS) maternal rectovaginal colonization during pregnancy may be a risk factor for preterm delivery. This article is the fifth of 11 in a series. We aimed to assess the association between GBS maternal colonization and preterm birth in order to inform estimates of the burden of GBS. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data from investigator groups on the association of preterm birth (<37 weeks' gestation) and maternal GBS colonization (GBS isolation from vaginal, cervical, and/or rectal swabs; with separate subanalysis on GBS bacteriuria). We did meta-analyses to derive pooled estimates of the risk and odds ratios (according to study design), with sensitivity analyses to investigate potential biases. We identified 45 studies for inclusion. We estimated the risk ratio (RR) for preterm birth with maternal GBS colonization to be 1.21 (95% confidence interval [CI], .99-1.48; P = .061) in cohort and cross-sectional studies, and the odds ratio to be 1.85 (95% CI, 1.24-2.77; P = .003) in case-control studies. Preterm birth was associated with GBS bacteriuria in cohort studies (RR, 1.98 [95% CI, 1.45-2.69]; P < .001). From this review, there is evidence to suggest that preterm birth is associated with maternal GBS colonization, especially where there is evidence of ascending infection (bacteriuria). Several biases reduce the chance of detecting an effect. Equally, however, results, including evidence for the association, may be due to confounding, which is rarely addressed in studies. Assessment of any effect on preterm delivery should be included in future maternal GBS vaccine trials.

Management of term infants at increased risk for early-onset bacterial sepsis.

Early-onset neonatal bacterial sepsis (EOS) is sepsis occurring within the first 7 days of life. This statement provides updated recommendations for the care of term (≥37 weeks' gestational age) newborns at risk of EOS, during the first 24 hours of life. Maternal Group B streptococcus (GBS) colonization in the current pregnancy, GBS bacteriuria, a previous infant with invasive GBS disease, prolonged rupture of membranes (≥18 hours) and maternal fever (temperature ≥38°C) are the factors most commonly associated with EOS. These risk factors are additive; the presence of more than one factor increases the likelihood of EOS. At present, there is no laboratory test, including white blood cell indices, that has sufficient sensitivity to allow clinicians to safely rule out EOS. All unwell infants with clinical signs suggesting sepsis must be treated empirically with antibiotics, once cultures have been taken. The management of well-appearing, at-risk term infants depends on the number of risk factors (including maternal GBS colonization) and whether maternal intrapartum antibiotic prophylaxis for GBS was used. In some cases, management should be individualized. Careful assessment and observation of these at-risk infants are a fundamental component of appropriate care.

Group B streptococcal bacteriuria during pregnancy as a risk factor for maternal intrapartum colonization: a prospective cohort study.

Current evidence is inconclusive regarding the intrapartum administration of chemoprophylaxis, merely based on the presence of group B streptococcal (GBS) bacteriuria of any colony count, in the prevention of early-onset neonatal GBS infection. The aim of this study was to assess whether GBS bacteriuria is a risk factor for intrapartum colonization (IPC) regardless of urinary concentration or the results of late third-trimester rectovaginal screening cultures (RVSCs). Six hundred and eight pregnant women, with urine specimens cultured between May 2011 and May 2013, were enrolled in this prospective cohort study. RVSCs were available for 582 women and intrapartum rectovaginal cultures for 246. The prevalence of GBS bacteriuria and positive RVSCs was 10.8 and 16.5 %, respectively. The frequency of IPC was 15.9 % (39/246). Sensitivity, specificity, positive and negative predictive values of urine culture and of RVSC in predicting GBS IPC were 41, 94.7, 59.3 and 89.5 %, and 76.9, 95.4, 76.9 and 95.4 %, respectively. GBS bacteriuria was significantly associated with IPC, overall [relative risk (RR) 5.6] and in women with negative RVSC (RR 8.5), with bacteriuria <104 c.f.u. ml-1 (RR 5.9) or when both circumstances coexisted (RR 8.9). The urinary colony count was <104 c.f.u. ml-1 in 13 of the 16 women with GBS bacteriuria and IPC. GBS bacteriuria is a risk factor for IPC, irrespective of urinary GBS concentration or of colonization status at late gestation. Therefore, microbiology laboratories should search, and report, GBS of any colony count in urine from pregnant women, and not only in the presence of ≥104 c.f.u. ml-1 as the 2010 CDC guidelines recommend.

Late-onset group B streptococcus infection in a preterm neonate

Early-onset group B streptococcus (GBS) is transmitted vertically from the birth canal of colonized mothers. The mode of transmission of late-onset GBS is less clear, although it is believed to reflect a delayed infection after early colonization from either vertical or horizontal transmission. We present a premature female infant whose mother was GBS negative at the time of delivery but later had GBS bacteriuria in postpartum. The infant had an initial blood culture and multiple weekly nasal surveillance cultures that were all negative for GBS. The infant’s nasal culture grew GBS after 25 days, 1 day after she had signs of sepsis and her blood grew GBS. This is the first case in preterm infants to demonstrate the horizontal transmission of late-onset GBS bacteremia without the need for early-onset colonization.

Legal Briefs: Late-Onset Group B Streptococcus Meningitis: Should It Happen in a Newborn Intensive Care Unit?

* Abbreviations: BP; : blood pressure CBC; : complete blood cell CNS; : central nervous system EOGBS; : early-onset group B Streptococcus GBS; : group B Streptococcus HR; : heart rate IAP; : intrapartum antibiotic prophylaxis ID; : infectious disease LOGBS; : late-onset group B Streptococcus A 28-6/7-weeks'-gestational-age boy whose birthweight was 1,340 g was born to a 32-year-old G3P0 woman whose pregnancy was complicated by a short cervix and preterm labor. Two cervical cultures and 1 urine culture were positive for group B Streptococcus (GBS), the latest positive cervical culture taken 2 days before delivery. Antibiotics were not given despite preterm labor with a positive GBS culture and bacteriuria. The infectious disease (ID) consult retained by the plaintiff was critical of this omission. The mother was given magnesium sulfate for tocolysis and antenatal steroids. An emergency cesarean delivery was performed because of heart rate (HR) decelerations down to the 70s for 6 to 7 minutes. At the time of delivery, membranes were ruptured and clear fluid was found. Apgar scores were 91 and 105. The GBS status was documented “unknown” in the delivery and neonatal records and remained unknown throughout the infant’s hospital stay. The plaintiff ID expert was critical of the physicians caring for the infant because he felt they should have become aware of the maternal GBS status . The treating neonatologists pointed out that nothing would have been done differently for the infant with that knowledge because the infant ’ s blood culture was sent and he was given empiric antibiotic. Continuous positive airway pressure was started immediately after birth, but because respiratory distress syndrome developed, he was intubated and given poractant alfa (Curosurf; Cornerstone Therapeutics, Inc, Cary, NC). The infant was extubated a few hours later and remained on room air for 1 month, initially with nasal continuous positive airway pressure, then nasal cannula. The blood culture was negative, and complete blood cell (CBC) count was normal. Ampicillin and gentamicin were discontinued after 2 days. His baseline HRs averaged 146 beats per minute until caffeine was started. Then …

Are we using too many antibiotics during pregnancy?

Are we using too many antibiotics during pregnancy?

Maternal and neonatal risk factors for early-onset group B streptococcal disease: a case control study

ObjectivesTo identify the prominent maternal and neonatal risk factors associated with early-onset group B streptococcus (EOGBS) disease in neonates and to determine their importance by comparing them with a control group.SettingNeonatal unit at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia.PatientsCases were infants <7 days of age with invasive group B streptococcus (GBS) disease diagnosed between January 1, 2000 and December 31, 2009. Controls were healthy infants born in the same hospital during the same period having the same birth weight and gestational age category.Main outcome measuresMaternal risk factors for developing EOGBS disease, feto–maternal and neonatal clinical data, their morbidities, mortalities, and length of hospital stay.ResultsA total of 99 cases and 200 controls were included. The majority of cases presented in the first 72 hours of life (62/99 [63.9%]), of which 87/99 (89.7%) had at least one clinical risk factor for the development of EOGBS disease. Mothers of neonates with EOGBS disease were more likely to have GBS bacteriuria (odds ratio [OR] 10.76, 95% confidence interval [CI] 1.24–93.42), infection in the peripartum period (OR 8.92, CI 2.87–27.68), and temperature ≥38°C (OR 7.10, CI 2.50–20.17). GBS disease was associated with premature rupture of membranes and fetal tachycardia (P<0.01 for both). Neonates with EOGBS disease were more likely to have respiratory distress disease and convulsions, require tube feeding, and have longer hospital stays compared with the controls (P<0.01 for all). Stepwise multiple logistic regression has identified three risk factors that were associated with the highest tendency for the development of EOGBS disease. These were lack of antenatal attendance (OR =0.30 and CI 0.98–0.88), rupture of membranes (OR =9.62 and CI 3.1–29.4), and antibiotic use in labor (OR =0.16 and CI 0.38–0.67).ConclusionA number of maternal risk factors were significantly associated with EOGBS disease. Taking these factors into consideration may result in preventing the occurrence of EOGBS disease, improve maternal and neonatal medical care, decrease their hospital stay, and reduce unnecessary hospital resource utilization.

Management of Group B Streptococcal Bacteriuria in Pregnancy

ObjectiveTo provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. OutcomesThe outcomes considered were neonatal GBS disease, preterm birth, pyelonephritis, chorioamnionitis, and recurrence of GBS colonization. EvidenceMedline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). Low colony counts refer to < 100 000 CFU/mL, and high (significant) colony counts refer to ≥ 100 000 CFU/mL. Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to February 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. ValuesRecommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table). Benefits, Harms, and CostsThe recommendations in this guideline are designed to help clinicians identify pregnancies in which it is appropriate to treat GBS bacteriuria to optimize maternal and perinatal outcomes, to reduce the occurrences of antibiotic anaphylaxis, and to prevent increases in antibiotic resistance to GBS and non-GBS pathogens. No cost-benefit analysis is provided.

Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes?

Objective: To investigate pregnancy outcomes of patients with and without group-B streptococcus (GBS) bacteriuria. Methods: A retrospective study comparing pregnancy outcomes of women with GBS bacteriuria during pregnancy, those with positive GBS vaginal cultures and those without GBS colonization during pregnancy was conducted. Results: A significant linear association was found with regard to intrapartum fever (U-GBS 0.5%, V-GBS 0.3%, no GBS 0.1%, p = 0.001) and chorioamnionitis (U-GBS 3.3%, V-GBS 1%, no GBS 0.7%, p = 0.001). In addition preterm delivery (15.3% vs. 7.9%, p = 0.001) and premature rupture of membranes (10.7% vs. 7.9, p = 0.001) were significantly higher in the U-GBS group compared to no GBS. Woman with U-GBS had higher rates of diabetes mellitus, hypertensive disorders, and habitual abortions as well as a higher risk for intrauterine growth restriction (IUGR). In addition patients with U-GBS underwent induction of labor and cesarean delivery more frequently. Conclusions: Our study showed a significant association between U-GBS and adverse obstetrical outcomes. In addition a linear association was found between GBS culture location and obstetric complications. However, GBS was not associated with adverse perinatal outcome in our population.

Recolonization of group B Streptococcus (GBS) in women with prior GBS genital colonization in pregnancy

Objective: The purpose of the study is to evaluate the incidence of women with prior GBS genital colonization who have recolonization in subsequent pregnancies. Methods: This is a retrospective, cohort study of patients with a prior GBS genital colonization in pregnancy and a subsequent pregnancy with a recorded GBS culture result, from January 2000 through June 2007. Documentation of GBS status was through GBS culture performed between 35 to 37 weeks gestation. Exclusion criteria included pregnancies with unknown GBS status, patients with GBS bacteriuria, women with a previous neonate with GBS disease and GBS finding prior to 35 weeks. Data was analyzed using SPSS 15.0. The sample proportion of subjects with GBS genital colonization and its confidence interval were computed to estimate the incidence rate. Logistic regression was performed to assess potential determinants of GBS colonization. Regression coefficients, odds ratios and associated confidence intervals, and p-values were reported, with significant results reported. Results: There were 371 pregnancies that met the test criteria. There were 151 subsequent pregnancies with GBS genital colonization and 220 without GBS recolonization. The incidence of GBS recolonization on patients with prior GBS genital colonization was 40.7% (95% confidence interval 35.7–45.69%). The incidence rate for the sample was significantly larger than 30% (p < .001), which is the estimated incidence rate for all pregnant women who are GBS carriers regardless of prior history. Conclusion: These results suggest that patients with a history of GBS are at a significantly higher risk of GBS recolonization in subsequent pregnancies.

Compliance with Group B Streptococcus Testing Prior to Labor and Delivery

We tested whether group B streptococcus (GBS) screening is performed as recommended by the Centers for Disease Control and Prevention (CDC) and evaluated the need for a rapid GBS test for women with full-term pregnancies. A retrospective cohort analysis at a single, large academic institution was performed. Women who delivered full-term (>37 weeks) infants and had documented prenatal care were included. The primary outcome was documented screening. One hundred sixty-five full-term pregnancies were included; 158 women [95.76%; 95% confidence interval (CI), 92.68 to 98.83%] were screened prior to presentation at labor and delivery. This frequency was significantly greater than the a priori hypothesis of 90% ( P = 0.01). Of the 158 women ever screened, 15 had GBS bacteriuria and 143 had genital culture performed. However, only 118 of the 143 (80.61%; 95% CI, 74.57 to 86.64%) were cultured at the appropriate time as recommended by the CDC (between 35 and 37 weeks). This screening frequency was significantly lower than the a priori hypothesis of 90% ( P < 0.001). Most full-term women presenting to labor and delivery have been screened for GBS. However, screening performed at the appropriate gestational age per CDC recommendations was lower than expected. Rapid GBS testing does not appear to be necessary for this population.

Asymptomatic Bacteriuria in Pregestational Diabetic Pregnancies and the Role of Group B Streptococcus

We sought to determine if gravidas with pregestational diabetes mellitus (DM) are at increased risk for asymptomatic bacteriuria (ASB) compared with nondiabetic gravidas. This is a retrospective case-control study of 150 pregnant patients with pregestational DM and 294 nondiabetic controls. Rates of ASB and any colony count of group B streptococcus (GBS) bacteriuria were reviewed. The incidence of ASB among pregestational diabetics was higher compared with nondiabetic gravidas (18% versus 8.2%, odds ratio [OR] 2.47, 95% confidence interval [CI] 1.37 to 4.45). GBS was the most common organism in diabetic gravidas (26%). There was no difference in incidence of ASB recurrence (OR 1.26, 95% CI 0.37 to 4.36), but antibiotic resistance was higher in the control group (OR 0.28, 95% CI 0.09 to 0.91). Diabetic gravidas with ASB or any level of GBS bacteriuria had higher hemoglobin A (1c) values compared with diabetics without ASB (8.31 +/- 1.89 versus 7.31 +/- 1.84, P = 0.0035). Our results demonstrate that gravidas with DM are at increased risk of ASB including GBS bacteriuria compared with non-diabetic gravidas.

Impacto de la investigación sistemática de estreptococo del grupo B en orina en la identificación de gestantes colonizadas

To evaluate the effectiveness of systematic investigation for Group B Streptococcus (GBS) in urine samples to detect colonization in pregnant women. This study included 1036 pregnant women whose urine samples were cultured in our laboratory during 2006. Any colony consistent with GBS was identified in urine or in rectovaginal samples submitted for screening of GBS colonization. GBS was recovered in urine samples from 111 of the 1036 women (10.7%), and in 77 of them bacterial count was <10(4) colony forming units/mL. Screening for GBS in rectovaginal samples was performed in 841 of the 925 pregnant women who did not have GBS bacteriuria (10.1% positive results) and in 61 of the 111 with GBS bacteriuria (60.7% positive results; no significant differences were found when results were stratified by colony count). Estimated rectovaginal colonization was 15.4%, and colonization exclusively detected in urine was 4.2%. Only 30% of pregnant women with GBS bacteriuria, but negative antenatal screening cultures who were admitted to our hospital for delivery received intrapartum antibiotic prophylaxis. Systematic investigation of the presence of GBS in urine samples from pregnant women improves the detection of carriers who are candidates for receiving intrapartum prophylaxis to prevent perinatal GBS infection, when compared with rectovaginal screening culture in the last trimester of gestation alone.