1887

Abstract

Group B streptococcus (GBS) is an important cause of neonatal sepsis worldwide. Data on the prevalence of maternal GBS colonization, risk factors for carriage, antibiotic susceptibility and circulating serotypes are necessary to tailor adequate locally relevant public health policies.

A prospective study including pregnant women and their newborns was conducted between March and July 2013 in Morocco. We collected clinical data and vagino-rectal and urine samples from the recruited pregnant women, together with the clinical characteristics of, and body surface samples from, their newborns. Additionally, the first three newborns admitted every day with suspected invasive infection were recruited for a thorough screening for neonatal sepsis. Serotypes were characterized by molecular testing.

A total of 350 pregnant women and 139 of their newborns were recruited. The prevalence of pregnant women colonized by GBS was 24 %. In 5/160 additional sick newborns recruited with suspected sepsis, the blood cultures were positive for GBS. Gestational hypertension and vaginal pruritus were significantly associated with a vagino-rectal GBS colonization in univariate analyses. All of the strains were susceptible to penicillin, while 7 % were resistant to clindamycin and 12 % were resistant to erythromycin. The most common GBS serotypes detected included V, II and III.

In Morocco, maternal GBS colonization is high. Penicillin can continue to be the cornerstone of intrapartum antibiotic prophylaxis. A pentavalent GBS vaccine (Ia, Ib, II, III and V) would have been effective against the majority of the colonizing cases in this setting, but a trivalent one (Ia, Ib and III) would only prevent 28 % of the cases.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000720
2018-05-01
2020-01-27
Loading full text...

Full text loading...

/deliver/fulltext/jmm/67/5/652.html?itemId=/content/journal/jmm/10.1099/jmm.0.000720&mimeType=html&fmt=ahah

References

  1. Edmond KM, Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AK et al. Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis. Lancet 2012;379:547–556 [CrossRef][PubMed]
    [Google Scholar]
  2. Dagnew AF, Cunnington MC, Dube Q, Edwards MS, French N et al. Variation in reported neonatal group B streptococcal disease incidence in developing countries. Clin Infect Dis 2012;55:91–102 [CrossRef][PubMed]
    [Google Scholar]
  3. Lawn JE, Bianchi-Jassir F, Russell NJ, Kohli-Lynch M, Tann CJ et al. Group B streptococcal disease worldwide for pregnant women, stillbirths, and children: why, what, and how to undertake estimates?. Clin Infect Dis 2017;65:S89–S99 [CrossRef][PubMed]
    [Google Scholar]
  4. Chan GJ, Lee AC, Baqui AH, Tan J, Black RE. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis. PLoS Med 2013;10:e1001502 [CrossRef][PubMed]
    [Google Scholar]
  5. Verani JR, McGee L, Schrag SJ.Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC) Prevention of perinatal group B streptococcal disease-revised guidelines from CDC, 2010. MMWR Recomm Rep 2010;59:1–36[PubMed]
    [Google Scholar]
  6. Schrag SJ, Verani JR. Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: experience in the United States and implications for a potential group B streptococcal vaccine. Vaccine 2013;31:D20–D26 [CrossRef][PubMed]
    [Google Scholar]
  7. Bassat Q. Maternal immunization: an intelligent solution to reduce the hidden burden of group B streptococcus perinatal disease. J Trop Pediatr 2013;59:333–337 [CrossRef][PubMed]
    [Google Scholar]
  8. Koenig JM, Keenan WJ. Group B streptococcus and early-onset sepsis in the era of maternal prophylaxis. Pediatr Clin North Am 2009;56:689–708 [CrossRef][PubMed]
    [Google Scholar]
  9. Korir ML, Knupp D, Lemerise K, Boldenow E, Loch-Caruso R et al. Association and virulence gene expression vary among serotype III group B streptococcus isolates following exposure to decidual and lung epithelial cells. Infect Immun 2014;82:4587–4595 [CrossRef][PubMed]
    [Google Scholar]
  10. Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing, 20th Informational Supplement, M100-S24. Wayne, PA, USA: CLSI; 2014
    [Google Scholar]
  11. Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991;29:297–301[PubMed]
    [Google Scholar]
  12. Poyart C, Tazi A, Réglier-Poupet H, Billoët A, Tavares N et al. Multiplex PCR assay for rapid and accurate capsular typing of group B streptococci. J Clin Microbiol 2007;45:1985–1988 [CrossRef][PubMed]
    [Google Scholar]
  13. Imperi M, Pataracchia M, Alfarone G, Baldassarri L, Orefici G et al. A multiplex PCR assay for the direct identification of the capsular type (Ia to IX) of Streptococcus agalactiae. J Microbiol Methods 2010;80:212–214 [CrossRef][PubMed]
    [Google Scholar]
  14. Bassir A, Dhibou H, Farah M, Mohamed L, Amal A et al. [Vaginal colonization by group B streptococcus among pregnant women in the region of Marrakech]. Pan Afr Med J 2016;23:107 [CrossRef][PubMed]
    [Google Scholar]
  15. Mahmoud M, Yahyaoui G, Benseddik N, Saadi M, Chaara H et al. Dépistage de streptocoque du groupe B au cours du troisième trimestre de grossesse au CHU Hassan II de Fès. Revue Tunisienne d'Infectiologie 2011;5:12–15
    [Google Scholar]
  16. Cools P, Jespers V, Hardy L, Crucitti T, Delany-Moretlwe S et al. A multi-country cross-sectional study of vaginal carriage of group B streptococci (GBS) and Escherichia coli in resource-poor settings: prevalences and risk factors. PLoS One 2016;11:e0148052 [CrossRef][PubMed]
    [Google Scholar]
  17. Kwatra G, Adrian PV, Shiri T, Buchmann EJ, Cutland CL et al. Serotype-specific acquisition and loss of group B streptococcus recto-vaginal colonization in late pregnancy. PLoS One 2014;9:e98778 [CrossRef][PubMed]
    [Google Scholar]
  18. Stoll BJ, Schuchat A. Maternal carriage of group B streptococci in developing countries. Pediatr Infect Dis J 1998;17:499–503 [CrossRef]
    [Google Scholar]
  19. Russell NJ, Seale AC, O'Driscoll M, O'Sullivan C, Bianchi-Jassir F et al. Maternal colonization with group B streptococcus and serotype distribution worldwide: systematic review and meta-analyses. Clin Infect Dis 2017;65:S100–S111 [CrossRef][PubMed]
    [Google Scholar]
  20. Le Doare K, Jarju S, Darboe S, Warburton F, Gorringe A et al. Risk factors for Group B streptococcus colonisation and disease in Gambian women and their infants. J Infect 2016;72:283–294 [CrossRef][PubMed]
    [Google Scholar]
  21. Kruk CR, Feuerschuette OH, Silveira SK, Cordazo M, Trapani Júnior A. Epidemiologic profile of Streptococcus agalactiae colonization in pregnant women attending prenatal care in a city of southern of Brazil. Braz J Infect Dis 2013;17:722–723 [CrossRef][PubMed]
    [Google Scholar]
  22. Mitima KT, Ntamako S, Birindwa AM, Mukanire N, Kivukuto JM et al. Prevalence of colonization by Streptococcus agalactiae among pregnant women in Bukavu, Democratic Republic of the Congo. J Infect Dev Ctries 2014;8:1195–1200 [CrossRef][PubMed]
    [Google Scholar]
  23. Al-Sweih N, Maiyegun S, Diejomaoh M, Rotimi V, Khodakhast F et al. Streptococcus agalactiae (Group B streptococci) carriage in late pregnancy in Kuwait. Med Princ Pract 2004;13:10–14 [CrossRef][PubMed]
    [Google Scholar]
  24. Stuart KL, Cummins GT, Chin WA. Bacteriuria, prematurity, and the hypertensive disorders of pregnancy. Br Med J 1965;1:554–556 [CrossRef][PubMed]
    [Google Scholar]
  25. Moist L, Sontrop JM, Garg AX, Clark WF, Suri RS et al. Risk of pregnancy-related hypertension within 5 years of exposure to drinking water contaminated with Escherichia coli O157:H7. J Clin Hypertens 2010;12:613–620 [CrossRef][PubMed]
    [Google Scholar]
  26. López-Jaramillo P, Herrera JA, Arenas-Mantilla M, Jáuregui IE, Mendoza MA. Subclinical infection as a cause of inflammation in preeclampsia. Am J Ther 2008;15:373–376 [CrossRef][PubMed]
    [Google Scholar]
  27. Conde-Agudelo A, Villar J, Lindheimer M. Maternal infection and risk of preeclampsia: systematic review and metaanalysis. Am J Obstet Gynecol 2008;198:7–22 [CrossRef][PubMed]
    [Google Scholar]
  28. Rustveld LO, Kelsey SF, Sharma R. Association between maternal infections and preeclampsia: a systematic review of epidemiologic studies. Matern Child Health J 2008;12:223–242 [CrossRef][PubMed]
    [Google Scholar]
  29. Kobayashi M, Vekemans J, Baker CJ, Ratner AJ, Le Doare K et al. Group BStreptococcusvaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries. F1000Res 2016;5:2355 [CrossRef][PubMed]
    [Google Scholar]
  30. Terry RR, Kelly FW, Gauzer C, Jeitler M. Risk factors for maternal colonization with group B beta-hemolytic streptococci. J Am Osteopath Assoc 1999;99:571–573 [CrossRef][PubMed]
    [Google Scholar]
  31. Jaureguy F, Carton M, Teboul J, Butel MJ, Panel P et al. Risk factors and screening strategy for group B streptococcal colonization in pregnant women: results of a prospective study]. J Gynecol Obstet Biol Reprod 2003;32:132–138
    [Google Scholar]
  32. Ramos E, Gaudier FL, Hearing LR, del Valle GO, Jenkins S et al. Group B streptococcus colonization in pregnant diabetic women. Obstet Gynecol 1997;89:257–260 [CrossRef][PubMed]
    [Google Scholar]
  33. Zusman AS, Baltimore RS, Fonseca SN. Prevalence of maternal group B streptococcal colonization and related risk factors in a Brazilian population. Braz J Infect Dis 2006;10:242–246 [CrossRef][PubMed]
    [Google Scholar]
  34. Regan JA, Klebanoff MA, Nugent RP. The epidemiology of group B streptococcal colonization in pregnancy. Vaginal Infections and Prematurity Study Group. Obstet Gynecol 1991;77:604–610[PubMed]
    [Google Scholar]
  35. Sáez-López E, Cossa A, Benmessaoud R, Madrid L, Moraleda C et al. Characterization of vaginal Escherichia coli isolated from pregnant women in two different african sites. PLoS One 2016;11:e0158695 [CrossRef][PubMed]
    [Google Scholar]
  36. Gherardi G, Imperi M, Baldassarri L, Pataracchia M, Alfarone G et al. Molecular epidemiology and distribution of serotypes, surface proteins, and antibiotic resistance among group B streptococci in Italy. J Clin Microbiol 2007;45:2909–2916 [CrossRef][PubMed]
    [Google Scholar]
  37. Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008;299:2056–2065 [CrossRef][PubMed]
    [Google Scholar]
  38. Kimura K, Nagano N, Nagano Y, Suzuki S, Wachino J et al. High frequency of fluoroquinolone- and macrolide-resistant streptococci among clinically isolated group B streptococci with reduced penicillin susceptibility. J Antimicrob Chemother 2013;68:539–542 [CrossRef][PubMed]
    [Google Scholar]
  39. Madrid L, Seale AC, Kohli-Lynch M, Edmond KM, Lawn JE et al. Infant Group B streptococcal disease incidence and serotypes worldwide: systematic review and meta-analyses. Clin Infect Dis 2017;65:S160–S172 [CrossRef][PubMed]
    [Google Scholar]
  40. Dangor Z, Cutland CL, Izu A, Kwatra G, Trenor S et al. Temporal changes in invasive Group B streptococcus serotypes: implications for vaccine development. PLoS One 2016;11:e0169101 [CrossRef][PubMed]
    [Google Scholar]
  41. Ekin IH, Gurturk K. Characterization of bovine and human group B streptococci isolated in Turkey. J Med Microbiol 2006;55:517–521 [CrossRef][PubMed]
    [Google Scholar]
  42. Palmeiro JK, Dalla-Costa LM, Fracalanzza SE, Botelho AC, da Silva Nogueira K et al. Phenotypic and genotypic characterization of group B streptococcal isolates in southern Brazil. J Clin Microbiol 2010;48:4397–4403 [CrossRef][PubMed]
    [Google Scholar]
  43. Diedrick MJ, Flores AE, Hillier SL, Creti R, Ferrieri P. Clonal analysis of colonizing group B streptococcus, serotype IV, an emerging pathogen in the United States. J Clin Microbiol 2010;48:3100–3104 [CrossRef][PubMed]
    [Google Scholar]
  44. Puopolo KM, Madoff LC. Type IV neonatal early-onset group B streptococcal disease in a United States hospital. J Clin Microbiol 2007;45:1360–1362 [CrossRef][PubMed]
    [Google Scholar]
  45. Amin A, Abdulrazzaq YM, Uduman S. Group B streptococcal serotype distribution of isolates from colonized pregnant women at the time of delivery in United Arab Emirates. J Infect 2002;45:42–46 [CrossRef][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000720
Loading
/content/journal/jmm/10.1099/jmm.0.000720
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error