Group B Streptococcus Carriage Research Articles

Development and early testing of a simple, low cost, fast sensor for maternal and neonatal group B Streptococcus

Streptococcus agalactiae, (Group B Streptococcus (GBS)), is a common colonizer of the female vagina. In women giving birth it can be transmitted to the baby and cause serious illness and even death to the child. We have developed a biosensor comprising of phospholipids and fatty acids vesicles encapsulating high concentration, self-quenched carboxyfluorescein, which is released by the lysis of the vesicle by virulence factors expressed by GBS, becoming diluted and fluorescent. The microbial specificity of the sensor was tested against a number of GBS strains and other microbes including Candida albicans, Enterococcus faecalis and Staphylococcus epidermidis and a statistically significant response to GBS measured over these other microbes. To test the invivo efficacy of the biosensor, a pilot study using donated lower vaginal swabs from non-pregnant women was conducted, where 58 female adults were recruited. Participants donated two swabs, one which was used for the vesicle test and one for the ‘gold standard’, enriched culture media (ECM) test. An overall GBS carriage rate of 17.2% was measured using the ECM test. The vesicle biosensor test took 45 min to obtain a result, and showed a sensitivity of 83.3%, specificity of 85.7% and accuracy of 85.3%. The test accuracy is in line with current novel GBS identification tests, with the advantage of being rapid, easy to use, low-cost and able to be conducted by bedside during start of labour.

Incidence of group B streptococcus early-onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: a multicenter retrospective study

BackgroundThe difference in incidence of early onset sepsis (EOS) caused by Group B Streptococcus (GBS) among term neonates whose mothers receive first versus second-line intrapartum prophylaxis is poorly described. ObjectiveTo compare the incidence of GBS EOS in term neonates born to mothers who receive first, second-line or no intrapartum antibiotics, and describe the short term and survival outcomes of neonates who developed GBS EOS stratified by maternal antepartum prophylaxis. Study DesignThis was a retrospective review of electronic medical records. We queried the Pediatrix Medical Group Clinical Data Warehouse to evaluate the outcomes of term neonates born to GBS positive mothers between 2003 – 2020, and compared the incidence and outcomes of neonates with GBS EOS whose mothers received first versus second-line/no intrapartum prophylaxis. ResultsAmong 496,180 neonates, 104,196 (21%) were born to GBS positive mothers. Out of 97,983 GBS positive mothers with adequate prenatal antibiotic documentation, 49,234 (50%), 12,679 (13%) and 36,070 (37%) received first-line, second-line and no intrapartum prophylaxis, respectively. Incidence of GBS EOS among all neonates with maternal GBS carriage was 0.22% (231/104,196). Neonates whose mothers received second-line intrapartum antibiotics and no antibiotics had higher risk of GBS EOS infection compared to first-line intrapartum antibiotics [adjusted odds ratio (aOR) 4.12, 95% confidence interval (CI): 2.66 – 6.38 and aOR 3.80, 95% CI: 2.66 – 5.44, respectively]. No statistically significant difference in the risk of GBS EOS in neonates born to mothers who received second-line versus no antibiotics (aOR 0.92, 95% CI: 0.64 – 1.33). ConclusionNeonates exposed to second-line maternal GBS prophylaxis had increased risk of GBS EOS compared to those exposed to first-line maternal GBS prophylaxis. There was no statistically significant difference in GBS EOS incidence between second-line versus no antibiotics in mothers with GBS carriage.

Inferring longitudinal patterns of group B Streptococcus colonization during pregnancy

Maternal colonization by Group B Streptococcus (GBS) can lead to severe infection in neonates and has also been associated with prematurity and stillbirth. Better quantitative understanding of the trajectories of GBS carriage during pregnancy is essential for the design of informative epidemiological studies. Here, we describe analyses of published longitudinal data using Bayesian hidden Markov models, which involve the estimation of parameters related to the succession of latent states (infection status) and observations (culture positivity). In addition to quantifying infection acquisition and clearance probabilities, the statistical approach also suggests that for some longitudinal patterns of culture results, pregnant women were likely to have been GBS-colonized despite a negative diagnostic result. We believe this method, if used in future longitudinal studies of maternal GBS colonization, would improve our understanding of the pathologies linked to this bacterium and could also inform maternal GBS vaccine trial design.

CHROMagarTM Strep B for detecting group B Streptococcus in pregnant women at 35th to 37th of gestation

Group B Streptococcus (GBS) is one of the common causes of neonatal sepsis spreading from mothers to newborns. A common method to isolate and identify GBS is using Blood agar which delivers results in at least 48 hours. Although chromogenic culture media including CHROMagarTM StrepB, can develop colored colonies for detecting pathogenic bacteria easily, there has not been approached GBS isolation in Vietnam. This study was conducted to find out the GBS infection ratio in pregnant women at the 35th – 37th week of gestation. Furthermore, this research evaluates the efficacy of CHROMagarTM StrepB media and Blood agar in GBS detection as well. In a cross-sectional survey, a total of 258 pregnant women at 35th to 37th of gestation screened for GBS at Thuan Kieu General Clinic from 04/2021 to 12/2021 were recruited. Rectovaginal swabs from these patients were cultured on Blood agar and CHROMagarTM StrepB. We performed data analysis using SPSS ver 20, p<0.05 was statistically significant. Overall, out of 258 participants, 52 (20.16%) were GBS carriers. CHROMagarTM StrepB has significantly higher sensitivity than blood agar if spending a similar time (1.52 fold, p-value < 0.001), or event training a shortened time (18 hours and 48 hours), CHROMagarTM StrepB media is still more sensitive than blood agar (1.16 fold, p-value 0.044). In this study, the GBS infection ratio in pregnant women at 35-37 weeks of gestation at Thuan Kieu General Clinic is 20.16%. Culturing vaginal-rectal specimens on CHROMagarTM StrepB medium is higher sensitivity and rapidly than blood agar for GBS detection. CHROMagarTM StrepB should be used to get more effective in identifying GBS carriers in near-term pregnant women.

Vaginal Carriage of Group B Streptococcus (GBS) in Pregnant Women, Antibiotic Sensitivity and Associated Risk Factors in Dakar, Senegal.

The eradication of neonatal Group B Streptococcus (GBS) infections, considered as a major public health priority, necessarily requires a mastery of the data on vaginal carriage in pregnant women. The aims of this study were to determine the prevalence of vaginal carriage of GBS in pregnant women, antibiotic susceptibility, and associated risk factors. This was a cross-sectional, descriptive study conducted over a period of 9 months (July 2020 to March 2021) in pregnant women between 34 and 38 weeks of gestation (WG) followed at the Nabil Choucair health center in Dakar. Identification and antibiotic susceptibility of GBS isolates were performed on the Vitek 2 from vaginal swabs cultured on Granada medium. Demographic and obstetric interview data were collected and analyzed on SPSS (version 25). The level of significance for all statistical tests was set at P < .05. The search of GBS vaginal carriage had involved 279 women aged 16 to 46 years, with a median pregnancy age of 34 (34-37) weeks' gestation. GBS was found in 43 women, for a vaginal carriage rate of 15.4%. In 27.9% (12/43) of volunteers screened, this carriage was monomicrobial, while in 72.1% (31/43) of women, GBS was associated with other pathogens such as Candida spp. (60.5%), Trichomonas vaginalis (2.3%), Gardnerella vaginalis (34.9%) and/or Mobiluncus spp. (11.6%). The level of resistance was 27.9% (12/43) for penicillin G, 53.5% (23/43) for erythromycin, 25.6% (11/43) for clindamycin and 100% for tetracycline. However, the strains had retained fully susceptible to vancomycin and teicoplanin. The main risk factor associated with maternal GBS carriage were ectocervical inflammation associated with contact bleeding (OR = 3.55; P = .005). The high rate of maternal vaginal GBS carriage and the levels of resistance to the various antibiotics tested confirm the importance of continuous GBS surveillance in our resource-limited countries.

Simultaneous carriage of multiple serotypes of Group B Streptococcus: Systematic review and meta-analysis.

Epidemiological studies evaluating the distribution of Group B Streptococcus (GBS) serotypes are crucial for serotype-specific vaccine development and post-licensure surveillance. However, there is a paucity of data about the prevalence of simultaneous carriage of multiple serotypes. We conducted a systematic review of three databases (Medline, Embase, PubMed) to identify studies reporting GBS serotype co-carriage at the same anatomical site (multiple serotypes in one sample) or different anatomical sites (paired samples from one individual with different serotypes). We conducted a random-effects meta-analysis to evaluate the prevalence of co-carriage. 18 articles met the inclusion criteria, representing at least 12,968 samples from 14 countries. In a random-effects meta-analysis, we identified that 10% (95% CI: 4-19) of the positive samples taken from one anatomical site have more than one serotype, and 11% (95% CI: 5-20) of positive participants with samples taken from two anatomical sites carried different serotypes. When reported, the number of serotypes simultaneously carried ranged from 1 to 4. The serotypes most often associated with co-carriage are III (20.3%), V (20.3%) and Ia (19.5%). This systematic review demonstrates that co-carriage is a minor but definite phenomenon, but the data are too limited to give a precise picture of the current epidemiology. Co-colonisation detection needs to be taken into consideration in the design and methods of future GBS carriage surveillance studies to estimate and evaluate the potential for serotype replacement once vaccines are introduced.

Study on the Correlation between Genital Tract Microenvironment and GBS Carrier Rate of Late-Stage Pregnant Women in Dongguan.

The carrier rate of group B Streptococcus (GBS) in the genital tract of women in the late stage of pregnancy and its correlation with the genital tract microenvironment were investigated in a group of pregnant women in Dongguan, China, to provide a basis for the clinical prevention and treatment of GBS. A retrospective analysis was done of the results of routine testing for GBS, leucorrhea and bacterial vaginosis (BV) in 6,166 women in the late stage of pregnancy (35 - 37 weeks of gestation) who underwent a prenatal examination at Dongguan Southeast Central Hospital from January 2018 to December 2020. GBS positivity was detected by RT-PCR. Normal saline floating microscopy was used to detect routine indicators of leucorrhea, including white blood cells (WBCs), Lactobacillus (Lab), vulvovaginal Candida (VVC), and trichomoniasis (TV). BV was detected based on an enzymatic reaction. The correlation between GBS infection and age and the vaginal microenvironment was determined statistically. The rate of GBS positivity was 10.53% (649/6,166) and was statistically significant for women 20 years of age (p < 0.05). Logistic regression showed that abnormal VVC, TV, BV, WBCs, and Lactobacillus were associated with GBS infection. The results of a rank sum test of the WBC group showed that the infection risk in groups with < 15 WBCs/hpf increased as the WBC count increased, but there was no statistical difference between groups with > 15 WBCs/hpf. The rank sum test results for Lactobacillus showed a significant difference between the abnormal and normal and other groups, but no significant difference between the other groups. The overall carrier rate of GBS in the genital tract of late-stage pregnant women in Dongguan was 10.53%. GBS infection is related to the genital tract microenvironment. Our results provide a basis for the prevention and treatment of clinically confirmed GBS.

Maternal Group B Streptococcal Rectovaginal Colonization after Intrapartum Antibiotic Prophylaxis.

Maternal rectovaginal colonization with Group B Streptococcus (GBS) during labor is a prerequisite for neonatal early-onset GBS disease. Intrapartum antibiotic prophylaxis (IAP) has been proven to prevent GBS perinatal infection, while there are few studies on the evaluation of the effectiveness of different antibiotic prophylaxis regimens. This study aimed to assess the maternal rectovaginal GBS colonization status after IAP, antimicrobial susceptibility and maternal and neonatal outcomes among women administered different antibiotic prophylaxis regimens. A prospective study was conducted between June 2018 and June 2022. GBS carriers identified at 35-37 weeks of gestation were provided IAP (penicillin, cefazolin or clindamycin) at delivery based on the local protocol for GBS prevention. Rectovaginal samples were obtained from participants again after delivery. Antimicrobial susceptibility testing in GBS isolates was performed using the broth microdilution method. A total of 295 cases were included in this study. In the postpartum re-examination for GBS, the overall negative rectovaginal culture rate was 90.8% (268/295). Women who received cefazolin prophylaxis had the highest negative culture rate (95.2%, 197/207), which was followed by those who received penicillin (80.7%, 67/83) and clindamycin (80.0%, 4/5) (p = 0.001). All GBS isolates achieved sensitivity to penicillin and cefazolin, whereas resistance to clindamycin was shown in 21.4% of the strains. There were no significant differences in maternal and neonatal outcomes among the IAP groups. The use of IAP is highly effective in reducing the maternal rectovaginal GBS colonization. Cefazolin may offer equivalent efficacy and safety compared to standard penicillin prophylaxis.

Changes in Group B Streptococcus Colonization among Pregnant Women before and after the Onset of the COVID-19 Pandemic in Brazil.

Group B Streptococcus (GBS) is a leading cause of neonatal infections. The genitourinary and gastrointestinal tract of pregnant women are the main source of transmission to newborns. This work investigated the prevalence and characterized GBS from pregnant women in Rio de Janeiro, Brazil, comparing the periods before (January 2019 to March 2020; 521) and during (May 2020 to March 2021; 285) the COVID-19 pandemic. GBS was detected in 10.8% of anovaginal samples. Considering scenarios before and during the pandemic, GBS colonization rate significantly decreased (13.8% vs. 5.3%; p = 0.0001). No clinical and sociodemographic aspect was associated with GBS carriage (p > 0.05). A total of 80%, 13.8% and 4.6% GBS strains were non-susceptible to tetracycline, erythromycin and clindamycin, respectively. Serotype Ia was the most frequent (47.7%), followed by V (23.1%), II (18.4%), III (7.7%) and Ib (3.1%). An increasing trend of serotypes Ib and V, as well as of antimicrobial resistance rates, and a decreasing trend of serotypes II and III, were observed after the pandemic onset, albeit not statistically significant (p > 0.05). The reduction in GBS colonization rates and alterations in GBS serotypes and resistance profiles during the pandemic were not due to changes in the sociodemographic profile of the population. Considering that control and preventive measures related to the COVID-19 pandemic onset have impacted other infectious diseases, these results shed light on the need for the continuous surveillance of GBS among pregnant women in the post-pandemic era.

The Group B Streptococcal Adhesin BspC Interacts with Host Cytokeratin 19 To Promote Colonization of the Female Reproductive Tract.

ABSTRACTStreptococcus agalactiae, otherwise known as Group B Streptococcus (GBS), is an opportunistic pathogen that vaginally colonizes approximately one third of healthy women. During pregnancy, this can lead to in utero infection, resulting in premature rupture of membranes, chorioamnionitis, and stillbirths. Furthermore, GBS causes serious infection in newborns, including sepsis, pneumonia, and meningitis. Previous studies have indicated that GBS antigen (Ag) I/II family proteins promote interaction with vaginal epithelial cells; thus, we hypothesized that the Ag I/II Group B streptococcal surface protein C (BspC) contributes to GBS colonization of the female reproductive tract (FRT). Here, we show that a ΔbspC mutant has decreased bacterial adherence to vaginal, ecto-, and endocervical cells, as well as decreased auto-aggregation and biofilm-like formation on cell monolayers. Using a murine model of vaginal colonization, we observed that the ΔbspC mutant strain exhibited a significant fitness defect compared to wild-type (WT) GBS and was less able to ascend to the cervix and uterus in vivo, resulting in reduced neutrophil chemokine signaling. Furthermore, we determined that BspC interacts directly with the host intermediate filament protein cytokeratin 19 (K19). Surface localization of K19 was increased during GBS infection, and interaction was mediated by the BspC variable (V) domain. Finally, mice treated with a drug that targets the BspC V-domain exhibited reduced bacterial loads in the vaginal lumen and reproductive tissues. These results demonstrate the importance of BspC in promoting GBS colonization of the FRT and that it may be targeted therapeutically to reduce GBS vaginal persistence and ascending infection.

HbA1c at term delivery and adverse pregnancy outcome

BackgroundThere are no obvious thresholds at which the risk of adverse pregnancy outcomes increases as a result of maternal hyperglycemia. HbA1c level which is representative of average blood glucose levels over the last 2–3 months is not as strongly predictive of adverse outcome compared to blood glucose values of oral glucose tolerance test. Data is sparse on the predictive value of HbA1c at term just prior to delivery on adverse outcome. We sought to evaluate HbA1c taken on admission for delivery at term on adverse outcomes of Cesarean delivery and large (≥ 90th centile) for gestational age (LGA) infants.MethodsA prospective cross-sectional study was conducted in a university hospital in Malaysia from December 2017-August 2018. 1000 women at term whose deliveries were imminent were enrolled. Blood were drawn and immediately sent for HbA1c analysis at our hospital laboratory. Primary outcomes were Cesarean delivery and LGA.ResultsOn crude analyses, Cesarean births (vs. vaginal births) were associated with significantly higher HbA1c (%) levels 5.4[5.2–5.7] vs. 5.3[5.1–5.6] P = < 0.001 but not for LGA vs. non-LGA 5.4[5.1–5.6] vs. 5.3[5.1–5.6] P = 0.17. After controlling for significant confounders identified on crude analysis (diabetes in pregnancy, parity, ethnicity, body mass index (BMI), previous cesarean, labor induction, Group B streptococcus (GBS) carriage and birth weight), HbA1c is independently predictive of Cesarean birth, adjusted odds ratio (AOR) 1.47 95% CI 1.06–2.06 P = 0.023 per HbA1c 1% increase. Following adjustment for significant confounders (BMI, predelivery anemia [hemoglobin < 11 g/dl] and GBS carriage), the impact of raised HbA1c level on LGA is AOR 1.43 95% CI 0.93–2.18 P = 0.101 per HbA1c 1% increase and non-significant.ConclusionRaised HbA1c level at term births in the general pregnant population is independently predictive of Cesarean delivery after adjustment for potential confounders including diabetes in pregnancy.

Colonization of pregnant women with group B streptococcus: current view at the problem

The relevance of the problem of group B streptococcus (GBS) in obstetric practice casts no doubt. Attracting the close attention of leading experts, introducing new solutions and based on practical experience gained, it is still not possible to prevent all cases of neonatal infections associated with GBS. The review article demonstrates the current view of the problem. According to the literature, African-American race in combination with sexually transmitted infections are predisposing risk factors for GBS colonization. A direct relationship between obesity and the percentage of GBS carriers was revealed. GBS-colonized primigravidas have a 50 % increased chance of detecting the pathogen in subsequent pregnancies. Absolute factors for massive GBS colonization of the birth tract include GBS-associated asymptomatic bacteriuria and a history of GBS-colonized children. It is assumed that such virulence factors as hemolytic pigment and hyaluronidase contribute to the GBS pathogenic potential. The protective function in the immune system is performed by Kaschenko–Gofbauer cells, but their role is ambiguous. Early neonatal GBS infection realized in 90 % of newborns that manifested by sepsis, pneumonia and purulent meningitis. Implemented measures to prevent early neonatal GBS infection have a number of disadvantages. False-negative results of culture screening for GBS antigen at gestational age of 35–37 weeks increase a risk of vertical transmission, whereas false-positive results underlie a reason for prescribing irrational intranatal antibiotic prophylaxis. Moreover, antenatal GBS microbiological screening and antibiotic prophylaxis at birth do not prevent the risks of late-onset neonatal GBS infection.

Colonization of Streptococcus agalactiae among pregnant patients in Trinidad and Tobago

ObjectiveTo assess colonization of Streptococcus agalactiae [group B streptococcus (GBS)], and delineate capsular serotype distribution and antibiotic susceptibility profiles among pregnant women in Trinidad and Tobago. MethodsVaginal swabs were collected from 248 pregnant women attending antenatal clinics in northern Trinidad, and processed using standard microbiological laboratory tests to confirm GBS. Polymerase chain reaction detected atr and cps serotype genes. Antimicrobial susceptibility tests were performed using the Kirby–Bauer method, and SPSS Version 25 was used for statistical analysis. Prevalence ratio measured the risk, and P≤0.05 was considered to indicate significance. ResultsThe GBS carriage rate was 29% (72/248, 95% confidence interval 23.3–34.8), and carriage was significantly associated with variables including gestational diabetes (P=0.042), age 25–35 years (P=0.006), multiparity (P=0.035) and marital status (P=0.006). The most common serotype was type II [47.2% (34/72)], and serotypes V, VI, VII and VIII were not encountered. GBS showed high resistance to amoxicillin-clavulanic acid (37.5%), erythromycin (30.6%), trimethoprim-sulphamethoxazole (58.3%) and tetracycline (97.2%). ConclusionGBS colonization among pregnant women and resistance to commonly used antibiotics are high in Trinidad and Tobago. A population-based study is required to obtain accurate figures in order to improve maternal healthcare services.

A Retrospective National Study on Colonization Rate and Antimicrobial Susceptibility of Streptococcus agalactiae in Pregnant Korean Women, 2018-2020.

PurposeThe prevalence of Group B Streptococcus (GBS) colonization in pregnant Korean women is increasing; however, nationwide studies are lacking. Therefore, we aimed to analyze regional colonization rates and antimicrobial susceptibility for GBS in pregnant Korean women through a nationwide survey.Materials and MethodsFrom January 2018 to December 2020, data from the Seoul Clinical Laboratories on vaginal swab cultures were retrospectively analyzed to detect maternal GBS carriers. Each swab specimen was inoculated onto a 5% blood agar plate and incubated at 35℃–37℃ in a 5% CO2 incubator for 24 h. GBS isolates were identified using a Microflex MALDI Biotyper. Antimicrobial susceptibility tests were performed using the Vitek 2 automated system.ResultsThe overall nationwide GBS colonization rate in pregnant Korean women was found to be 10.6% (3578/33721). The maternal GBS colonization rates ranged from 10.5%–10.8% over the 3-year study period. The GBS colonization rates by province, in descending order, were as follows: Jeolla-do, 13.2%; Gangwon-do, 12.0%; Chungcheong-do, 11.8%; Gyeonggi-do, 11.3%; Seoul, 10.2%; and Gyeongsang-do, 9.6%. During the study period, the resistance rates against chloramphenicol, levofloxacin, clindamycin, erythromycin, and tetracycline were 2.6%–2.7%, 18.2%–19.6%, 33.4%–35.7%, 35.6%–36.8%, and 50.5%–53.3%, respectively.ConclusionIn pregnant Korean women, GBS colonization rates were in the range of 9.6%–13.2%, with Gyeongsang-do being the lowest and Jeolla-do the highest. The resistance rate against clindamycin was high (33.4%–35.7%). GBS colonization rates during pregnancy should be studied nationwide according to the Centers for Disease Control and Prevention-recommended guidelines with periodic antimicrobial resistance monitoring.

Prevalence, Antimicrobial Susceptibility Pattern and Factors Associated with GBS Colonization in Pregnant Women at the Regional Hospital Bamenda (RHB)

Introduction: Maternal asymptomatic colonization with GBS (Group-B Streptococcus) has become a major cause of sepsis, meningitis and encephalopathy in neonates alongside premature births, stillbirths and post-natal infections. Routine screening of pregnant women for GBS carriage and antimicrobial susceptibility are therefore necessary. This study was aimed at evaluating the prevalence, antimicrobial susceptibility pattern and factors associated with GBS colonization in pregnant women at the Regional Hospital Bamenda (RHB). Materials and Methods: Vaginal and rectal swab samples were collected from 121 pregnant women in the 3rd trimester at the RHB from December 2017 to May 2018. Sociodemographic, obstetric and neonatal history and some clinical parameters were obtained through a questionnaire approach. Cultures for the isolation and identification of GBS from the samples were done and grouping as well as susceptibility testing of GBS isolates was done. Results: The colonisation rates were 5.8% (7), 1.7% (2) and 5.8% (7) for rectal, vaginal and concomitant recto-vaginal carriage. GBS was isolated in the vagina/rectum of 16 participants (13.2% prevalence). Of the 16 GBS strains used for in vitro susceptibility test, no resistance to ampicillin, oxacillin, amoxicillin-clavulanate, ceftriaxone, erythromycin, imipenem, aztreonam and clindamycin was recorded. 6.3% (1) of the strains had intermediate susceptibility to ampicillin and amoxicillin-clavulanic acid. Of the isolates examined, 37.5% (6), and 12.5% (2) were respectively sensitive to gentamycin and levofloxacin. Maternal overweight, HIV positive status, history of PROM and spontaneous abortion, presence of Gardnerella vaginalis and Candida albicans had a high rate of GBS colonization but only HIV positive status had a statistical significance (p = 0.01). Other microbes isolated were Gardnerella vaginalis (55.4%, 67), Candida albicans (40.5%, 49), and Candida spp (12.4%, 15). Conclusion: GBS prevalence was 13.2%. GBS had decreased susceptibility to some antibiotics. Only HIV positive status was significantly associated with GBS colonization.

PREVALENCE OF GROUP B STREPTOCOCCUS AND LEVEL OF RELIGIOSITY OF JEWISH MOTHERS IN NORTHERN ISRAEL - IS THERE A CONNECTION?

Group B streptococcus (GBS) during pregnancy is associated with increased risk of preterm delivery and is a leading cause of invasive infections in newborns. Rates of vaginal GBS prevalence in pregnant women vary among ethnic groups and geographical regions, with a range of 0.5-38%. The aim is to assess the prevalence rate of GBS bacteria among Jewish pregnant mothers in northern Israel, according to their level of religiosity. A cross-sectional study was pursued in 303 Jewish mothers at Ziv Medical Center, Safed of whom 89 (29.4%) were secular, 59 (19.5%) traditional, 60 (19.8%) Orthodox and 95 (31.3%) ultra-Orthodox, from December 2019-July 2020. All participants were tested for GBS from pregnancy week 35 as part of the routine medical care at their Health Maintenance Organization (HMO) and submitted the GBS test result upon arrival at the hospital delivery room. The overall prevalence of GBS was 33.7%: 16.9% of the secular mothers, 25.4% of the traditional women and 46.5% of the Orthodox and ultra-Orthodox group (p&lt;0.001). In a univariate regression model the risk of GBS carriage in Orthodox mothers was 2.5 times higher and 6 times higher in ultra-Orthodox mothers than in secular mothers (p for trend &lt;0.001). The prevalence of GBS was directly and significantly associated with the level of the birthing mother's religiosity. This study shows the need for systematic GBS screening of all pregnant women, particularly of Orthodox and ultra-Orthodox women, prior to their arrival in the delivery room.

Development and Clinical Evaluation of a CRISPR-Based Diagnostic for Rapid Group B Streptococcus Screening.

Vertical transmission of group B Streptococcus (GBS) is among the leading causes of neonatal illness and death. Colonization with GBS usually is screened weeks before delivery during pregnancy, on the basis of which preventive measures, such as antibiotic prophylaxis, were taken. However, the accuracy of such an antenatal screening strategy has been questionable because of the intermittent nature of GBS carriage. We developed a simple-to-use, rapid, CRISPR-based assay for GBS detection. We conducted studies in a prospective cohort of 412 pregnant women and a retrospective validation cohort to evaluate its diagnostic performance. We demonstrated that CRISPR-GBS is highly sensitive and offered shorter turnaround times and lower instrument demands than PCR-based assays. This novel GBS test exhibited an overall improved diagnostic performance over culture and PCR-based assays and represents a novel diagnostic for potential rapid, point-of-care GBS screening.

Diagnostic Performance of Various Methodologies for Group B Streptococcus Screening in Pregnant Woman in China.

Maternal vaginal/rectal colonization of group B streptococcus (GBS) is a main risk for neonatal invasive infection. Efficient determination of GBS colonization in pregnant women is crucial. This study aimed to investigate the prevalence of GBS carriage and evaluate the diagnostic performance of six methodologies for GBS screening conducted in China, including blood agar plate, liquid chromogenic medium, and loop-mediated isothermal amplification (LAMP) without pre-enrichment, chromogenic agar plate with pre-enrichment, and GBS antigen detection without and with pre-enrichment in comparison with the standard reference method (Lim broth-enriched subculture with plating on 5% sheep blood agar). Vaginal/rectal swabs were collected from 1,281 pregnant women at 35–37 weeks of gestation. Of them, 309 were taken in triplicate, one for Lim broth-enriched subculture, one for blood agar plate, and the third for GBS antigen detection (Reagent W); 177 were acquired in duplicate, one for Lim broth-enriched subculture and the other for GBS antigen detection (Reagent H); 502 were obtained in duplicate, one for Lim broth-enriched subculture and the other for liquid chromogenic medium; 158 were collected in duplicate, one for Lim broth-enriched subculture and the other for LAMP; and 135 were inoculated in Lim broth-enriched for GBS antigen detection (Reagent W) and subculture with chromogenic agar plate and 5% blood agar plate. The overall prevalence of GBS carriage was 10.1% (130/1,281, 95% CI: 8.5–12.1%) according to the standard reference method. Compared with the standard reference method, the LAMP had excellent performance of sensitivity (100%, 95%CI: 83.4–100%), specificity (94%, 95%CI: 88.1–97.1%), and Yoden index (0.940); as well as the blood agar plate with sensitivity (81.5%, 95%CI: 61.3–93.0%), specificity (100%, 95%CI: 98.3–100.0%), and Yoden index (0.815). The other four methods were not sufficient to reach the threshold in terms of sensitivity or specificity compared to the standard reference method. Furthermore, for LAMP, results can be obtained within 0.5–1 h, while for blood agar plate, which needed 24–48 h, and further identification was required. Our data suggested that the performance of LAMP was highly comparable to the standard Lim broth-enriched subculture and LAMP is considered as an alternative for fast and accurate GBS screening.

Capsular genotype distribution of Group B Streptococcus colonization among at-risk pregnant women in Sao Paulo, Brazil.

BackgroundVaccines in development against Group B Streptococcus (GBS) should contain the most prevalent capsular genotypes screened in the target population. In low- and middle-income countries epidemiological data on GBS carriage among pregnant women, a prerequisite condition for GBS neonatal sepsis, is needed to inform vaccine strategies. ObjectiveTo investigate the prevalence of different GBS capsular genotypes that colonizes at-risk pregnant women in a private maternity hospital in São Paulo, Brazil. MethodsGBS strains isolated in routine maternity procedures from at-risk pregnant women from 2014 to 2018 were confirmed by mass spectrometry (MALDI-TOF) with subsequent DNA extraction for identification of capsular genotype through polymerase chain reaction (PCR). Demographic and gestational data were analyzed. ResultsA total of 820 Todd-Hewitt broths positive for GBS were selected for streptococcal growth. Recovery and confirmation of GBS by MALDI-TOF were possible in 352. Strains were processed for determination of capsular genotype by PCR. From the total of 352 GBS isolates, 125 strains (35.5%) were genotyped as Ia; 23 (6.5%) as Ib; 41 (11.6%) as II; 36 (10.2%) as III; 4 (1.1%) as IV; 120 (34.1%) as V and 1 strain (0.3%) as VIII. Two isolates (0.7%) were not genotyped by used methodology. No statistically significant correlation between gestational risk factors, demographic data and distribution of capsular genotypes were found. ConclusionsGBS capsular genotypes Ia, Ib, II, III, and V were the most prevalent isolates colonizing at risk pregnant women in the present study. The inclusion of capsular genotypes Ia and V in the composition of future vaccines would cover 69.6% of capsular genotypes in the studied population. No statistically significant differences were observed between capsular genotype and gestational and demographic data and risk factors.

Poor Adherence to the Screening-Based Strategy of Group B Streptococcus Despite Colonization of Pregnant Women in Greece.

Group B streptococcus (GBS) is a leading cause of serious neonatal infections. Maternal GBS colonization is associated with early- and late-onset neonatal disease (EOD/LOD). In Greece, a screening-based strategy is recommended, in which concurrent vaginal-rectal cultures should be obtained between 36 0/7 and 37 6/7 weeks’ gestation. We sought to examine the level of adherence to the GBS screening guidelines and estimate the prevalence of GBS colonization among pregnant women. Although in Greece the screening-based strategy is followed, we also examined known EOD risk factors and linked them to GBS colonization. A cross-sectional study of 604 women postpartum in three hospitals and maternity clinics was conducted. Following written informed consent, data were collected via a short self-completed questionnaire and review of patients’ records. In 34.6% of the enrolled pregnant women, no culture had been taken. Of the remaining, 12.8% had proper vaginal-rectal sample collections. The overall maternal colonization rate was 9.6%. At least one risk factor for EOD was identified in 12.6% of participants. The presence of risk factors was associated with positive cultures (p = 0.014). The rate of culture collection did not differ between women with or without an EOD risk factor. Adherence to a universal screening of pregnant women with vaginal-rectal cultures was poor. Despite probable underestimation of GBS carrier status, almost 1 in 10 participants were GBS positive during pregnancy. Screening of women with risk factors for EOD should, at least, be prioritized to achieve prevention and prompt intervention of EOD.