Antibiotic treatment of parturient women colonized with group B streptococci

A prospective study was conducted among third-trimester parturient women with cervical or urethral colonization with group B streptococci to determine the influence of antibiotic treatment on subsequent colonizations among their infants. Cultures were obtained from dry swabs inoculated directly onto selective blood agar media containing neomycin and naladixic acid. Seventy-four women were found to be colonized among 1,098 cultured (7 per cent). A significant reduction in colonization was noted among mothers treated with ampicillin within three weeks of completion of therapy. This difference was no longer apparent at delivery. There was likewise no difference in the colonization rate of infants in the treatment and no-treatment groups. The data suggest that additional measures must be undertaken to prevent maternal recolonization.     

Correlates of antibiotic-resistant group B streptococcus isolated from pregnant women

Despite antibiotic prophylaxis for at-risk mothers during labor and delivery, group B streptococcus still causes substantial morbidity and mortality among newborns. Resistance to antibiotics recommended for penicillin-allergic pregnant women, such as erythromycin and clindamycin, has increased. A better understanding of factors associated with group B streptococcus resistance is essential to effectively prevent group B streptococcus disease.A total of 117 sequential group B streptococcus isolates were obtained between August 1999 and March 2000 from pregnant women at the University of Michigan Medical Center. Serotype and susceptibility to ten antimicrobials using disk diffusion with E-test for confirmation were determined, and the association between several host factors and colonization with a resistant strain was evaluated.Group B streptococcus was frequently resistant to erythromycin (29%) and clindamycin (21%) but was susceptible to all other antimicrobials tested. A stepwise logistic regression model revealed that black ethnicity (P =.02) and carriage of a serotype V strain (P =.01) were associated with group B streptococcus resistance.Among this population of pregnant women, black ethnicity and serotype V were the strongest predictors of colonization with an erythromycin- or clindamycin-resistant group B streptococcus strain. A better understanding of factors associated with antibiotic resistance is needed to minimize group B streptococcus disease risks and to maximize effective chemoprophylaxis.     

Significance of group B streptococcus (GBS) infections in parturient women

OBJECTIVES: Maternal infections of group B streptococcus (GBS) has recently been associated with preterm labor and early onset of neonatal infections. DESIGN: The aim of this study was to determine the incidence of GBS infections in parturient women, as well as, GBS infections influence on the pregnancy duration, cesarean section rate, birth weight and Apgar score. MATERIALS AND METHODS: A total of 701 cervical swabs were taken and cultured from pregnant women, who came to delivered to Department of Obstetrics and Gynaecology of Silesian Medical School from 1st of January to 30th of September 2002. Results of cervical swabs cultures were clinically analyzed. Mann Whitney test was used to perform statistical analysis. RESULTS: In 23 of 701 women (3.3%) who were admitted to our department GBS infections were detected. In women with GBS, preterm birth and low birth weight, as well as, low Apgar score were more frequently observed. CONCLUSIONS: Positive--GBS infection cervical swabs was found in 23 of 701 parturient women (3.3%) who were admitted to our department. In women with GBS, higher preterm birth rate, as well as, higher cesarean section rate performed because of intrauterine infection were observed, but the differences were not statistically significant.     

Maternal blood group and colonization with the group B streptococcus

A recent report showing a significant association of maternal blood type B and cervical colonization with the group B streptococcus prompted this review of blood types and vaginal group B streptococcal colonization. No association of blood type and group B streptococcal colonization was found. Possible reasons for the difference in results are discussed, and further research is suggested.     

围产期B族链球菌感染的预防

B族链球菌(group B streptococcus,GBS)又称无乳链球菌,是一种兼性革兰阳性菌,可无症状地定植于人胃肠道和泌尿生殖道.孕妇肛门、会阴或阴道定植的GBS 可在分娩时或破膜后垂直传播,造成新生儿早发型GBS 感染.若未应用"产时抗生素预防"(intrapartum antibiotic prophyl...     

Choice of antibiotic for group B streptococcus in women in labour based on antibiotic sensitivity testing

ObjectiveTo determine whether pregnant women testing positive for Group B Streptococcus (GBS) are receiving appropriate antibiotic prophylaxis in labour based on sensitivity testing.MethodsWe performed a retrospective chart review of all women who delivered at our institution from January 1 to December 31, 2008. We identified all GBS-positive women, and then abstracted data regarding demographic characteristics, method of GBS detection (recto-vaginal or urine culture), prevalence, and antibiotic use. The main outcome measure was the proportion of GBS-positive women who were managed appropriately.ResultsDuring the study period 628 (22%) of 2878 women were identified as having GBS-positive cultures. Sensitivity testing was available for 481 of the recto-vaginal cultures. All were sensitive to penicillin. The rates of resistance for recto-vaginal culture were 22% for erythromycin, 19% for clindamycin, and 18% for both. Four hundred eighty-one women (93%) were treated with penicillin, 30 (6%) with clindamycin, three with cefazolin, and two with vancomycin. One hundred nine women (17%) who were GBS-positive did not receive antibiotics. Forty-four women (9%) did not receive appropriate antibiotic prophylaxis based on sensitivity testing.ConclusionMost GBS-positive women at our institution received an appropriate antibiotic during labour based on sensitivity testing. Our population reflects the Canadian GBS-positivity rate, which is similar to those observed in published studies from other populations. Future work should focus on developing strategies that re-emphasize GBS testing and treatment guidelines for prenatal care providers and on systems to ensure GBS-positive women are given the appropriate antibiotics during labour.     

Intraamniotic infection due to group G streptococcus: treatment and antibody response

Penicillin treatment and antibody response were studied using a rhesus monkey model for intraamniotic infection with type III group B streptococci (T3GBS). Acute and convalescent phase sera from mothers and their offspring were tested with a radioactive antigen-binding assay to determine the concentration of antibody to the capsular T3GBS antigen. The frequency of placentitis was significantly lower in penicillin-treated animals (3 of 8) than in controls (10 of 10; P less than .01). The penicillin group also had a significantly lower neonatal mortality (1 of 9) than controls (6 of 10; P less than .05). Both groups of rhesus mothers developed a significant increase in concentration of antibody to T3GBS, but the antibody response was of lesser magnitude in the penicillin-treated group. This experimental model appears to be useful for studying both therapy for intraamniotic infection and the humoral immune response to infection with T3GBS.     

Pulsed-field fingerprinting of vaginal group B streptococcus in pregnancy

OBJECTIVE: There is more to be learned about the epidemiology of group B beta-hemolytic streptococci infections in pregnancy. In this study, we investigated the discriminating capabilities of pulsed-field gel electrophoresis of group B streptococci strains from pregnant patients and mother/infant pairs of patients compared with serotyping. METHODS: Forty-two vaginal strains of group B streptococci cultured from pregnant patients in the third trimester and strains from 20 mother/infant pairs with documented newborn group B streptococci infection were studied. Isolates were serotyped by the Lancefield capillary precipitin method and molecularly characterized by counterclamped homogeneous electrical field pulsed-field gel electrophoresis with rarely cutting restriction enzymes. RESULTS: Nine of the 13 serotypes of group B streptococci identified thus far in the scientific literature (Ia, Ia/c, Ib, Ib/c, II, IIc, III, V, and NT/c) were represented among the 62 isolates. Among the 42 maternal isolates, eight serotypes were represented, and among the 20 mother/infant isolates, six serotypes were represented. Serotypes of mother/infant isolates matched in nine of the ten pairs. Restriction endonuclease profiles, or digests, from the 42 maternal isolates resulted in 25 unique profiles that were arranged into five major groups based on the overall relatedness. Each group was comprised of one predominant serotype. The 20 mother/infant paired isolates displayed nine unique restriction endonuclease profiles and nine of the ten paired isolates showed indistinguishable restriction endonuclease profiles between mother and infant. CONCLUSION: Deoxyribonucleic acid profiling using pulsed-field gel electrophoresis is more discriminating of group B streptococci strains than serotyping because of the different yet closely related patterns within each restriction endonuclease profile group that are linked to one specific serotype. Pulsed-field gel electrophoresis can refine our epidemiologic studies of group B streptococci transmission and acquisition.     

Optimization of prenatal screening for group B streptococcus

The prophylaxis of endogen B streptococcal infections (GBS are part of the normal flora of the gastrointestinal and genital tract) in the presence of predisposed conditions for development of experience for every delivery (tissues' damage, time of delivery, loss of blood, obstetrics manipulations) has been a complicated objective. In the University Hospital of Obstet. Gynecol. "Maichin dom" have been delivered annually on the average 0,6-0,9/1000 born alive with GBS sepsis. The medium Granada shortens the duration for detection of GBS by 24 hours. On entrance of a pregnant woman the direct inoculations of cervico-vaginal secretions and the fast positive reactions of GBS can assist the therapeutical behavior of the mother as well as the newborn.     

成都地区妊娠晚期B群链球菌定植情况调查及围产结局分析

目的:探讨成都地区妊娠晚期B群链球菌(GBS)的定植情况及预防性应用抗生素对围产结局的影响。方法:纳入2015年1月~2017年3月在我院建卡定期产检的538例孕妇,于孕35~37周采用标准方法采集阴道及直肠拭子进行GBS培养,按培养结果分为GBS阳性组和GBS阴性组。阳性组临产或胎膜早破后应用抗生素预防感染,比较阳性组与阴性组的围产结局。结果:(1)538例孕妇共采集标本1076份,GBS阳性标本55份,阳性率5.11%。538例孕妇中,GBS直肠及阴道标本均阳性组41例,其中阴道和直肠标本均阳性14例,仅阴道标本阳性16例,仅直肠标本阳性11例。阴道及直肠标本联合筛查、单独阴道标本筛查和单独直肠标本筛查,GBS检出率分别为7.62%(41/538)、5.58%(30/538)和4.65%(25/538);联合筛查与单独直肠标本筛查比较,GBS检出率差异有统计学意义(P0.05);联合筛查、单独直肠标本与单独阴道标本筛查的GBS检出率比较,差异均无统计学意义(P0.05)。(2)夫妻双方之一为医护人员的孕妇共33例,其GBS定植率为18.18%(6/33),其他职业孕妇GBS定植率为6.93%(35/505),两者比较差异有统计学意义(P0.05)。(3)GBS阳性组中,29例孕妇阴道试产,临产或胎膜早破后预防性应用抗生素,新生儿均采集鼻和耳拭子进行GBS培养,阳性率6.90%(2/29)。(4)GBS阳性组和阴性组孕妇的围产结局,如早产、胎膜早破、羊水粪染、胎儿窘迫、产后出血、新生儿出生体重、Apgar评分、新生儿肺炎及新生儿转NICU率等比较,差异均无统计学意义(P0.05)。结论:成都地区孕妇妊娠晚期GBS定植率为7.62%,夫妻双方之一为医护人员者的定植率显著增加至18.18%,阴道和直肠联合筛查可提高检出率。GBS阳性孕妇预防性应用抗生素后,改善不良围产结局的发生率。故应重视孕晚期尤其是高危孕妇GBS的规范筛查,并进行规范化预防干预,可有效改善围产结局。     

B族链球菌携带及感染孕妇外周血单核细胞炎症因子的水平变化#br#

目的分离培养B族链球菌(GBS)感染孕妇外周血单核细胞,探究GBS感染后炎症因子的变化。方法选择2017年6月至2018年12月在青岛市海慈医疗集团产科分娩的GBS阳性孕妇和正常孕妇,以及育龄期妇女作为研究对象,分离培养受试者外周血单核细胞,探究IL-1、IL-6、IL-8、TNF-α、CRP的m RNA及蛋白表达量的变化。结果GBS感染组外周血单核细胞IL-6(102.22±98.62)ng/L和IL-8(98.17±87.12)ng/L的水平显著高于正常孕妇组IL-6(24.62±53.14)ng/L、IL-8(20.25±30.11)ng/L和育龄期妇女组IL-6(22.13±56.23)ng/L、IL-8(17.12±20.63)ng/L(P<0.001)。GBS感染组新生儿发病率为20.0%,显著高于正常孕妇组(0.0%;P<0.05)。结论GBS感染阳性孕妇外周血单个核细胞中,IL-6和IL-8炎症因子表达显著上升,且新生儿发病风险增加,临床上应给予重视。     

The ethics of screening for group B streptococcus in pregnancy

Group B streptococcus is carried by approximately 25% of the pregnant population. If passed to newborns during labour, it can cause serious illness and death. Currently, a risk-based screening strategy for pregnant women is advised by both the UK Screening Committee and Royal College of Obstetricians. This enables intrapartum antibiotics to be given to reduce the incidence of early onset group B streptococcal disease. The reasons why universal screening has not been adopted into UK practice are examined in this review. The proposal to screen between 35 and 37 weeks has not been shown to have a high enough sensitivity, and many cases occur in preterm infants, prior to the proposed screening gestation. Antibiotic use has risks for both the mother and neonate, and has not been shown to reduce mortality or serious morbidity rates. Incidence of neonatal group B streptococcus is similar to the UK in countries where universal screening has been adopted. For these and other reasons, more research is needed to ensure that the introduction of universal screening will be beneficial, and to resolve the ethical conflicts raised.