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Hsu CY, Moradkasani S, Suliman M, Uthirapathy S, Zwamel AH, Hjazi A, Vashishth R, Beig M. Global patterns of antibiotic resistance in group B Streptococcus: a systematic review and meta-analysis. Front Microbiol 2025; 16:1541524. [PMID: 40342597 PMCID: PMC12060732 DOI: 10.3389/fmicb.2025.1541524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 03/14/2025] [Indexed: 05/11/2025] Open
Abstract
Objectives Streptococcus agalactiae, or group B Streptococcus (GBS), is a significant pathogen associated with severe infections in neonates, particularly sepsis and meningitis. The increasing prevalence of antibiotic resistance among GBS strains is a growing public health concern, necessitating a comprehensive meta-analysis to evaluate the prevalence of this resistance globally. Methods We conducted a comprehensive systematic search across four major scientific databases: Scopus, PubMed, Web of Science, and EMBASE, targeting articles published until December 13, 2023. This meta-analysis focused on studies that examined antibiotic resistance in GBS strains. The Joanna Briggs Institute tool was employed to assess the quality of the included studies. This meta-analysis applied a random-effects model to synthesize data on antibiotic resistance in GBS, incorporating subgroup analyses and regression techniques to explore heterogeneity and trends in resistance rates over time. Outliers and influential studies were identified using statistical methods such as Cook's distance, and funnel plot asymmetry was assessed to evaluate potential publication bias. All analyses were conducted using R software (version 4.2.1) and the metafor package (version 3.8.1). Results This study included 266 studies from 57 countries, revealing significant variability in GBS antibiotic resistance rates. The highest resistance rates were observed for tetracycline (80.1, 95% CI: 77.1-82.8%), while tedizolid (0.1, 95% CI: 0.0-0.8%) showed the lowest resistance rates. Significant heterogeneity in resistance rates was observed, particularly for antibiotics such as azithromycin and gentamicin (I 2 = 97.29%), variability across studies. On the other hand, tigecycline and ceftaroline exhibited no heterogeneity (I 2 = 0%), suggesting consistent resistance patterns. Subgroup analyses revealed disparities in resistance rates based on country, continent, and methodological categories. Significant increase in resistance rates for several antibiotics over time, including clindamycin, erythromycin, ceftriaxone, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, chloramphenicol, and ofloxacin. Ofloxacin and cefuroxime showed particularly steep trends. Conversely, a declining resistance trend was observed for oxacillin. Conclusion This study emphasizes the growing issue of antibiotic resistance in GBS strains. Notable resistance to older and newer antibiotics, increasing resistance over time, regional disparities, and methodological variations are noted. Rising resistance trends for multiple antibiotics underscore the urgent need for global surveillance and improved antibiotic stewardship. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024566269, CRD42024566269.
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Affiliation(s)
- Chou-Yi Hsu
- Thunderbird School of Global Management, Arizona State University Tempe Campus, Phoenix, AZ, United States
| | | | - Muath Suliman
- Department of Laboratory Medicine, School of Medical Sciences, King Khalid University, Abha, Saudi Arabia
| | - Subasini Uthirapathy
- Pharmacy Department Tishk International University Erbil, Kurdistan Region, Iraq
| | - Ahmed Hussein Zwamel
- Medical Laboratory Technique College, The Islamic University, Najaf, Iraq
- Medical Laboratory Technique College, The Islamic University of Al Diwaniyah, Al Diwaniyah, Iraq
- Medical Laboratory Technique College, The Islamic University of Babylon, Babylon, Iraq
| | - Ahmed Hjazi
- Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Raghav Vashishth
- Department of Surgery, National Institute of Medical Sciences, NIMS University Rajasthan, Jaipur, India
| | - Masoumeh Beig
- Department of Bacteriology, Pasteur Institute of Iran, Tehran, Iran
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Shimeles G, Gedefie A, Motbainor H, Genet C. Vaginal colonization, vertical transmission rate, antimicrobial susceptibility profile, and associated factors of potential neonatal pathogens among pregnant women at public health facilities of Northeast Ethiopia. Front Public Health 2025; 13:1475357. [PMID: 39975790 PMCID: PMC11836021 DOI: 10.3389/fpubh.2025.1475357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 01/22/2025] [Indexed: 02/21/2025] Open
Abstract
Background Vaginal colonization by pathogenic bacteria increases the risk of bacterial infections such as sepsis, which is associated with high neonatal mortality. More than half a million newborn deaths occur globally each year due to infections that lead to sepsis. However, the problem is worsening in Ethiopia the evidence of vaginal colonization and vertical transmission is scarce. Methods A healthcare facility-based cross-sectional study was conducted in Dessie town from April 1 to June 30, 2023, among 348 pregnant women and their newborns. Socio-demographic, clinical, and related data were collected using a pre-tested semi-structured questionnaire. Vaginal swab samples from pregnant women and pooled external ear, nasal area, and umbilical swab samples from the newborns were collected and transported using Amies transport media. Samples were inoculated into blood agar, Todd Hewitt selective enrichment broth, and MacConkey agar for bacterial isolation, and Sabouraud Dextrose Agar and CHROM Agar for Candida species isolation. The antimicrobial susceptibility was performed on isolates using the Kirby-Bauer disc diffusion technique. Data was analyzed by SPSS version 25.0. Logistic regression model was used to identify the associated factors. Finally, variables with p < 0.05 and their 95% confidence interval were considered statistically significant. Results A total of 348 pregnant women attending vaginal delivery were included in the study. The maternal colonization and vertical transmission rates were 55.5% (193/348) and 53.9% (104/348), respectively. The most frequent potential pathogen among pregnant women was Escherichia coli (27.6%), followed by Candida spp. (14.1%), and Klebsiella spp. (6%). Similarly, the predominant isolates in the newborns were E. coli (16.4%), Candida spp. (6.3%), and Klebsiella spp. (3.6%). The overall multidrug resistance levels of potential pathogens were 37.3%. Living with domestic animals (p = 0.001), having premature rupture of membrane (p = 0.010) and history of urinary tract infection (p = 0.013) were significantly associated with maternal colonization. Potential pathogen colonization newborn was significantly associated with duration of labor (p = 0.024) and low birth weight (p < 0.001). Conclusion The finding of the present study revealed that vaginal colonization and vertical transmissions of potential pathogens and their antimicrobial resistance is still a significant problem. This alarms the urgency of evidence based-intervention to improve maternal and neonatal health.
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Affiliation(s)
- Getnet Shimeles
- Gishe Rabel Health Center, Debre Birhan, Ethiopia
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Hilina Motbainor
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Genet
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Institute of Biotechnology, Bahir Dar University, Bahir Dar, Ethiopia
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Ha MT, Tran-Thi-Bich H, Bui-Thi-Kim T, Nguyen-Thi ML, Vu-Tri T, Ho-Huynh TD, Nguyen TA. Comparison of qPCR and chromogenic culture methods for rapid detection of group B streptococcus colonization in Vietnamese pregnant women. Pract Lab Med 2024; 42:e00435. [PMID: 39497793 PMCID: PMC11532469 DOI: 10.1016/j.plabm.2024.e00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 10/10/2024] [Accepted: 10/14/2024] [Indexed: 11/07/2024] Open
Abstract
Introduction Neonatal infections can rapidly become severe, with delays in treatment often proving fatal. Streptococcus agalactiae (Group B Streptococcus, GBS) is a common cause, typically transmitted from colonized pregnant women to neonates during childbirth. In Vietnam, routine prenatal care lacks standardized GBS screening protocols. This study aims to compare enhanced qPCR methods with the culture method, evaluate the diagnostic accuracy of these qPCR procedures, and assess the frequency of GBS infection in pregnant Vietnamese women during their final trimester. Materials and methods Pregnant women aged 35 weeks gestation or more were recruited. Rectovaginal swabs were collected and analyzed for GBS using chromogenic culture, a commercial real-time PCR kit, and in-house real-time PCR assays targeting the cfb and sip genes. Clinical diagnostic values were calculated, and GBS prevalence was determined. Results The study included 259 pregnant women with a mean age of 30.2 ± 5.0 years. Of these, 96.6 % had gestational ages of 37 weeks or more at delivery. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the cfb-based and sip-based qPCR assays were 94.1/92.7, 99.0/99.5, 97.1/98.5, 97.8/97.3, and 97.6 %, respectively. The Kappa values were excellent (0.940 and 0.939), with results available in under 2 h. GBS prevalence was 24.7 % and 25.5 % by cfb-based and sip-based qPCR assays, aligning with the culture method (25.5 %). Conclusions Both direct real-time PCR assays demonstrated high accuracy and were comparable to chromogenic culture in diagnosing GBS. A significant prevalence of GBS colonization was found among Vietnamese pregnant women in their final trimester.
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Affiliation(s)
- Manh-Tuan Ha
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
- University Medical Center Ho Chi Minh City - Branch 2, Ho Chi Minh City, Viet Nam
| | - Huyen Tran-Thi-Bich
- University Medical Center Ho Chi Minh City - Branch 2, Ho Chi Minh City, Viet Nam
| | - Thao Bui-Thi-Kim
- University Medical Center Ho Chi Minh City - Branch 2, Ho Chi Minh City, Viet Nam
| | | | - Thanh Vu-Tri
- Thu Duc Region General Hospital, Thu Duc City, Viet Nam
| | | | - Tuan-Anh Nguyen
- University Medical Center Ho Chi Minh City - Branch 2, Ho Chi Minh City, Viet Nam
- Molecular Biomedical Center, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Sherif M, Abera D, Desta K. Prevalence and antibiotic resistance pattern of bacteria from sepsis suspected neonates at St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia. BMC Pediatr 2023; 23:575. [PMID: 37980512 PMCID: PMC10656775 DOI: 10.1186/s12887-023-04399-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 10/30/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Neonatal sepsis is the major cause of neonatal mortality and morbidity, especially in low and middle-income countries. Continuous monitoring of pathogens and their antibiotic resistance pattern is crucial for managing neonatal sepsis. This study aimed to determine neonatal sepsis due to bacteria, antibiotic resistance patterns, associated risk factors and patient outcomes at St. Paul's Hospital Millennium Medical College. METHOD An institutional-based cross-sectional study was conducted on 400 neonates suspected of sepsis at St. Paul's Hospital Millennium Medical College from March 2020 to July 2020. A questionnaire was used to collect socio-demographic information, clinical parameters and potential risk factors from study participants. About 2ml of blood was drawn aseptically and inoculated into Tryptone Soya Broth at the patient's bedside. Bacterial identification was performed by using standard microbiological techniques. The disk diffusion method was used to determine the antibiotic susceptibility patterns of each isolated bacteria. Data entry and analysis were done using Statistical Package for Social Sciences (SPSS) version 20 software. Bivariate and multivariable logistic regressions were used to assess associated risk factors of neonatal sepsis. A p-value less than 0.05 was considered statically significant with a 95% confidence interval. RESULTS The overall prevalence of neonatal septicemia was 21% (84/400). Of these, 67 (79.8%) and 17 (20.2%) were gram-negative and gram-positive bacteria, respectively. Klebsiella spp, 37 (44%), E. coli 19 (21.6%) and Coagulase negative Staphylococci 13 (15.47%) were the leading cause of neonatal sepsis. Ciprofloxacin and amikacin were the most effective antibiotics for gram-negative and gram-positive bacteria. Multidrug resistance was observed in 84% of the bacterial isolates. Low birth weight and preterm were associated with neonatal septicemia (AOR = 49.90, 95% CI = 15.14-123.081, P = 0.002) and (AOR = 18.20, 95% CI = 6.835-27.541, P = 0.004) respectively. CONCLUSION Klebsiella spp and E. coli were frequently isolated bacteria in our study. The proportion of multidrug-resistance was significantly high. Most isolated bacteria were resistant to ampicillin, ceftazidime, cefotaxime and gentamycin, which indicates the necessity of continuous evaluation of antibiotic resistance rate.
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Affiliation(s)
- Merema Sherif
- St Paul hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dessie Abera
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Kassu Desta
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Adhisivam B. Maternal Colonization of Group B Streptococcus and Neonatal Sepsis. Indian J Pediatr 2022; 89:1171-1172. [PMID: 36107290 DOI: 10.1007/s12098-022-04360-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/02/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Bethou Adhisivam
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India.
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Gurudas G, Arjun R, Jain N, Ranganayaki V, Sasikumar C, Mohan V, Hussain F, Pournami F. Prevalence of Group B Streptococcus in pregnant women in Kerala and relation to neonatal outcomes: a prospective cross-sectional study. J Trop Pediatr 2022; 68:6777798. [PMID: 36306123 DOI: 10.1093/tropej/fmac092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Early onset sepsis (EOS) in neonates is a scourge that contributes to morbidity and mortality. Prominent stakeholders recommend universal screening of antenatal women for Group B Streptococcus (GBS) and intrapartum antibiotic prophylaxis (IAP) for those who are carriers. However, there are controversies. Other guidelines allow region-specific protocols due to sociodemographic, geographical and ethnic differences. We planned to analyze the prevalence of GBS rectovaginal carriage at 36-37 weeks gestation and its effect on early neonatal status. METHODS This prospective multidisciplinary study (Obstetrics, Perinatology, Neonatology, Microbiology and Infectious diseases) was conducted in our tertiary care center between February 2020 and May 2021. RESULTS In our study group which included 966 mothers who delivered at the hospital, 4.8% of mothers who were screened by genito-rectal swabs were positive for GBS at 36-37 weeks gestation. All these mothers were given IAP as per protocol. Other organisms detected on screening mothers were Candida and Gram-negative bacteria. None of the neonates born to these mothers required any intensive care unit admission or therapy for systemic illness. There was no difference in clinically relevant outcomes between neonates who were born to GBS-positive mothers as compared to those born to negative screen result mothers. CONCLUSIONS GBS prevalence in our cohort was lower than most scientific reports. The neonates born to carrier mothers did not present with signs of early-onset sepsis.
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Affiliation(s)
- Girija Gurudas
- Department of Obstetrics and Gynecology, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Rajalakshmi Arjun
- Department of Infectious Diseases, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Naveen Jain
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Vidyalekshmy Ranganayaki
- Department of High Risk Obstetrics and Perinatology, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Chinnu Sasikumar
- Department of Obstetrics and Gynecology, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Viji Mohan
- Department of Microbiology, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Febeena Hussain
- Department of Infectious Diseases, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
| | - Femitha Pournami
- Department of Neonatology, Kerala Institute of Medical Sciences, Trivandrum 695029, Kerala, India
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