Group B Streptococcus Screening Research Articles

Association between Group B Streptococcus and clinical chorioamnionitis by gestational week at delivery- a multicenter cohort study.

In the era of Group B Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP), GBS colonization has been associated with a lower risk of chorioamnionitis, possibly due to a protective effect of IAP. We sought to confirm this finding and assess whether this association varies by gestational week at delivery. We performed a retrospective cohort study of term (37.0-42.6 weeks), singleton parturients with known GBS status who delivered from 2005-2021 at two academic medical centers in Israel. We excluded patients who underwent planned cesarean, out of hospital birth, or had a fetal demise. Patients received GBS screening and IAP for GBS positivity as routine clinical care. The primary outcome was a diagnosis of clinical chorioamnionitis as determined by ICD-10 code, compared between GBS positive and negative groups, and assessed by gestational week at delivery. Of 292,126 deliveries, 155,255 met inclusion criteria. 30.1% were GBS positive and 69.9% were negative. GBS positive patients were 21% less likely to be diagnosed with clinical chorioamnionitis than GBS negative patients, even after controlling for confounders (1.5% vs. 2.2%, aOR 0.79, 95%CI [0.68-0.92]). When assessed by gestational week at delivery, there was a significantly greater difference in rates of clinical chorioamnionitis between GBS positive vs. GBS negative groups with advancing gestational age: 1.5 fold difference at 38-40 weeks, but a 2-fold difference at 42 weeks. The risk of clinical chorioamnionitis remained stable in the GBS positive group, but increased significantly in the GBS negative group at 41 and 42 weeks gestation (2.0% vs. 2.9%, p<0.01 at 41 weeks; up to 3.9% at 42 weeks, p<0.01). In a large multicenter cohort with universal GBS screening and IAP, GBS positivity was associated with a lower risk of chorioamnionitis, driven by an increasing rate of chorioamnionitis among GBS negative patients after 40 weeks.

Development and performance evaluation of a qPCR-based assay for the fully automated detection of group B Streptococcus (GBS) on the Panther Fusion Open Access system.

Streptococcus agalactiae [group B Streptococcus (GBS)] poses a major threat as the primary cause of early-onset neonatal invasive disease, particularly when mothers are colonized rectovaginally. Although culture remains the gold standard for antepartum GBS screening, quantitative polymerase chain reaction (qPCR) offers advantages in terms of sensitivity and turnaround time. The aim of this study was to validate the clinical utility of an automated qPCR laboratory-developed test (LDT) for antepartum GBS screening using the Panther Fusion Open Access system (Hologic, California, USA). The LDT targeted a conserved region of the GBS surface immunogenic protein gene, demonstrating no cross-reactivity and high coverage (99.82%-99.99%). The limit of detection (LoD) was 118 CFU/mL. Comparison with commercial qPCR assays (Panther Fusion GBS and VIASURE Streptococcus B Real-Time) revealed an overall agreement of 99.7%, with a robust Cohen's kappa coefficient of 0.992. Testing of 285 rectovaginal swabs from pregnant women and 15 external quality assessment samples demonstrated exceptional diagnostic performance of the LDT, achieving a diagnostic sensitivity and specificity of 100%, underscoring its accuracy. Prevalence and predictive values were also determined to reinforce test reliability. Our research highlights the limitations of culture-based screening and supports the suitability of our qPCR-based LDT for GBS detection in a clinical setting.IMPORTANCERectovaginal colonization by GBS is a major risk factor for early-onset invasive neonatal disease. The most effective approach to reducing the incidence of early-onset disease (EOD) has been described as universal screening, involving assessment of GBS colonization status in late pregnancy and intrapartum antibiotic prophylaxis. Despite its turnaround time and sensitivity limitations, culture remains the gold standard method for GBS screening. However, nucleic acid amplification-based tests, such as qPCR, have been utilized due to their speed and high sensitivity and specificity. This study validated the clinical usefulness of an automated qPCR-LDT for antepartum GBS screening through the Panther Fusion Open Access system (Hologic). Our study addresses the critical need for more robust, sensitive, and rapid strategies for GBS screening in pregnant women that could favorably impact the incidence of EOD.

Group B Streptococcus colonization status and antibiotic use during labour - a single-centre observational study.

Group B streptococcus (GBS) colonization among pregnant women is the leading cause of neonatal infection. Intrapartum antibiotic prophylaxis (IAP) is the most effective method to reduce the incidents of neonatal sepsis. We describe compliance with GBS management and the implementation of IAP in the context of the long-term effect of antibiotics. The study was conducted among 249 childbearing women hospitalized between January 2022 and February 2022 at University Clinical Center in Gdansk, Poland. The data were obtained from the questionnaire and medical records. We analyzed maternal colonization with GBS, compliance with GBS screening and treatment guidelines, risk factors contributing to GBS colonization, IAP administration, and neonatal congenital infection occurrence. Of all patients, 240 (96.4%) were screened for GBS, 215 (89.6%) between 35-37 weeks of gestation. Fifty (20%) were GBS-positive, 184 (74%) negative, 15 (6%) had unknown GBS status. There were no significant differences between the GBS-positive and GBS-negative groups in maternal age, mode of delivery, gestational age at birth, maternal comorbidities, parity, GBS status in previous pregnancies, and the development of infection among infants of both groups, regardless of IAP administration. Of all the studied women, 158 (63.5%) received antibiotics, 91 (36.5%) did not. The study showed the low positive and the high negative predictive value of the antenatal GBS screening test. We found that compliance with the universal GBS screening is widespread. The management of women with absent or only partial screening test requires assessing the risk factors before administering IAP.

Establishment and application of a rapid molecular diagnostic platform for the isothermal visual amplification of group B Streptococcus based on recombinase polymerase.

With growing concerns about Group B streptococcal (GBS) infections and their adverse effects on perinatal pregnancies, including infection, premature delivery, neonatal septicemia, and meningitis, it is urgent to promote GBS screening at all pregnancy stages. The purpose of this study is to establish a device-independent, fast, sensitive, and visual GBS detection method. Taking advantage of the characteristics of the recombinase polymerase isothermal amplification (RPA), the activity of the nfo nuclease cleavage base analog (tetrahydrofuran, THF) site, and the advantages of visual reading of the lateral flow chromatography strip (LFS), a GBS detection method was developed. This method focused on the conservative region of the Christie-Atkins-Munch-Petersen factor encoded by the cfb gene, a virulence gene specific to GBS. Two forward primers, two biotin-labeled reverse primers, and one fluorescein isothiocyanate (FITC)-labeled and C3spacer-blocked probe were designed. The study involved optimizing the primer pair and probe combination, determining the optimal reaction temperature and time, evaluating specificity, analyzing detection limits, and testing the method on 87 vaginal swabs from perinatal pregnant women. The results showed that the visual detection method of GBS-RPA-LFS, using the cfb-F1/R2/P1 primer probe, could detect GBS within 15 min at the temperature ranging from 39°C to 42°C. Furthermore, the method specifically amplified only GBS, without cross-reacting with pathogens like Lactobacillus iners, Lactobacillus crispatus, Candida albicans, Listeria monocytogenes, Yersinia enterocolitica, Klebsiella Pneumoniae, Enterobacter cloacae, Citrobacter freundii, Vibrio alginolyticus, Vibrio parahaemolyticus, Salmonella typhimurium, Staphylococcus aureus, Pseudomonas aeruginosa, or Trichomonas vaginalis. It could detect a minimum of 100 copies per reaction. In clinical 98 samples of vaginal swabs from pregnant women, the agreement rate between the GBS-RPA-LFS method and TaqMan real-time fluorescence quantification method was 95.92%. In conclusion, this study successfully established a combined RPA and LFS GBS in situ detection platform, with short reaction time, high sensitivity, high specificity, portability, and device independence, providing a feasible strategy for clinical GBS screening.

The current status of Group B Streptococcus infection in the reproductive tract of late-pregnancy women and its impact on pregnancy outcomes.

Analyze Group B Streptococcus (GBS) infection in late-pregnancy pregnant women in Shanghai, the risk factors of GBS infection, and its impact on pregnancy outcomes, providing guidance for early prevention and treatment in clinical practice. We selected 12,132 late-pregnancy pregnant women admitted from January 2022 to December 2022 as the research subjects. Based on the GBS test results of reproductive tract secretion samples from pregnant women, 210 cases of GBS positive pregnant women were randomly selected as the observation group, and 200 cases of GBS negative pregnant women were selected as the control group. The risk factors of infection and the impact on pregnancy outcomes were compared between the two groups. The GBS colonization rate of pregnant women in this study was 6.52%; the incidence of Vaginal delivery and Neonatal infection in GBS positive group was significantly higher than that in GBS negative group (P < 0.05); with Neonatal infection as the dependent variable, and the GBS infection, Vaginal delivery and GDM of the elderly and women in late pregnancy as independent variables, the results showed that GBS infection of women in late pregnancy was an independent risk factor for Neonatal infection. Clinical practice should attach great importance to GBS infection in late pregnancy, strengthen GBS screening in late pregnancy, and actively implement the strategy of intrapartum antibiotic intervention (IAP), which is of great significance in reducing the vertical infection rate of maternal and infant GBS and improving the quality of newborn birth.

SURVEY ON THE SITUATION OF GROUP B STREPTOCOCCUS INFECTION IN PREGNANT WOMEN OVER 35 WEEKS AT MEDLATEC GENERAL HOSPITAL

Group B Streptococcus (GBS) is still considered as leading cause of early neonatal infections. Vertical transmission from mother to child may occur when a pregnant woman was infected with GBS in vaginal - rectum at the time of labor or the water breaks of delivery. Therefore, early screening for GBS in pregnant women over 35 weeks is essential to prevent neonatal infection due to GBS.Objectives: 1) Determine the prevalence of GBS exposure in the vaginal rectum of pregnant women over 35 weeks using cultural and Realtime PCR techniques. 2) Evaluation of the sensitivity of the isolated GBS to antibiotics.Subjects and methods: Prospective study in 243 pregnant women over 35 weeks who visited and/or had a culture test for Group B Streptococcus at Medlatec General Hospital. Samples of vaginal - rectum fluid were paralelly tested by 2 methods of culture and Realtime PCR. GBS-isolated strains were tested for their susceptibility to antibiotics. &#x0D; Results: The rate of GBS infection in pregnant women over 35 weeks by culture method is 16.9%, Realtime PCR is 18.9%. The rate of group B Streptococcus sensitive to ampicillin, ceftriaxone, cefotaxime, vancomycin, linezolid are 100%; with levofloxacin at 95.0%, erythromycin at 29.0% and clindamycin at 25.0%.Conclusions: The rate of Group B Streptococcus infection in pregnant women over 35 weeks as determined by culture method (16.9%), is lower than Realtime PCR (18.9%). Group B Streptococcus is sensitive to most of the first-line antibiotics such as penicillin, ampicillin, ceftriaxone, cefotaxime and is high resistance to erythromycin (68.4%) and clindamycin (72.5%).

Abstract 17584: Tricuspid Valve Infective Endocarditis: A Catastrophic Complication of Preterm Rupture of Membranes

Background: Few cases of post-partum complication of Group B Streptococcus (GBS) tricuspid valve (TV) infective endocarditis (IE) after live vaginal birth have been reported. We present the same, further complicated by septic emboli tospleen through patent foramen ovale (PFO). Case: 33-year-old 4 weeks post-partum female (G7P6) in septic shock was diagnosed with GBS TV IE with 41mm X 21mm vegetation(F1) with septic emboli to lungs and spleen. Echocardiogram showed PFO with right to left shunt. Ceftriaxone and Gentamycin were started. Her pregnancy was complicated with preterm premature rupture of membrane (PPROM); she had received no antenatal care. Vegetation was debulked with AngioVac procedure (AVP) while PFO was occluded with trans-septal compliant balloon(F2). After recovery from acute illness TV was replaced with bioprosthetic valve. Decision-Making: IE was most likely a post-partum complication in absence of IV drug use, intravascular device, right sided cardiac anomaly. Large size of vegetation with embolization warranted use of AVP to debulk the vegetation as a bridge to valve surgery. PFO occlusion with balloon during AVP prevented potential catastrophic embolization to the brain. Conclusion: Mothers colonized with GBS routinely get antibiotics to prevent transmission to the newborn; this case highlights the need for GBS screening and treatment to reduce maternal morbidity as well. Minimally invasive AVP can debulk vegetations thus decreasing infectious burden and risk of septic embolization before surgery.

Epidemiologic Changes of Neonatal Early-onset Sepsis After the Implementation of Universal Maternal Screening for Group B Streptococcus in Hong Kong.

The epidemiology of neonatal early-onset sepsis (EOS) has changed with time and with changes in prevention strategy. Population-representative contemporary data provide insights on how to further improve EOS prevention and triage strategies. Neonates born in public hospitals in Hong Kong from January 1, 2006, to December 31, 2017 were included. The epidemiological characteristics of EOS and the use of intrapartum antibiotic prophylaxis (IAP) were compared between the 2 epochs before (January 1, 2006 to December 31, 2011) and after (January 1, 2012 to December 31, 2017) the territory-wide implementation of universal maternal group B Streptococcus (GBS) screening. EOS developed in 1.07‰ of live births (522/490,034). After the implementation of universal GBS screening, the EOS rate decreased in neonates born ≥34 weeks (1.17‰-0.56‰, P < 0.001) and remained similar in those born <34 weeks (7.8‰-10.9‰, P = 0.15), whereas the proportions of IAP coverage increased in both groups [7.6%-23.3% ( P < 0.001) and 28.5%-52.0% ( P < 0.001), respectively]. The major pathogen for EOS shifted from GBS to Escherichia coli , and for early-onset meningitis from GBS to Streptococcus bovis . IAP was associated with subsequent isolation of pathogens resistant to ampicillin [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI): 1.3-4.2], and second-generation [aOR 2.0; 95% CI: 1.02-4.3] and third-generation [aOR 2.2; 95% CI: 1.1-5.0] cephalosporins. Pathogen profile of EOS changed with the implementation of universal GBS screening. S. bovis has emerged as a more common pathogen associated with the risk of meningitis. IAP may not be as effective in reducing EOS rate among infants born <34 weeks as compared with those ≥34 weeks, and newer strategies may be needed.

Factors Affecting Awareness of Pregnancy Screening for Group B Streptococcus Infection Among Women of Reproductive Age in Jazan Province, Saudi Arabia.

Group B streptococcus (GBS) infection is one of the leading causes of neonatal sepsis and meningitis. GBS screening and intrapartum antibiotic prophylaxis can effectively prevent early-onset GBS disease. This study aimed to assess the awareness of the risks of GBS infection and screening in Jazan Province, Saudi Arabia. A cross-sectional study was conducted using a survey of 995 women aged 18-45 in Jazan, Saudi Arabia. Data were collected between January to April 2023 and included information on sociodemographic characteristics, awareness of GBS infection, and perspectives on GBS screening. The response rate was 97.45%, and the mean age of the participants was 31.50 ± 9.80 years. Most were married (60.2%), had a university education (81.11%), and 59% were pregnant or had a pregnancy history. Only 23% had heard of GBS, associated with age, marital status, job, pregnancy status, awareness of GBS risk factors, and pregnancy follow-up (p < 0.05). Women most aware were students (55.9%), married (55.46%), pregnant or had a pregnancy history (51.09%), knew risk factors of GBS (38.86%), and were followed by a specialist (88.14%). Regarding GBS screening preferences, 40% preferred universal screening without consent, 31% with consent, 16% for high-risk pregnancies with consent, and 13% for high-risk pregnancies without consent. The study found low awareness of GBS among women residing in Jazan, Saudi Arabia. Factors related to demographic details and obstetric follow-up were associated with better understanding. Most women preferred universal screening for GBS, with or without consent. Effective health education is needed to raise women's awareness of screening benefits and risks. This education can help women make informed decisions and improve prevention and care. Future studies may evaluate healthcare providers' awareness of GBS.

Recent research on the epidemiology and preventive strategies of neonatal group B Streptococcus infection in the latest decade

Currently, the main strategy for preventing neonatal group B Streptococcus (GBS) infection is prenatal screening combined with intrapartum antibiotic prophylaxis, which has effectively reduced the incidence of neonatal GBS early-onset disease. However, the burden of GBS infection is still significant. The intrapartum antibiotic prophylaxis strategy has limitations such as inducing antibiotic resistance and inability to effectively prevent GBS late-onset disease. It is crucial to develop and evaluate other prevention strategies, while paying close attention to assessing penicillin allergy in pregnant women and how to prevent GBS infection in neonates with negative maternal GBS screening. In recent years, there has been some progress in GBS vaccines and related immunological research, and the use of specific vaccines is expected to significantly reduce GBS infection in neonates.

The value of routine empiric antibiotic use in neonates born to mothers with prolonged rupture of membranes

Background. The routine use of empiric antibiotics in neonates born to mothers with prolonged rupture of membranes (PROM) iscontroversial.Objectives. To determine the incidence of probable and proven sepsis in such neonates and identify risk factors for sepsis and theiroutcomes.Methods. This was a retrospective chart review conducted at King Edward VIII Hospital over two years. Study participants included 200neonates and 181 mothers. Data were captured onto Microsoft Excel, collated and analysed using descriptive statistics and comparative data utilising the R Core Team’s R Statistical Computing Software, 2020.Results. Seven neonates (3.5%) had proven sepsis, 58 (29%) had probable sepsis, and 135 (67.5%) were without sepsis. Two (1.0%) neonates died and 188 (94.0%) received antibiotics. White cell count was normal in all cases without sepsis and abnormal in 65.5% and 28.6% of cases with probable and proven sepsis, respectively. A raised C-reactive protein was observed in only 22.4% and 14.3% of neonates with probable and proven sepsis, respectively. One hundred and sixty-seven (83.5%) mothers had no Group B Streptococcus (GBS) screening. Of those screened, three had GBS infection, but two did not receive antibiotics.Conclusions. The incidence of sepsis following PROM is low. Identifying neonates at risk is challenging, but the absence of clinical features and normal rapidly obtained supportive laboratory markers of sepsis provides reassurance that antibiotics could be temporarily withheld. Better GBS screening programmes and appropriate antibiotic responses for pregnant women should be implemented rigorously.

Neonatal morbidity associated with maternal Group B Streptococcal colonization in individuals undergoing planned cesarean delivery

Objective To examine the association between unknown maternal Group B Streptococcal (GBS) colonization and the risk of severe neonatal morbidity among individuals undergoing planned cesarean delivery. Methods We performed a secondary analysis of a multicenter, prospective observational study of individuals with singleton gestations and planned cesarean delivery ≥37 weeks gestation with cervical dilation ≤3 cm, intact membranes, and no evidence of labor or induction. GBS status was categorized as positive, negative, or unknown. The primary outcome was a composite of severe neonatal morbidity, including clinical or culture-proven sepsis, ventilator support in the first 24 h, respiratory distress syndrome, hypotension requiring treatment, intubation, necrotizing enterocolitis, hypoxic-ischemic encephalopathy, or death. We compared individuals with unknown GBS status to those with positive and negative GBS status. Results In this cohort, 4,963 individuals met inclusion criteria; 72% had unknown GBS status, 25% were GBS negative and 3% were GBS positive. Among individuals with unknown GBS status, 208 (5.9%) had the primary composite neonatal outcome, compared with 75 (6%) of GBS negative individuals and 6 (4%) of GBS positive individuals. There was no difference in composite severe neonatal morbidity among GBS unknown, GBS negative, and GBS positive individuals (5.9% vs 6% vs 4%, p = .61). After adjusting for male sex and intrapartum antibiotic exposure, unknown GBS status was not associated with severe neonatal morbidity (adjusted risk ratio, 0.95; 95% confidence interval, 0.73–1.22). Conclusion GBS status at time of planned cesarean delivery does not appear to be associated with composite severe neonatal morbidity. The cost effectiveness and clinical utility of GBS screening among individuals undergoing planned cesarean delivery requires further investigation.

Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances

Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats. The objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines. Original research articles, review articles, and guidelines on GBS were reviewed. The following recommendations are based on review of the evidence and professional society guidelines. Screening for GBS should occur between 36 weeks and the end of the 37th week. The culture swab should go 2 cm into the vagina and 1 cm into the anus. Patients can perform their own swabs as well. Penicillin allergy testing has been shown to be safe in pregnancy. Patients with GBS in the urine should be treated at term with antibiotic prophylaxis, independent of the colony count of the culture. Patients who are GBS-positive with preterm and prelabor rupture of membranes after 34 weeks are not candidates for expectant management, as this population has higher rates of neonatal infectious complications. Patients with a history of GBS colonization in prior pregnancy who are GBS-unknown in this current pregnancy and present with labor should receive intrapartum prophylaxis. Work on the GBS vaccine continues. Although all of the efforts and focus on neonatal early-onset GBS infection have led to lower rates of disease, GBS still remains a major cause of neonatal morbidity and mortality requiring continued vigilance from obstetric providers.

Group B Streptococcus among Pregnant Women and Neonates in Saudi Arabia: A Systemic Review.

Sepsis caused by Group B Streptococcus (GBS) continues to cause mortality and morbidity in newborns, especially in developing countries. Bacterial sepsis in newborns varies nationally and even within countries. Developing countries have reported 34 deaths per 1000 live births compared to 5 in developed countries. This systemic review aimed to assess the prevalence of GBS colonization among pregnant women and the incidence of neonatal GBS sepsis in Saudi Arabia. A literature search of PubMed, MEDLINE Ovid, and Google Scholar was conducted. A total of 21 studies were found: 15 described maternal GBS colonization and 6 studies described neonatal GBS infections. The GBS colonization prevalence among pregnant women ranged from 2.1% to 32.8%. Inconsistencies in the reporting method for neonatal GBS infection rates were observed. Only two studies have the incidence of neonatal GBS as the primary outcome. No national multicenter studies exist on the GBS rates among neonates. Nationwide studies are warranted to assess the burden of GBS infections in neonates. These studies would guide appropriate GBS screening strategies during pregnancy for application in a national public health program.

Clinical Profile and Risk Factors of Group B Streptococcal Colonization in Mothers from the Eastern District of China.

Objective The main aim of this study was to determine the prevalence, capsular genotyping, antimicrobial susceptibility, and associated factors of colonizing Group B Streptococcus (GBS) in pregnant women admitted to a hospital in Jinan, East China. Methods Demographic data, clinical characteristics, and vaginal and rectal swabs were obtained from a group of expecting mothers subjected to GBS screening at the late stage of pregnancy who went into labor over the period from November 2019 to October 2020. Identification of GBS and determination of antimicrobial resistance patterns were performed using a BD Phoenix-100 system. Capsular genotypes were analyzed using polymerase chain reaction and the associated factors were evaluated via logistic regression. Result A total of 2761 pregnant women were recruited for this study. The GBS colonization rate was 6.70% (185/2761). Among the 172 GBS strains examined, all were susceptible to vancomycin and linezolid. Resistance was the highest for erythromycin (80.2%), followed by clindamycin (75.0%), levofloxacin (65.1%), and tetracycline (57.6%). The most common serotype identified was Ia (61.0%), followed by III (29.7%), VI (4.6%), II (3.5%), VII (0.6%), and a nontypeable strain. Risk factors for maternal GBS colonization included maternal age (older than 30 years) (OR = 1.913 (1.662, 2.478)), gestational age at birth (average gestational age) (OR = 1.992 (1.445, 2.746)), and prelabor rupture of membrane (OR = 3.838 (1.619, 9.099)). Conclusion The prevalence of GBS was relatively low. The maternal age was a factor associated with GBS colonization. Subjects showing GBS positivity during late pregnancy were prone to prolonged rupture of the membrane (PROM) and birth at lower a gestation age than the GBS-negative group. Penicillin could still be used as the first agent of choice for intrapartum antibiotic prophylaxis (IAP).

False-positive detection of Group B Streptococcus (GBS) in chromogenic media (Strep B Carrot Broth) due to presence of Enterococcus faecalis in High Vaginal swabs.

Introduction. Vaginal colonization of Group B Streptococcus (GBS) is associated with preterm births and neonatal sepsis. Thus routine screening of GBS in prenatal care is recommended.Hypothesis. Chromogenic media (carrot broth) aids in specific and rapid detection of GBS.Aim. To investigate the efficiency of Strep B Carrot Broth for detection of GBS in high vaginal swabs from pregnant women.Methods. In this study 201 vaginal swab samples were collected from pregnant women. Swabs were inoculated in chromogenic media (Strep B Carrot Broth). The positive and negative cultures were inoculated on blood agar and crome agar plates. The colonies were subjected to 16S rRNA sequencing and gene-specific PCR for confirmation. The Christie Atkins Munch Peterson (CAMP) and bile esculin agar (BEA) tests were used for biochemical confirmation. PCR was performed on genomic DNA isolated from uncultured vaginal swabs.Results. It was found that 20/201 (9.9 %) vaginal swab samples were positive in the Strep B Carrot Broth and 17/20 (85 %) and 19/20 (95 %) of these samples yielded colonies on blood agar and crome agar, respectively. Of the 181 carrot broth-negative samples, 1 (0.5 %) and 38 (20.9 %) yielded colonies on blood agar and crome agar plates, respectively. However, 16 s rRNA sequencing revealed that none of the 20 carrot broth-positive cultures were GBS and had sequence similarities to Enterococcus faecalis. This was also confirmed by using gene-specific PCR and BEA positivity. Furthermore, E. faecalis was detected by PCR in DNA isolated from 57 uncultured vaginal swabs samples, GBS could only be detected by PCR in four samples.Conclusion. Carrot broth-based culture can lead to false-positive detection due to the presence of E. faecalis. Thus GBS-positive results in carrot broth must be confirmed by the other molecular and biochemical tests before making a final diagnosis.

Vertical Transmission, Risk Factors, and Antimicrobial Resistance Patterns of Group B Streptococcus among Mothers and Their Neonates in Southern Ethiopia.

Background Group B Streptococcus (GBS) contributes to maternal and neonatal morbidity and mortality by increasing intrauterine infection or vertical transmission at the time of birth. Despite many efforts to reduce the potential risk of vertical transmission, GBS remains the main cause of serious disease (neonatal sepsis, meningitis, and/or pneumonia) in vulnerable newborns during the first week of life. This study aimed to assess vertical transmission, risk factors, and antimicrobial resistance patterns of GBS among pregnant women and their neonates. Methods A facility-based cross-sectional study was conducted among mothers and their neonates from February to May 2021. A total of 201 pregnant women with their neonates participated in this study. A well-designed questionnaire was used to collect sociodemographic and clinical data. A vaginal swab from mother before delivery and neonatal nasal and ear canal swab samples were taken as soon as after delivery within 30 minutes. Vaginal swabs, neonatal ear canal, and nasal swabs were placed into Todd–Hewitt broth and incubated at 37°C for 18–24 hours at 35–37°C in 5% CO2 conditions and then subcultured on 5% sheep blood agar for 18–48 hours. Presumptive identification of GBS was made by morphology, Gram stain, catalase, and hemolytic activity on sheep blood agar plates. CAMP and bacitracin susceptibility tests were used as confirmatory tests for GBS. Data were analyzed using SPSS version 21. P value ≤0.05 was considered statistically significant. Results Vertical transmission rates of GBS (mother to neonates) were 11.9%. The prevalence of GBS among pregnant women and newborns was 24/201 (11.9%) (95% CI = 7.5–16.9) and 11/201 (5.5%) (95% CI = 2.5–9.0), respectively. The history of prolonged rupture of membranes (AOR = 3.5, CI = 2.2–18.8) and urinary tract infection (AOR = 2.9, CI = 1.7–16.3) were associated factors for maternal GBS colonization. Gestational age of <37 weeks (p=0.008), low birth weight of <2.5 kg (p=0.001), and maternal history of vaginal discharge (p=0.048) were associated factors for neonatal GBS colonization. Low antibiotic resistance was observed for erythromycin 8.6%, clindamycin 5.7%, and chloramphenicol 2.9%. Conclusion In this study, high vertical transmission (mother to neonates) rate was observed. The prevalence of vaginal GBS colonization of women at delivery was 11.9% and significantly associated with the history of prolonged rupture of membranes and urinary tract infections. Gestational age of <37 weeks, low birth weight of <2.5 kg, and maternal history of vaginal discharge were associated with neonatal GBS colonization. Hence, there is a need for antenatal culture-based GBS screening, risk factor-based interventions, and regular follow-up of drug resistance patterns for proper treatment and management of GBS.

Performance of BD MAX Group B Streptococcus (GBS) Assay without Enrichment for the Detection of GBS.

Group B streptococcus (GBS) is an important pathogen causing neonatal early-onset disease. We evaluated the diagnostic performance of BD Max GBS assay (Becton Dickinson, Franklin Lakes, NJ, USA) without enrichment (direct BDM) for detecting GBS using vaginal and rectal specimens in comparison with culture. In total, 716 specimens collected from 358 pregnant women between June 2018 and May 2020 were included in this study. Bacterial culture was performed using ChromID Strep B agar (bioMérieux, Marcy-l’Étoile, France), and species identification results were confirmed using the VITEK-MS system (bioMérieux). The sensitivity of direct BDM for vaginal and rectal specimens was 75.0% and 100%, respectively. Thirteen specimens showed discrepant results: 10 false-negative results in the vaginal specimens and three false-positive results in the rectal specimens. The overall agreement between direct BDM and culture was 98.9% (354/358). The final sensitivity and specificity of direct BDM were 98.5% and 99.0%, respectively. Discrepant results—one false-negative and three false-positives—were obtained for four specimens. Direct BDM shows a good diagnostic performance and will be useful for GBS screening within a few hours.

Diagnostic Accuracy of Loop-Mediated Isothermal Amplification Assay for Group B Streptococcus Detection in Recto-Vaginal Swab: Comparison with Polymerase Chain Reaction Test and Conventional Culture.

A rapid method for obtaining group B streptococcus (GBS) screening results has been required in the obstetric field. We aimed to determine the diagnostic performance of the Loop-Mediated Isothermal Amplification (LAMP) assay is acceptable compared to the existing polymerase chain reaction (PCR) assay. The study involved 527 pregnant women aged 19 to 44 years. Rectovaginal swabs were collected between 35 and 37 weeks of gestation or prior to impending preterm births or term labor without GBS screening. We presented the diagnostic performance of the LAMP assay with a 95% confidence interval (CI) compared to the PCR and microbiological culture. In total, 115 (21.8%), 115 (21.8%) and 23 (4.4%) patients showed positive results using the LAMP, PCR assay and microbiological culture method, respectively. The LAMP assay showed 100% sensitivity (95% CI, 96.8–100.0), 100% specificity (95% CI, 99.1–100.0) and 100% diagnostic accuracy (95% CI, 99.3–100.0) with the reference being the PCR assay. Meanwhile, the LAMP assay showed 87.0% sensitivity (95% CI, 71.0–100.0), 81.2% specificity (95% CI, 77.6–84.7), and 81.4% diagnostic accuracy (95% CI, 78.0–84.8) with the microbiological culture as a reference. This study presented the LAMP assay as an acceptable method for GBS screening with a similar performance to the existing PCR method.

Group B Streptococcal Colonization among Pregnant Women and Neonates in a Tertiary Care Hospital in South India.

ObjectivesTo assess the prevalence of maternal and neonatal group B Streptococcal colonization, incidence of neonatal systemic illness, and antibiotic sensitivity of isolates.MethodsThis prospective cohort study was conducted in a South Indian tertiary care hospital. Rectovaginal swabs from pregnant mothers at 360/7–376/7 wk gestation and throat and rectal swabs from their neonates at 48 h of age were collected. Presence of group B Streptococcus (GBS) was identified by broth enrichment step, and traditional microbiologic methods and antibiotic sensitivity of isolates was noted. All mothers received intrapartum antibiotic prophylaxis (IAP). Culture-positive sepsis, clinical sepsis, pneumonia, meningitis, and urinary tract infection were defined as neonatal systemic illness. Neonates of colonized mothers were followed at 3 mo for late-onset sepsis.ResultsOf the 310 mothers, 40 were GBS colonized (prevalence: 12.9%; 95% CI 9.2%, 17.6%). None of the neonates were colonized. Maternal GBS colonization was significantly associated with premature rupture of membrane (RR - 2.93, 95% CI - 1.66–5.16) and neonatal systemic illness (RR - 2.78, 95% CI - 1.39–5.54). Positive correlation was noted between duration of IAP ≤ 4 h and neonatal illness and between maternal GBS colonization and Apgar at 1 min ≤ 4. Clindamycin resistance was noted in 20%. All neonates remained well at 3 mo follow-up.ConclusionHigh maternal colonization alerts the need for GBS screening in India. Clindamycin resistance among GBS isolates questions its effectiveness as alternative therapy in penicillin allergy.