Intrapartum Antibiotic Prophylaxis Research Articles

Group B Streptococcus CAMP Factor Does Not Contribute to Interactions with the Vaginal Epithelium and Is Dispensable for Vaginal Colonization in Mice.

ABSTRACTThe Gram-positive pathogen group B Streptococcus (GBS) is a leading cause of neonatal bacterial infections, preterm birth, and stillbirth. Although maternal GBS vaginal colonization is a risk factor for GBS-associated adverse birth outcomes, mechanisms promoting GBS vaginal persistence are not fully defined. GBS possesses a broadly conserved small molecule, CAMP factor, that is co-hemolytic in the presence of Staphylococcus aureus sphingomyelinase C. While this co-hemolytic reaction is commonly used by clinical laboratories to identify GBS, the contribution of CAMP factor to GBS vaginal persistence is unknown. Using in vitro biofilm, adherence and invasion assays with immortalized human vaginal epithelial VK2 cells, and a mouse model of GBS vaginal colonization, we tested the contribution of CAMP factor using GBS strain COH1 and its isogenic CAMP-deficient mutant (Δcfb). We found no evidence for CAMP factor involvement in GBS biofilm formation, or adherence, invasion, or cytotoxicity toward VK2 cells in the presence or absence of S. aureus. Additionally, there was no difference in vaginal burdens or persistence between COH1 and Δcfb strains in a murine colonization model. In summary, our results using in vitro human cell lines and murine models do not support a critical role for CAMP factor in promoting GBS vaginal colonization.IMPORTANCE Group B Streptococcus (GBS) remains a pervasive pathogen for pregnant women and their newborns. Maternal screening and intrapartum antibiotic prophylaxis to GBS-positive mothers have reduced, but not eliminated GBS neonatal disease, and have not impacted GBS-associated preterm birth or stillbirth. Additionally, this antibiotic exposure is associated with adverse effects on the maternal and neonatal microbiota. Identifying key GBS factors important for maternal vaginal colonization will foster development of more targeted, alternative therapies to antibiotic treatment. Here, we investigate the contribution of a broadly conserved GBS determinant, CAMP factor, to GBS vaginal colonization and find that CAMP factor is unlikely to be a biological target to control maternal GBS colonization.

Group B Streptococcal Colonization in African Countries: Prevalence, Capsular Serotypes, and Molecular Sequence Types.

Streptococcus agalactiae or group B streptococcus (GBS) is a commensal of the gastrointestinal and genitourinary tracts of healthy women and an important cause of neonatal invasive infections worldwide. Transmission of bacteria to the newborn occurs at birth and can be prevented by intrapartum antibiotic prophylaxis. However, this not available in resource limited settings in Africa, which carries a particular high burden of disease. Serotype based vaccines are in development and present a suitable alternative to prevent neonatal infections. To be able to assess vaccine efficacy, knowledge and surveillance of GBS epidemiological data are required. This review summarizes investigations about the serotype distribution and the multi-locus sequence types (MLST) found in different African countries. While most serotypes and MLST data are comparable to findings from other continents, some specific differences exist. Serotype V is predominant among colonizing maternal strains in many different African countries. Serotypes that are rarely detected in western industrialized nations, such as serotypes VI, VII and IX, are prevalent in studies from Ghana and Egypt. Moreover, some specific MLST sequence types that seem to be more or less unique to Africa have been detected. However, overall, the data confirm that a hexavalent vaccine can provide broad coverage for the African continent and that a protein vaccine could represent a promising alternative.

Impact of Intrapartum Antibiotic Prophylaxis on Offspring Microbiota.

Infants are born into a world filled with microbes and must adapt without undue immune response while exploiting the microbiota's ability to produce otherwise unavailable nutrients. The process by which humans and microbes establish this relationship has only recently begun to be studied with the aid of genomic methods. Nearly half of all pregnant women receive antibiotics during gestation to prevent maternal and neonatal infection. Though this has been largely successful in reducing early-onset sepsis, we have yet to understand the long-term consequences of antibiotic administration during gestation to developing infants. Studies involving antibiotic use in infants suggest that dysbiosis during this period is associated with increased obesity, allergy, autoimmunity, and chronic diseases in adulthood, however, research around the limited doses of intravenous antibiotics used for intrapartum prophylaxis is limited. In this mini review, we focused on the state of the science regarding the effects of intrapartum antibiotic prophylaxis on the newborn microbial colonization process. Although, the literature indicates that there is wide variety in the specific bacteria that colonize infants from birth, limited parenteral antibiotic administration prior to delivery consistently affects the microbiota of infants by decreasing bacteria in the phylum Bacteroidetes and increasing bacteria in the phylum Proteobacteria, thus altering the normal pattern of colonization that infants experience. Delivery by cesarean section and formula feeding magnify and prolong this effect. Our mini review shows that the impact of intravenous antibiotic administration during gestation has on early colonization, growth, or immune programming in the developing offspring has not been well studied in human or animal models.

High rates of colonization and antimicrobial resistance of group B streptococcus highlight the need for vaccination even after implementation of guidelines for intrapartum antibiotic prophylaxis

IntroductionIt is estimated that about 11–35% of pregnant women are colonized with Group B streptococcus. Intrapartum antibiotic prophylaxis (IAP) is the primary intervention to decrease the risk of infecting babies born to GBS colonized mothers. MethodsA total of 5,996 pregnant women, who received the Taiwanese universal GBS screening program from 2012 to 2020, were included in this study that investigated GBS colonization, antimicrobial resistance rates and their neonatal incidence of invasive GBS infection. ResultsThe average GBS colonization rate was 18.5%. Older age groups had higher colonization rates than younger age groups. Compared to Taiwanese, immigrant women from Indonesia had a greater positive rate. GBS isolated from Vietnamese women had significant greater resistance to clindamycin relative to Taiwanese women. Rates of resistance to erythromycin increase from 35.5% to 45.5% over the 9 years of measurements. The incidence of invasive GBS disease was about 0.6/1,000 (4/6,204) live births during the study. ConclusionsAlthough relatively low incidence of invasive GBS diseases was observed after implementation of IAP, the colonization of GBS remains high and antimicrobial resistance of GBS is increasing. An effective GBS vaccine holds promise to be a solution for these issues.

Absent Red Reflexes and Cloudy Corneas.

Absent Red Reflexes and Cloudy Corneas.

Prevention of neonatal group B streptococcal disease

Group B streptococcal (GBS) disease and its early onset continues to pose major economic and perinatal implications regarding maternal and neonatal morbidity and mortality rates and methods of treatment. Universal GBS screening via rectovaginal culture is now recommended between 36 and 37 weeks and 6 days of gestation for all pregnant women. Timely identification of groups of women suitable for intravenous intrapartum antibiotic prophylaxis of GBS early onset infection has also proven to be effective, although less so than the universal screening approach.

Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis

ObjectiveTo systematically review and meta-analyse studies of the efficacy of probiotics to reduce antenatal Group B Streptococcus (GBS) colonisation. ParticipantsAntenatal participants with known positive GBS colonisation or unknown GBS status. InterventionProbiotic interventions containing species of Lactobacillus or Streptococcus. DesignSystematic review and meta-analysis. Measurements and findingsThe systematic review included 10 studies. Five articles contained in vitro studies of probiotic interventions to determine antagonistic activity against GBS. Six clinical trials of probiotics to reduce antenatal GBS were systematically reviewed and meta-analysed. The meta-analysis revealed that the use of an antenatal probiotic decreased the probability of a positive GBS result by 44% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 10 had a low risk of bias. Key conclusionsThe probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion. The findings of the meta-analysis of the clinical trials revealed that probiotics are a moderately effective intervention to reduce antenatal GBS colonisation. More well-controlled trials with diverse participants and with better elucidation of variables influencing GBS colonisation rates are needed. Implications for practiceProbiotic interventions appear to be a safe and effective primary prevention strategy for antenatal GBS colonisation. Application of this low-risk intervention needs more study but may reduce the need for intrapartum antibiotic prophylaxis in countries or regions where antenatal GBS screening is used. Midwives can be instrumental in conducting and supporting larger well-controlled clinical trials.

Garlic: An Alternative Treatment for Group B Streptococcus.

ABSTRACTPrenatal screening in pregnant women between 35 and 37 weeks of gestation and intrapartum antibiotic prophylaxis has successfully reduced the incidence of neonatal morbidity and mortality related to Streptococcus agalactiae. However, the contamination rates of newborns are still considerable. In traditional and folk medicines, it has been observed that garlic has been effective in treating S. agalactiae infection. The aim of this study was to isolate and identify the active compounds from garlic that have antimicrobial activity against S. agalactiae. In order to do this, SP80 (Sep-Pak 80%) obtained from crude garlic extract (CGE) was fractionated by reverse-phase ultrafast liquid chromatography with UV (RP-UFLC-UV) using a Shim-pack PREP-ODS column. All fractions obtained were tested using a microbial growth inhibition test against the S. agalactiae strain (ATCC 12386). Five clinical isolates were used to confirm the action of the fractions with antimicrobial activity, and the bacterial growth curve was determined. Identification of the antimicrobial compounds was carried out through liquid chromatography coupled with mass spectrometry (LC/MS) and nuclear magnetic resonance (NMR). The active compounds found to exhibit antimicrobial activity were Ƴ-glutamyl-S-allyl-cysteine (fraction 18), Ƴ-glutamyl-phenylalanine (fraction 20), and the two stereoisomers (E and Z) of ajoene (fraction 42). The MICs of these fractions were 5.41 mg/ml, 4.60 mg/ml, and 0.16 mg/ml, respectively, and they inhibited the growth of the clinical isolates tested. Antimicrobial compounds from garlic may be a promising source in the search for new drugs against S. agalactiae.IMPORTANCE Invasive disease due to group B streptococcal (GBS) infection results in a wide spectrum of clinical disease in neonates. Maternal colonization by GBS is the primary risk factor for disease. The strategy recommended by the Centers for Disease Control to reduce neonatal GBS infection is the culture-based screening of all pregnant women at 35 to 37 weeks of gestation and intrapartum antibiotic prophylaxis (IAP). However, indiscriminate use of antibiotics favors the selection and spread of resistant bacteria. The global scenario of antibacterial resistance has been of great concern for public health, and natural products can be a source of new substances to help us grapple with this problem.

Group B Streptococcus Capsular Serotype Alters Vaginal Colonization Fitness.

Group B Streptococcus (GBS) remains a leading cause of infant morbidity and mortality. A candidate vaccine targets 6 GBS serotypes, offering a potential alternative to intrapartum antibiotic prophylaxis to reduce disease burden. However, our understanding of the contributions of specific capsule types to GBS colonization and disease remains limited. Using allelic exchange, we generated isogenic GBS strains differing only in the serotype-determining region in 2 genetic backgrounds, including the hypervirulent clonal complex (CC) 17. Using a murine model of vaginal cocolonization, we evaluated the roles of the presence of capsule and of expression of specific capsular types in GBS vaginal colonization fitness independent of other genetic factors. Encapsulated wild-type strains COH1 (CC17, serotype III) and A909 (non-CC17, serotype Ia) outcompeted isogenic acapsular mutants in murine vaginal cocolonization. COH1 wild type outcompeted A909. Notably, expression of type Ia capsule conferred an advantage over type III capsule in both genetic backgrounds. Specific capsule types may provide an advantage in GBS vaginal colonization in vivo. However, success of certain GBS lineages, including CC17, likely involves both capsule and noncapsule genetic elements. Capsule switching in GBS, a potential outcome of conjugate vaccine programs, may alter colonization fitness or pathogenesis.

Virulence and pathogenicity factors of S. agalactiae strains isolated from pregnant women and newborns

BACKGROUND: Obstetric and neonatal infections caused by Steptococcus agalactiae are among the most significant perinatal infections. To date, intrapartum antibiotic prophylaxis is used to prevent the transmission of the pathogen to the child, however, the growth of antibiotic resistance and ineffectiveness of therapy against late-onset neonatal infection are its limitations. Vaccination is considered to be the most effective method for preventing diseases caused by S. agalactiae in both pregnant women and newborn babies. To identify promising vaccine targets and to develop alternative prevention approaches, it is necessary to study the virulence factors of S. agalactiae strains and their variability in the population.
 AIM: The aim of this study was to evaluate the variability of virulence and pathogenicity factors (capsular polysaccharides, pili, hypervirulent sequence type ST-17, biofilm-forming ability, antibiotic resistance) of S. agalactiae isolated from pregnant women and newborn infants in St. Petersburg, Russia.
 MATERIALS AND METHODS: We studied isolates of S. agalactiae out of clinical material samples obtained from pregnant women and newborns at the D.O. Ott Research Institute of Obstetrics, Gynecology, and Reproductology in 2018-2020. The PCR method was used to determine the types of capsular polysaccharides, pili, and strain affiliation with the hypervirulent sequencing type ST-17. Biofilm-forming ability was determined by the Christensen method. The antibiotic sensitivity was determined by disc diffusion.
 RESULTS: We examined 60 clinical isolates of S. agalactiae. The most common S. agalactiae serotypes were Ia, Ib, II, III, IV, and V; in total, these six serotypes accounted for 95.1% of all strains. The most common pili genotype was PI-1 + PI-2a (60%). Resistance to erythromycin was found in 36.7% of the strains, and a similar number of the strains were resistant to clindamycin. The ability to form biofilms was detected in 68% of the strains, and the increased ability was associated with the PI-2b pili allele.
 CONCLUSIONS: A hexavalent vaccine based on capsular polysaccharides of types Ia, Ib, II, III, IV, and V would have a 95% efficacy in this region. Stable distribution of different pili types is an important factor when using pili as vaccine targets. The high level of resistance of S. agalactiae strains to erythromycin and clindamycin indicates that isolates should be tested for sensitivity to these antibiotics before their use, and regular regional monitoring of antibiotic resistance of the pathogen to update clinical guidelines should be performed.

Preventing group B Streptococcus neonatal disease with intrapartum prophylaxis: a retrospective study to detect its use in case of unknown colonization status.

Group B Streptococcus (GBS) is the leading cause of neonatal morbidity and mortality in developed countries. This study aims primarily to estimate the prevalence of maternal GBS positivity and secondarily to evaluate the compliance and the effectiveness of the current GBS prevention protocol. This retrospective study has considered 27382 single pregnancies carried to delivery between 2001 and 2014 at our Obstetrics and Gynecology clinic. All women carrying a singleton pregnancy in the considered period were eligible to be included in this study. The GBS swab was positive in 17.66% of cases, negative in 51.93%, and unknown in 30.41%. Data collected revealed that out of the total of GBS-positive women, 3362 were treated with antibiotic prophylaxis, and 1331 were not. There were no differences between cases admitted to Neonatal Intensive Care Unit and perinatal deaths between treated and non-treated GBS-positive pregnancies. Moreover, the data showed that 74.62% of patients between 34 and 37 weeks of gestation at the time of delivery were treated with antibiotic prophylaxis unnecessarily, and 25.38% of patients >37 weeks of gestation whose GBS status at delivery was unknown would have required intrapartum antibiotic prophylaxis. The only risk factor for chorioamnionitis among GBS-positive women in multivariate logistic regression analysis was an early gestational age (OR 0.61; 95% CI: 0.56-0.66; P<0.05). GBS prevalence was found to be 17.66%, and prophylaxis in colonized patients was carried out correctly according to our internal procedure allowing a low incidence of adverse outcomes. Finally, the only risk factor associated with chorioamnionitis in GBS patients was early gestational age at delivery.

Analysis of Susceptibility to the Antimicrobial and Anti-Biofilm Activity of Human Milk Lactoferrin in Clinical Strains of Streptococcus agalactiae With Diverse Capsular and Sequence Types.

Group B Streptococcus (GBS) is one of the leading infection-related causes of adverse maternal and neonatal outcomes. This includes chorioamnionitis, which leads to preterm ruptures of membranes and can ultimately result in preterm or stillbirth. Infection can also lead to maternal and neonatal sepsis that may contribute to mortality. Currently, treatment for GBS infection include a bolus of intrapartum antibiotic prophylaxis to mothers testing positive for GBS colonization during late pregnancy. Lactoferrin is an antimicrobial peptide expressed in human breast milk, mucosal epithelia, and secondary granules of neutrophils. We previously demonstrated that lactoferrin possesses antimicrobial and antibiofilm properties against several strains of GBS. This is largely due to the ability of lactoferrin to bind and sequester iron. We expanded upon that study by assessing the effects of purified human breast milk lactoferrin against a panel of phenotypically and genetically diverse isolates of GBS. Of the 25 GBS isolates screened, lactoferrin reduced bacterial growth in 14 and biofilm formation in 21 strains. Stratifying the data, we observed that colonizing strains were more susceptible to the growth inhibition activity of lactoferrin than invasive isolates at lactoferrin concentrations between 250-750 µg/mL. Treatment with 750 µg/mL of lactoferrin resulted in differences in bacterial growth and biofilm formation between discrete sequence types. Differences in bacterial growth were also observed between capsular serotypes 1a and III. Maternally isolated strains were more susceptible to lactoferrin with respect to bacterial growth, but not biofilm formation, compared to neonatal sepsis isolates. Finally, high biofilm forming GBS strains were more impacted by lactoferrin across all isolates tested. Taken together, this study demonstrates that lactoferrin possesses antimicrobial and antibiofilm properties against a wide range of GBS isolates, with maternally isolated colonizing strains being the most susceptible.

Group B streptococcal infections in infants in Iceland: clinical and microbiological factors.

IntroductionGroup B streptococcus (GBS) is a leading cause of invasive neonatal infections. These have been divided into early-onset disease (EOD; <7 days) and late-onset disease (LOD; 7–89 days), with different GBS clonal complexes (CCs) associated with different disease presentations.Hypothesis/Gap StatementDifferent GBS CCs are associated with timing of infection (EOD or LOD) and clinical presentation (sepsis, meningitis or pneumonia).AimTo study infant GBS infections in Iceland from 1975 to 2019. Are specific GBS CCs related to disease presentation? Is CC17 overrepresented in infant GBS infections in Iceland?MethodologyAll culture-confirmed invasive GBS infections in infants (<90 days) in Iceland from 1975 to 2019 were included. Clinical information was gathered from medical records.ResultsA total of 127 invasive GBS infections in infants were diagnosed, but 105 infants were included in the study. Of these, 56 had EOD and 49 had LOD. The incidence of GBS infections declined from 2000 onwards but increased again at the end of the study period. Furthermore, there was a significant increase in LOD over the study period (P=0.0001). The most common presenting symptoms were respiratory difficulties and fever and the most common presentation was sepsis alone. Approximately one-third of the cases were caused by GBS CC17 of serotype III with surface protein RIB and pili PI-1+PI-2b or PI-2b. CC17 was significantly associated with LOD (P<0.001).ConclusionCC17 is a major cause of GBS infection in infants in Iceland. This clone is associated with LOD, which has been increasing in incidence. Because intrapartum antibiotic prophylaxis only prevents EOD, it is important to continue the development of a GBS vaccine in order to prevent LOD infections.

Long-Term Outcomes After Group B Streptococcal Disease in Infancy

Source: Horváth-Puhó E, van Kassel MN, P Gonçalves BP, et al. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a national matched cohort study. Lancet Child Adolesc Health. 2021;5(6):398-407; doi: 10.1016/S2352-4642(21)00022-5Investigators from multiple institutions conducted a matched cohort study to assess the long-term health outcomes among infants with invasive group B streptococcal disease (iGBS). Data for this study were obtained from national registries in Denmark and the Netherlands. Data from Danish children born from 1997–2017 and Dutch children born 2000–2017 were included.Children with iGBS, defined as GBS sepsis, meningitis, or pneumonia by the age of 89 days, were identified using ICD-10 codes within Denmark’s Medical Birth and National Patient Registries and positive culture results within the Netherlands’ Reference Laboratory for Bacterial Meningitis. Age of iGBS onset was calculated using the first hospital admission date for iGBS disease and categorized as early (0-6 days) or late onset (7-89 days). Children without iGBS were randomly selected from similar administrative databases and matched 10:1 to each child with iGBS on sex, birth month and year, and gestational age.All children were followed from birth until death, emigration, or the end of the study period. Investigators computed the mortality risk during the first 3 months and 5 years of life using data from the Danish Civil Registration system and Dutch Municipal Personal Records Database. Five-year mortality rates were compared among children with and without iGBS disease. Among those who survived the first 3 months of life, investigators calculated the risk of neurodevelopment impairments (NDI) by age 10 years among children with and without iGBS disease using ICD-10 codes for mental, behavioral, and nervous system disorders in the Danish National Patient Registry and use of special educational support in national databases in the Netherlands.There were 2,258 children identified as having iGBS disease and 22,462 matched children without iGBS disease. Among children with iGBS disease, 86% of Danish children and 64% of Dutch children had early onset disease (EOD). Mortality risk in the first 3 months was 2.3% (95% Confidence Interval [C I], 1. 7, 3. 2) in Denmark and 7.6% (95% CI, 5.6, 9.5) in the Netherlands. The 5-year mortality risk was significantly higher in Dutch children with (vs without) iGBS disease (hazard ratio, 3.97; 95% CI, 2.89, 5.46). There was an overall increased risk of NDI by age 10 years in both Denmark (relative risk [RR], 1.77; 95% CI, 1.44, 2.18) and the Netherlands (RR, 2.28; 95% CI, 1.64, 3.17).The investigators conclude that iGBS disease in infancy is associated with increased mortality and higher risk of NDI in later childhood.Dr Brady has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Group B streptococci are estimated to cause more than 300,000 cases of neonatal disease annually, resulting in about 90,000 deaths worldwide.1 The current researchers are the first to quantify the long-term effects on survivors of iGBS disease in high-income countries that use intrapartum antibiotic prophylaxis (IAP) and have advanced neonatal care. The burden of iGBS disease is likely higher in low-income countries where these resources are not available.2The prevalence of EOD and late-onset disease (LOD) in Denmark and the Netherlands was stable over the study period and EOD predominated. In contrast, EOD has declined and now occurs less frequently than does LOD in the US. (See AAP Grand Rounds. 2019;41[5]:51.)3,4 It is not clear why a decline was not noted in these European countries. However, not all mothers are screened, and maternal GBS cultures may be falsely negative.3 As noted in the US study, almost 50% of EOD disease occurs in newborns without any known risk factors.3The World Health Organization has identified GBS as a high priority for the development of a vaccine.5 Developing a GBS vaccine has been challenging because its capsular polysaccharides are poorly immunogenic.6 However, Absalon et al7 recently reported that a novel hexavalent GBS conjugate vaccine was safe and elicited robust immune responses that persisted 6 months after vaccination in a randomized trial in healthy, non-pregnant adults. Additional studies in pregnant women to assess safety and passive antibody transfer to the neonate are needed.The burden of iGBS disease remains high despite IAP and advanced neonatal care. Further development and evaluation of GBS vaccines in pregnant women is a public health priority.

Neonatal Hyperbilirubinemia and Cholestasis.

Neonatal Hyperbilirubinemia and Cholestasis.

Impact of Maternal Intrapartum Antibiotics, and Caesarean Section with and without Labour on Bifidobacterium and Other Infant Gut Microbiota.

Background and Aims: Few studies consider the joint effect of multiple factors related to birth, delivery mode, intrapartum antibiotic prophylaxis and the onset of labour, on the abundance of Bifidobacterium and the quantity of this genus and its species Bifidobacterium longum subsp. infantis in the infant gut microbiota. We implemented such a study. Methods: Among 1654 Canadian full-term infants, the gut microbiota of faecal samples collected at 3 months were profiled by 16S rRNA sequencing; the genus Bifidobacterium and Bifidobacterium longum subsp. infantis were quantified by qPCR. Associations between Bifidobacterium and other gut microbiota were examined by Spearman’s rank correlation. Results: Following vaginal birth, maternal IAP exposure was associated with reduced absolute quantities of bifidobacteria among vaginally delivered infants (6.80 vs. 7.14 log10 (gene-copies/g faeces), p < 0.05), as well as their lowered abundance relative to other gut microbiota. IAP differences in infant gut bifidobacterial quantity were independent of maternal pre-pregnancy body-mass-index (BMI), and remarkably, they were limited to breastfed infants. Pre-pregnancy BMI adjustment revealed negative associations between absolute quantities of bifidobacteria and CS with or without labour in non-breastfed infants, and CS with labour in exclusively breastfed infants. Significant correlations between Bifidobacterium abundance and other microbial taxa were observed. Conclusions: This study documented the impact of the birth mode and feeding status on the abundance of gut Bifidobacterium, and pointed to the important ecological role of the genus Bifidobacterium in gut microbiota due to its strong interaction with other gut microbiota in early infancy.

Influence of antibiotics given during labour and birth on body mass index z scores in children in the All Our Families pregnancy cohort.

Little is known about obesity risk associated with intrapartum antibiotic prophylaxis (IAP). Our objective was to determine if maternal antibiotic exposure during birth is associated with child body mass index (BMI) z scores in the first 3 years of life. In 2008 to 2010, 3388 pregnant women were recruited to the All Our Families study. Here, we included women with available data from obstetrical records on antibiotic use during birth (n=1303) and children with at least one valid BMI z score (final sample n=1262). The primary outcome was infant BMI z score at 1, 2 and 3 years of age. IAP occurred in 432 of 1262 women. Children exposed to IAP had significantly higher mean [standard error (SE)] BMI z scores (1.071 [0.087] unit) at 1year of age compared to non-exposed infants (0.744 [0.064] unit). Although the association was no longer significant after adjustment for confounding factors in the growth trajectory model, IAP resulted in a 0.255 unit increase in BMI z score at 1year of age. Differences in BMI z score between exposed and non-exposed at baseline (year 1) only remained significant in sensitivity analysis. The potential association between maternal IAP and increased infant BMI z score at 1year of age should be confirmed in other cohorts and warrants investigation of interventions to mitigate this possible risk.

Understanding Factors in Group B Streptococcus Late-Onset Disease.

Group B streptococcus (GBS) infection remains a leading cause of sepsis, pneumonia, and meningitis in infants. Rates of GBS early onset disease have declined following the widcespread use of intrapartum antibiotic prophylaxis; hence, late-onset infections (LOGBS) are currently a common presentation of neonatal GBS dicsease. The pathogenesis, mode of transmission, and risk factors associated with LOGBS are unclear, which interfere with effective prevention efforts. GBS may be transmitted from the mother to the infant at the time of delivery or during the postpartum period via contaminated breast milk, or as nosocomial or community-acquired infection. Maternal GBS colonization, prematurity, young maternal age, HIV exposure, and ethnicity (Black) are identified as risk factors for LOGBS disease; however, further studies are necessary to confirm additional risk factors, if any, for the implementation of effective prevention strategies. This narrative review discusses current and previous studies that have reported LOGBS. Few well-designed studies have described this condition; therefore, reliable assessment of maternal GBS colonization, breastfeeding, and twin delivery as risk factors for LOGBS remains limited.

Epidemiology and Trends of Infective Meningitis in Neonates and Infants Less than 3 Months Old in Hong Kong

ObjectivesMeningitis in neonates and young infants leads to significant morbidity and mortality worldwide. This study aimed to investigate pathogens, antibiotic resistance and secular change of incidence in Hong Kong. MethodsA retrospective search was performed on meningitis in neonates and infants aged <3 months in three Hong Kong public hospitals from 2004 to 2019. Medical charts were reviewed, with focus on the identification and antibiotic resistance of the pathogens. ResultsA total of 200 cases of meningitis were identified (67% were bacterial). Group B Streptococcus (GBS) and Escherichia coli (E. coli) were the commonest bacterial pathogens. The annual rates of early-onset GBS meningitis decreased after the implementation of universal GBS screening and intrapartum antibiotic prophylaxis (IAP) in 2012, while that of late-onset GBS meningitis remained similar. A significant portion of E. coli isolates were resistant to ampicillin and/or gentamicin. ConclusionGBS and E. coli were the most common bacteria for meningitis in this age group. The annual rate of bacterial meningitis in Hong Kong has declined in recent years, which has been attributed to the decline in early-onset GBS meningitis due to universal GBS screening and IAP. Antimicrobial-resistant bacterial strains that cause meningitis require further clinical and public health attention.

Performance of the early-onset-sepsis calculator in Israeli newborns

Riskin et al report a 2-year single-center prospective surveillance of performance of the early-onset-sepsis (EOS) calculator in Israeli infants born at 34 weeks' gestational age with one or more peripartum risk factors for EOS. The impact of use of the calculator in Israel compared with use in the US where it was invented and validated is of special interest because currently there is no recommendation for screening or intrapartum antibiotic prophylaxis (IAP) for group B Streptococcus (GBS) in Israel. The EOS calculator performed in Israeli infants with peripartum risk factor(s) similarly to its performance in this cohort of US infants and was associated with the expected decrease in laboratory testing and use of empiric antibiotics. However, during this surveillance period, GBS was the most common cause of EOS at this Israeli center, where GBS cases primarily were in infants without peripartum risk factors and who were asymptomatic at birth (which also was the case in the US prior to universal screening and IAP). It should be noted that approximately one-half of GBS EOS in the US currently occur in infants whose mothers' screening during pregnancy was negative. The bottom line is that although sepsis calculators appropriately applied can provide a level of confidence that permits providers to forego laboratory testing and excessive use of empiric antibiotic therapy, the critical element of optimal care of the neonate throughout the first day of life is repeated, templated clinical examinations with protocols in place for rapid response should abnormalities arise. Article page 71 ▸ Evaluation of Implementation of Early-Onset Sepsis Calculator in Newborns in IsraelThe Journal of PediatricsVol. 234PreviewTo evaluate the recommendations based on the early-onset sepsis (EOS) calculator in the first 2 years of its implementation in Israel. Full-Text PDF