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Charfi R, Guyonnet C, Untrau M, Giacometti G, Paper T, Poyart C, Plainvert C, Tazi A. Performances of two rapid LAMP-based techniques for the intrapartum detection of Group B Streptococcus vaginal colonization. Ann Clin Microbiol Antimicrob 2024; 23:37. [PMID: 38664821 PMCID: PMC11046945 DOI: 10.1186/s12941-024-00695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE Group B Streptococcus (GBS) is the leading cause of invasive infections in newborns. The prevention of GBS neonatal disease relies on the administration of an intrapartum antibiotic prophylaxis to GBS-colonized women. In recent years, rapid intrapartum detection of GBS vaginal colonization using real-time nucleic acid amplification tests (NAATs) emerged as an alternative to antenatal culture screening methods. METHODS We compared the performances of two loop-mediated isothermal amplification (LAMP) tests, the Ampliflash® GBS and the PlusLife® GBS tests, to standard culture for GBS detection in vaginal specimens from pregnant women. The study was conducted from April to July 2023 in a French hospital of the Paris area. RESULTS A total of 303 samples were analyzed, including 85 culture-positive samples (28.1%). The Ampliflash® GBS test and the PlusLife® GBS tests gave a result for 100% and 96.3% tests, respectively. The performances of the tests were as follows: sensitivity 87.1% (95% confidence interval (CI) 78.3-92.6) and 98.7% (95% CI 93.0-99.8), specificity 99.1% (95% CI 96.7-99.8), and 91.9% (95% CI 87.3-95.0), respectively. False negative results of the Ampliflash® GBS test correlated with low-density GBS cultures. Time-to-results correlated with GBS culture density only for the PlusLife® GBS test (p < 0.001). CONCLUSION Both techniques provide excellent analytical performances with high sensitivity and specificity together with a short turnaround time and results available in 10 to 35 min. Their potential to further reduce the burden of GBS neonatal disease compared with antenatal culture screening needs to be assessed in future clinical studies.
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Affiliation(s)
- Rym Charfi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
| | - Cécile Guyonnet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | | | | | | | - Claire Poyart
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | - Céline Plainvert
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France
| | - Asmaa Tazi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, F-75014, France.
- Service de Bactériologie, Centre National de Référence des Streptocoques, Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Hôpital Cochin, 27 rue du Faubourg Saint-Jacques, Paris, 75014, France.
- Fédération Hospitalo-Universitaire Fighting Prematurity - FHU Préma, Paris, France.
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Chen XJ, Wan TW, Chao QT, Teng LJ, Lee TF, Huang YT, Hsueh PR. Applicability of an in-house extraction protocol in a Bruker Biotyper matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system for the identification of Streptococcus agalactiae from broth-enriched vaginal/rectal swab specimens. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:815-821. [PMID: 37330378 DOI: 10.1016/j.jmii.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND PURPOSE Early laboratory identification of group B Streptococcus (GBS, Streptococcus agalactiae) in the birth canal of pregnant women is critical for prompt administration of antimicrobial therapy and may further reduce the mortality rate due to GBS neonatal infection. METHODS A total of 164 vaginal/rectal swab specimens collected from pregnant women at 35-37 weeks of gestation were screened for GBS vaginal colonization. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS, Bruker Biotyper, Bruker Daltonik GmbH, Bremen, Germany) system was used to detect GBS from Carrot broth and LIM broth enrichment using an in-house extraction protocol. The results were compared to those by conventional broth-enriched culture/identification methods as the gold standard. BD MAX™ GBS assay (Becton Dickinson, Sparks, MD, USA) was also performed for Carrot broth-enriched specimen. Discordant results were investigated using the GeneXpert® GBS PCR assay (Cepheid Inc., Sunnyvale, CA, USA). RESULTS Using the extraction protocol, 33 (20.1%) of the 164 specimens were positive in Carrot broth, and 19 (11.6%) were positive in LIM broth. Using the culture protocol, 38 (23.2%) samples in Carrot broth and 35 (21.3%) in LIM broth were positive. The sensitivity, specificity, and positive and negative predictive values using the extraction protocol in Carrot broth and LIM broth compared to the gold standard conventional culture/identification method were 86.8% and 50.0%, 100% and 100%, 100% and 100%, and 96.2% and 86.9%, respectively. CONCLUSIONS The extraction protocol with MALDI-TOF MS from Carrot broth-enriched samples provides a more rapid turnaround time, lower cost, and acceptable sensitivity and specificity to correctly identify pathogens when compared to conventional culture/identification methods.
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Affiliation(s)
- Xiang-Jun Chen
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tsai-Wen Wan
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Qiuo-Ting Chao
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lee-Jene Teng
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tai-Fen Lee
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Yu-Tsung Huang
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan.
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Peris MP, Martín-Saco G, Alonso-Ezcurra H, Escolar-Miñana C, Rezusta A, Acero R, Milagro-Beamonte A. Retrospective Study for the Clinical Evaluation of a Real-Time PCR Assay with Lyophilized and Ready-to-Use Reagents for Streptococcus agalactiae Detection in Prenatal Screening Specimens. Diagnostics (Basel) 2022; 12:diagnostics12092189. [PMID: 36140590 PMCID: PMC9497952 DOI: 10.3390/diagnostics12092189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus agalactiae is a leading cause of sepsis and meningitis in newborns and young infants. Screening programs and intrapartum antibiotic prophylaxis have reduced early neonatal onset of disease. The aim of this study was to evaluate a molecular assay with lyophilized and ready-to-use reagents: VIASURE® Streptococcus B Real Time PCR detection kit (CerTest Biotec) (Viasure qPCR assay) compared to both the GBS culture and a molecular assay with separated and frozen reagents: Strep B Real-TM Quant (Sacace Biotecnologies®) (Sacace qPCR assay). A total of 413 vaginal−rectal swabs from women between the 35th and 37th weeks of pregnancy were processed. GBS culture was firstly achieved through Granada medium and Columbia CNA agar at 35 °C in aerobic conditions. Then, nucleic acid extraction was performed for subsequent molecular analysis using both commercial assays. Discordant results were resolved via bidirectional Sanger sequencing. Viasure qPCR assay clinical sensitivity was 0.97 (0.92−0.99) and specificity 1 (0.98−1). This retrospective study demonstrated the good clinical parameters and the strong overall agreement (99.3%) between the Viasure qPCR assay and both reference assays. Finally, the added value observed of the assay under study was the stabilized and ready-to-use format, reducing the number of time-consuming steps, permitting the storage at room temperature, facilitating transport, being environmentally respectful, and reducing additional costs.
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Affiliation(s)
- María Paz Peris
- Health Research Institute Aragón, 50009 Zaragoza, Spain
- Department of Animal Pathology, Faculty of Veterinary, University of Zaragoza, 50009 Zaragoza, Spain
- Correspondence: or ; Tel.: +34-976765500 (ext. 2801)
| | - Gloria Martín-Saco
- Health Research Institute Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, 50009 Zaragoza, Spain
| | - Henar Alonso-Ezcurra
- Department of Microbiology, Paediatrics, Radiology, and Public Health, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Cristina Escolar-Miñana
- Department of Animal Production and Food Science, Faculty of Veterinary, University of Zaragoza, 50009 Zaragoza, Spain
| | - Antonio Rezusta
- Health Research Institute Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, 50009 Zaragoza, Spain
| | - Raquel Acero
- Department of Design and Manufacturing Engineering, School of Engineering and Architecture, University of Zaragoza, 50009 Zaragoza, Spain
- Instituto de Investigación en Ingeniería de Aragón (I3A), University of Zaragoza, 50009 Zaragoza, Spain
| | - Ana Milagro-Beamonte
- Health Research Institute Aragón, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Microbiology, 50009 Zaragoza, Spain
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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. Diagnostics (Basel) 2022; 12:diagnostics12071569. [PMID: 35885476 PMCID: PMC9322697 DOI: 10.3390/diagnostics12071569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Abstract
Neonatal bacterial meningitis is a devastating disease, associated with high mortality and neurological disability, in both developed and developing countries. Streptococcus agalactiae, commonly referred to as group B Streptococcus (GBS), remains the most common bacterial cause of meningitis among infants younger than 90 days. Maternal colonization with GBS in the gastrointestinal and/or genitourinary tracts is the primary risk factor for neonatal invasive disease. Despite prophylactic intrapartum antibiotic administration to colonized women and improved neonatal intensive care, the incidence and morbidity associated with GBS meningitis have not declined since the 1970s. Among meningitis survivors, a significant number suffer from complex neurological or neuropsychiatric sequelae, implying that the pathophysiology and pathogenic mechanisms leading to brain injury and devastating outcomes are not yet fully understood. It is imperative to develop new therapeutic and neuroprotective approaches aiming at protecting the developing brain. In this review, we provide updated clinical information regarding the understanding of neonatal GBS meningitis, including epidemiology, diagnosis, management, and human evidence of the disease's underlying mechanisms. Finally, we explore the experimental models used to study GBS meningitis and discuss their clinical and physiologic relevance to the complexities of human disease.
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Gao J, Chen Q, Peng Y, Jiang N, Shi Y, Ying C. Copan Walk Away Specimen Processor (WASP) Automated System for Pathogen Detection in Female Reproductive Tract Specimens. Front Cell Infect Microbiol 2021; 11:770367. [PMID: 34869072 PMCID: PMC8635742 DOI: 10.3389/fcimb.2021.770367] [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: 09/03/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Automation is increasingly being applied in clinical laboratories; however, preanalytical processing for microbiology tests and screening is still largely performed using manual methods owing to the complex procedures involved. To promote automation of clinical microbiology laboratories, it is important to assess the performance of automated systems for different specimen types separately. Therefore, the aim of this study was to explore the potential clinical application of the Copan Walk Away Specimen Processor (WASP) automated preanalytical microbiology processing system in the detection of pathogens in female reproductive tract specimens and its feasibility in optimizing diagnostic procedures. Methods Female reproductive tract specimens collected from pregnant women at their first obstetric check-up were inoculated into culture media using the Copan WASP automated specimen processing system and were also cultured using a conventional manual inoculation method. After 48 h of culture, the growth of colonies was observed, and the types of bacteria, number of colonies, and efficiency in isolating single colonies were compared between the automated and manual groups. The specimens collected from the WASP system using the Copan-ESwab sample collection tubes were further analyzed for the presence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Ureaplasmaurealyticum (UU) via fluorescence quantitative polymerase chain reaction (qPCR) and an immunochromatographic assay to investigate the feasibility of this method in optimizing detection of these common pathogens of the female reproductive tract. Results Compared with the manual culture method, the Copan WASP microbiology automation system detected fewer bacterial types (P<0.001) and bacterial colonies (P<0.001) but had a higher detection rate of single colonies (P<0.001). There was no significant difference in the detection rates of common pathogens encountered in clinical obstetrics and gynecology, including group B Streptococcus (GBS) (P=0.575) and Candida (P=0.917), between the two methods. Specimens collected in the Copan-ESwab tubes could be used for screening of GBS and CT via fluorescence-based qPCR but not with immunochromatography. However, UU and NG were not detected in any sample with either method; thus, further validation is required to determine the feasibility of the Copan system for screening these pathogens. Conclusion The Copan WASP microbiology automation system could facilitate the optimization of diagnostic procedures for detecting common pathogens of the female reproductive system, thereby reducing associated costs.
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Affiliation(s)
- Jing Gao
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Qiujing Chen
- Institute of Cardiovascular Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqian Peng
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Nanyan Jiang
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Youhao Shi
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Chunmei Ying
- Department of Clinical Laboratory, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
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Ahmed B, Konje JC. Screening for infections in pregnancy - An overview of where we are today. Eur J Obstet Gynecol Reprod Biol 2021; 263:85-93. [PMID: 34171635 DOI: 10.1016/j.ejogrb.2021.06.002] [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: 05/06/2021] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 12/09/2022]
Abstract
Although most infections in pregnancy have very little impact, some affect either the mother or fetus or both. Screening must target those infections with consequences and furthermore, must be cost-beneficial. The introduction of any screening test for infections should take into consideration the prevalence of the condition, its consequences (health impact), the accuracy of the test and whether there are remedial steps including primary and secondary prevention to take with a positive or negative test. For some of these infections (for example syphilis and rubella) universal screening of all pregnant women has been the norm world-wide but as the epidemiology of these infections continue to change, a review of this practice must evolve. Furthermore, emerging infections line severe acute respiratory syndrome coronavirus-2 pose greater public health challenges. This article provides an overview of screening for infections in pregnancy, critically appraising screening for the common infections and arguing for abandoning of universal screening for rubella but advocating for universal screening for GBS and selective screening for CMV and toxoplasmosis.
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Affiliation(s)
- Badredeen Ahmed
- Feto Maternal Centre, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar; Qatar University, Qatar
| | - Justin C Konje
- Department of Health Sciences, University of Leicester, UK.
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Schmitt C, Novy M, Hascoët JM. Term newborns at risk for early-onset neonatal sepsis: Clinical surveillance versus systematic paraclinical test. Arch Pediatr 2021; 28:117-122. [PMID: 33446431 DOI: 10.1016/j.arcped.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/06/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Early-onset neonatal sepsis is a rare but potentially lethal infection that is very often suspected in daily practice. Previous national guidelines recommended the use of systematic paraclinical tests for healthy term newborns with suspected infection. These guidelines were updated in 2017 by the French Health Authority (Haute Autorité de santé), and promote initial clinical monitoring taking into account the infectious risk level for term and near-term born infants. OBJECTIVES To assess the impact of the new recommendations on antibiotic therapy prescription and invasive tests, and on the outcomes of infants born from 36weeks' gestation. MATERIALS AND METHODS This study compared the management and the outcome of neonates born from 36weeks' gestation at the level III University Hospital of Nancy, according to their infectious risk level during two periods, before and after the update of national recommendations: from July 1 to December 31, 2017, versus July 1 to December 31, 2018. Data were retrospectively collected from the infants' files. This study compared the number and length of antibiotic treatment and the number of invasive tests, the number of documented infections, the number and length of hospitalization, and mortality between the two periods. RESULTS During the first period, among 1248 eligible newborns, 643 presented an infectious risk factor, versus 1152 newborns with 343 having an infectious risk factor during the second period. Antibiotic treatment was initiated for 18 newborns during the first period (1.4%) and for nine during the second (0.8%) (P=0.13). The mean (SD) duration of the antibiotic treatment was longer in the first than in the second period: 6.3±2days vs. 3.1±2.3days (P=0.003). There was no death related to neonatal infection. A total of 1052 blood samples were collected during the first period versus 51 during the second (P<0.01). There was no documented infection. In the first period, there were 18 newborns (1.4%) hospitalized for suspected infection versus nine (0.8%) in the second period (P=0.13). The duration of hospitalization was 5.7±1.7days in the first period versus 5.2±3days in the second (P=0.33). CONCLUSION In this study, the application of the new guidelines enabled a reduction of antibiotic exposure and a reduction of invasive tests without additional risk.
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Affiliation(s)
- C Schmitt
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France.
| | - M Novy
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France
| | - J-M Hascoët
- Neonatal Intensive Care Unit, Maternité Régionale, CHRU Nancy, 54000 Nancy, France; DevAH, Lorraine University, 54000 Nancy, France
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Plainvert C, Anselem O, Joubrel C, Marcou V, Falloukh A, Frigo A, Magdoud El Alaoui F, Ancel PY, Jarreau PH, Mandelbrot L, Goffinet F, Poyart C, Tazi A. Persistence of group B Streptococcus vaginal colonization and prevalence of hypervirulent CC-17 clone correlate with the country of birth: a prospective 3-month follow-up cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:133-140. [PMID: 32812077 DOI: 10.1007/s10096-020-04011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023]
Abstract
To identify factors associated with vaginal colonization and persistence by group B Streptococcus (GBS) and by the hypervirulent neonatal CC-17 clone in late pregnancy and after delivery, a multicentre prospective observational cohort with 3-month follow-up was established in two university hospitals, Paris area, France. Pregnant women were recruited when antenatal screening for GBS vaginal colonization at 34-38 weeks of gestational age was positive. Vaginal samples were analysed by conventional culture methods at antenatal screening, delivery, and 21 and 60 days following delivery. Identification of the hypervirulent neonatal GBS CC-17 was performed. Colonization was defined as persistent when all vaginal samples were positive for GBS. A total of 754 women were included. GBS vaginal colonization was persistent in 63% of the cases (95% CI 59%-67%). Persistent colonization was more likely in women born in Sub-Saharan Africa compared with women born in France (OR = 1.88, 95% CI 1.05-3.52), and GBS CC-17 was overrepresented in women born in Sub-Saharan Africa (OR = 2.09, 95% CI 1.20-3.57). Women born in Sub-Saharan Africa are at higher risk for GBS vaginal persistence than women born in France. This observation correlates with an increased prevalence of the hypervirulent GBS CC-17 in the former group, which likely reflect variations linked to ethnicity and vaginal community-state types and might account for the increased susceptibility of black neonates to GBS infections.
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Affiliation(s)
- Céline Plainvert
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Olivia Anselem
- FHU Prema, Paris, France
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Caroline Joubrel
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Valérie Marcou
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Amiel Falloukh
- Department of Neonatal Medicine, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Amandine Frigo
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Fatma Magdoud El Alaoui
- Department of Microbiology, Louis Mourier Hospital, AP-HP, Colombes, France
- Université de Paris, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
- URC-CIC P1419, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Pierre Henri Jarreau
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Laurent Mandelbrot
- FHU Prema, Paris, France
- Université de Paris, Paris, France
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, AP-HP, Colombes, France
| | - François Goffinet
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
| | - Claire Poyart
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
- Université de Paris, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France.
- FHU Prema, Paris, France.
- Université de Paris, Paris, France.
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Escobar DF, Diaz-Dinamarca DA, Hernández CF, Soto DA, Manzo RA, Alarcón PI, Pinto CH, Bastias DN, Oberg-Bravo CN, Rojas R, Illanes SE, Kalergis AM, Vasquez AE. Development and analytical validation of real-time PCR for the detection of Streptococcus agalactiae in pregnant women. BMC Pregnancy Childbirth 2020; 20:352. [PMID: 32517670 PMCID: PMC7285471 DOI: 10.1186/s12884-020-03038-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal infection. In this study, we aimed to evaluate the analytical validation of qualitative real-time polymerase chain reaction (qPCR) as a means to detect GBS. Methods Genomic DNA (gDNA) was purified from 12 ATCC bacterial strains, two belonging to GBS and the remainder acting as negative controls. Additionally, gDNA was isolated from 21 strains of GBS from various serotypes (Ia, Ib and II-VIII). All gDNA was used to evaluate the analytical validation of the qPCR method employing a specific Taqman probe. Inclusivity, exclusivity, anticipated reportable range, the limit of detection and robustness were evaluated. The methods used are described in international guidelines and other existing reports. The performance of this qPCR method for detecting GBS was compared to other microbiological methods used with vaginal-rectal samples from pregnant women. Results Our qPCR method for detecting GBS was analytically validated. It has a limit of detection of 0.7 GE/μL and 100% analytical specificity. It detects all strains of GBS with the same level of performance as microbiological methods. Conclusion Data suggest that this qPCR method performs adequately as a means to detect GBS in vaginal-rectal swabs from pregnant women.
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Affiliation(s)
- Daniel F Escobar
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego A Diaz-Dinamarca
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos F Hernández
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Químicas y Farmacéuticas, Universidad de Chile, Santos Dumont 964, Independencia, 8380494, Santiago, Chile
| | - Daniel A Soto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Ricardo A Manzo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pedro I Alarcón
- Sección Bacteriología del Departamento Biomédico, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Camila H Pinto
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Diego N Bastias
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile
| | - Carolayn N Oberg-Bravo
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile.,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile
| | - Robert Rojas
- Centro de Genómica y Bioinformática, Universidad Mayor, Santiago, Chile
| | - Sebastián E Illanes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universidad de los Andes, Santiago, Chile.,Department of Obstetrics and Gynecology, Clínica Dávila, Santiago, Chile
| | - Alexis M Kalergis
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Abel E Vasquez
- Sección de Biotecnología, Instituto de Salud Pública de Chile, Santiago, Chile. .,Escuela de Biotecnología y Escuela de Tecnología Médica, Facultad de Ciencias, Universidad Santo Tomas, Santiago, Chile. .,Facultad de Medicina y Ciencia, Universidad San Sebastián, Providencia, Santiago, Chile. .,Present address. Instituto de Salud Pública de Chile, Av. Marathon, Ñuñoa, 1000, Santiago, Chile.
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11
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Choera T, Jung-Hynes B, Chen DJ. Comparative study of Revogene GBS LB assay and GeneXpert GBS LB assay for the detection of group B Streptococcus in prenatal screening samples. BMC Infect Dis 2020; 20:38. [PMID: 31937247 PMCID: PMC6958782 DOI: 10.1186/s12879-019-4756-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 12/30/2019] [Indexed: 11/13/2022] Open
Abstract
Background Group B Streptococcal (GBS) infections in the United States are a leading cause of meningitis and sepsis in newborns. The CDC therefore recommends GBS screening for all pregnant women at 35–37 weeks of gestation and administration of intrapartum prophylaxis (in those that tested positive) as an effective means of controlling disease transmission. Several FDA approved molecular diagnostic tests are available for rapid and accurate detection of GBS in antepartum women. Method In this study, we report a clinical comparison of the Xpert GBS LB assay and a novel FDA-cleared test, Revogene GBS LB assay. A total of 250 vaginal-rectal swabs from women undergoing prenatal screening were submitted to the University of Wisconsin’s clinical microbiology laboratory for GBS testing. Results We found 96.8% of samples were concordant between the two tests, while 3.2% were discordant with a positive percent agreement of 98.0% and a negative percent agreement of 96.5% between the Revogene GBS LB assay and the GeneXpert GBS LB assay. Conclusion Overall, we report that both assays perform well for the detection of GBS colonization in pregnant women.
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Affiliation(s)
- Tsokyi Choera
- Department of Medical Microbiology & Immunology, University of Wisconsin- Madison, 1505 Adams Dr, Menlo Park, CA, 94025, USA
| | - Brittney Jung-Hynes
- Dept. Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 3170 MFCB, 1685 Highland Ave, Madison, WI, 53705, USA
| | - Derrick J Chen
- Dept. Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, 3170 MFCB, 1685 Highland Ave, Madison, WI, 53705, USA.
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12
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Leigh WJ, Zadoks RN, Costa JZ, Jaglarz A, Thompson KD. Development and evaluation of a quantitative polymerase chain reaction for aquatic Streptococcus agalactiae based on the groEL gene. J Appl Microbiol 2020; 129:63-74. [PMID: 31851413 DOI: 10.1111/jam.14556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/23/2019] [Accepted: 12/08/2019] [Indexed: 01/19/2023]
Abstract
AIMS The aim of this study was to develop a TaqMan quantitative polymerase chain reaction (qPCR), based on the Streptococcus agalactiae groEL gene, to specifically quantify levels of bacteria within samples derived from aquatic sources, particularly aquaculture. Enumeration of bacteria by qPCR was compared with culture-based methods. METHODS AND RESULTS The qPCR was sensitive to 33 isolates of S. agalactiae, representing 11 clonal complexes from aquatic, bovine and human hosts. The specificity of the assay was 92·5% at a threshold Cq value of 35. No cross-reaction with Streptococcus iniae was noted and of the 22 comparator species screened to test assay specificity, Streptococcus porcinus had a Cq value of 33·7 S, while Streptococcus gallolyticus subsp. macedonicus and Streptococcus ictaluri had one replicate value above the Cq threshold of 35 (34·5 and 34·4 respectively), while only S. agalactiae were detected with a Cq value of 30. The limit of detection of the assay was 1·7 copies per µl at Cq 35. Discrepancies between molecular and culture-based methods of enumeration were noted. CONCLUSIONS The qPCR was able to detect a diverse range of S. agalactiae isolates from different clonal complexes (CCs) and could distinguish between S. agalactiae and closely related species, notably S. iniae. The results suggest that a Cq 30 would be a very meaningful cut-off, allowing the detection of infected fish while ruling out all false positives. SIGNIFICANCE AND IMPACT OF THE STUDY This rapid and sensitive qPCR assay is useful to quantify DNA copy number in the laboratory and could prove useful for detecting low levels of S. agalactiae in aquaculture systems, including Oreochromis niloticus culture.
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Affiliation(s)
- W J Leigh
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK.,Institute of Biodiversity Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - R N Zadoks
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK.,Institute of Biodiversity Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - J Z Costa
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
| | - A Jaglarz
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
| | - K D Thompson
- Moredun Research Institute, Pentlands Science Park, Penicuik, UK
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13
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Johansen NR, Kjærbye-Thygesen A, Jønsson S, Westh H, Nilas L, Rørbye C. Prevalence and treatment of group B streptococcus colonization based on risk factors versus intrapartum culture screening. Eur J Obstet Gynecol Reprod Biol 2019; 240:178-181. [DOI: 10.1016/j.ejogrb.2019.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
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14
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Mu X, Zhao C, Yang J, Wei X, Zhang J, Liang C, Gai Z, Zhang C, Zhu D, Wang Y, Zhang L. Group B Streptococcus colonization induces Prevotella and Megasphaera abundance-featured vaginal microbiome compositional change in non-pregnant women. PeerJ 2019; 7:e7474. [PMID: 31440433 PMCID: PMC6699484 DOI: 10.7717/peerj.7474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 07/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Previous studies have indicated that variations in the vaginal microbiome result in symptomatic conditions. Group B Streptococcus (GBS) is a significant neonatal pathogen and maternal vaginal colonization has been recognized as an important risk factor for neonatal disease. Therefore, it is important to discover the relationship between the composition of the vaginal microbiome and GBS colonization. This study explores the potential relationship between the composition of the vaginal microbiome and GBS colonization in non-pregnant Chinese women. Methods A total of 22 GBS-positive, non-pregnant women and 44 matched GBS-negative women were recruited for the current study. The composition of the vaginal microbiome was profiled by sequencing the 16S rRNA genes. The microbiome diversity and variation were then evaluated. Results The vaginal microbiome of the 66 subjects enrolled in the current study were compared and the results showed that GBS-positive women exhibited significant vaginal microbial differences compared with the GBS-negative women based on the analysis of similarities (r = 0.306, p < 0.01). The relative abundance of the bacterial genus Lactobacillus (p < 0.01) was significantly lower in the GBS-positive group, while the abundances of the bacterial genera Prevotella (p < 0.01), Megasphaera (p < 0.01), and Streptococcus (p < 0.01) were significantly higher in the GBS-positive group. Discussion The current study addressed significant variations across the communities of the vaginal microbiome in GBS-positive and GBS-negative women in a Chinese cohort, which paves the way for a larger cohort-based clinical validation study and the development of therapeutic probiotics in the future.
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Affiliation(s)
- Xiaofeng Mu
- Tianjin University, Academy of Medical Engineering and Translational Medicine, Tianjin, China.,Clinical Laboratory and Core Research Laboratory; Qingdao Human Microbiome Center & Qingdao Institute of Oncology, The Affiliated Central Hospital of Qingdao University, Qingdao, China.,School of Precision Instruments and Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Changying Zhao
- Shandong Children's Microbiome Center, Qilu Children's Hospital of Shandong University, Jinan, China.,Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Junjie Yang
- College of Life Science, Qilu Normal University, Jinan, China
| | - Xiaofang Wei
- Clinical Laboratory and Core Research Laboratory; Qingdao Human Microbiome Center & Qingdao Institute of Oncology, The Affiliated Central Hospital of Qingdao University, Qingdao, China
| | - Jiaming Zhang
- School of Basic Medical Sciences, Shandong University, Jinan, China
| | - Cheng Liang
- School of Information Science and Engineering, Shandong Normal University, Jinan, China
| | - Zhongtao Gai
- Shandong Children's Microbiome Center, Qilu Children's Hospital of Shandong University, Jinan, China.,Research Institute of Pediatrics, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Chunling Zhang
- Clinical Laboratory and Core Research Laboratory; Qingdao Human Microbiome Center & Qingdao Institute of Oncology, The Affiliated Central Hospital of Qingdao University, Qingdao, China
| | - Dequan Zhu
- Microbiological Laboratory; Department of Infection Management; Department of Neurosurgery, Lin Yi People's Hospital, Linyi, China
| | - Ye Wang
- Clinical Laboratory and Core Research Laboratory; Qingdao Human Microbiome Center & Qingdao Institute of Oncology, The Affiliated Central Hospital of Qingdao University, Qingdao, China
| | - Lei Zhang
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University, Beijing, China
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15
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Subramaniam A, Blanchard CT, Ngek ESN, Mbah R, Welty E, Welty T, Dionne-Odom J, Sander M, Halle-Ekane G, Tita ATN. Prevalence of group B streptococcus anogenital colonization and feasibility of an intrapartum screening and antibiotic prophylaxis protocol in Cameroon, Africa. Int J Gynaecol Obstet 2019; 146:238-243. [PMID: 31127871 DOI: 10.1002/ijgo.12870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/10/2019] [Accepted: 05/23/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate group B streptococcus (GBS) colonization prevalence and feasibility of intrapartum GBS screening/antibiotic prophylaxis (IAP) in Cameroon, Africa. METHODS Prospective cohort in the Cameroon Baptist Convention Health Services network. Maternity providers collected anogenital swabs from consenting term women in labor for testing by a rapid GBS-polymerase chain reaction (PCR) system. Positive tests (GBS+) resulted in initiation of intravenous ampicillin until delivery. Primary outcomes were GBS prevalence and proportion of GBS+ women receiving ampicillin before delivery and more than 4 hours before delivery. RESULTS A total of 219 women were enrolled from January 10 to April 27, 2017. GBS prevalence was 12.3% (95% confidence interval [CI] 7.9-16.7) with GBS+ women more likely to reside in urban areas (19.6% vs 9.7%, P=0.004). Of 27 GBS+ women, 19 (70.4%) received ampicillin before delivery and 14 (51.9%) 4 hours or longer before delivery. A median two doses of ampicillin (interquartile range [IQR] 1-5) were given and started at a median of 105 minutes (IQR 90-155) after swab collection and 20 minutes (IQR 10-45) after GBS result. Of the 8 women who did not receive ampicillin, 7 (87.5%) delivered before test results. CONCLUSION A GBS IAP protocol is feasible in Cameroon and should be evaluated for widespread implementation in Cameroon and other low-income countries to decrease GBS-related morbidity.
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Affiliation(s)
- Akila Subramaniam
- Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Rahel Mbah
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Edith Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Thomas Welty
- Cameroon Baptist Convention Health Services, Bamenda, Cameroon
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melissa Sander
- Bamenda Center for Health Promotion and Research, Bamenda, Cameroon
| | | | - Alan T N Tita
- Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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- Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Comparison of Three Nucleic Acid Amplification Tests and Culture for Detection of Group B Streptococcus from Enrichment Broth. J Clin Microbiol 2019; 57:JCM.01958-18. [PMID: 30944190 PMCID: PMC6535594 DOI: 10.1128/jcm.01958-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/16/2019] [Indexed: 12/17/2022] Open
Abstract
Colonization of the gastrointestinal and genitourinary tracts of pregnant women with group B Streptococcus (GBS) can result in vertical transmission to neonates during labor/delivery. GBS infections in neonates can cause severe complications, such as sepsis, meningitis, and pneumonia. Accurate detection is critical because administration of intrapartum antibiotics can significantly reduce transmission. We compared the clinical sensitivities of three nucleic acid amplification tests (NAATs), the Hologic Panther Fusion GBS, Luminex Aries GBS, and Cepheid Xpert GBS LB assays, to that of the standard of care culture method recommended for GBS screening using 500 vaginal-rectal swab specimens after 18 to 24 h of broth enrichment. We identified 108 positive specimens (21.6%) by culture, while at least 1 of the 3 NAATs was positive for GBS in 155 specimens (31.0%). All 108 specimens positive by culture were also detected by the Panther Fusion assay, while 107/108 (99.1%) were detected by the Cepheid Xpert and Luminex Aries assays. Of the 61 specimens positive by at least 1 NAAT but negative by culture, 24 (39.3%) were positive by all 3 NAATs, suggesting that they represent true positives (TPs). NAATs offer less hands-on time, greater throughput, faster time to result, and potentially greater sensitivity than culture methods, and they should be considered the new gold standard for intrapartum GBS screening.
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17
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Comparison of BD MAX GBS and GenomEra GBS assays for rapid intrapartum PCR detection of vaginal carriage of group B streptococci. PLoS One 2019; 14:e0215314. [PMID: 30990861 PMCID: PMC6467400 DOI: 10.1371/journal.pone.0215314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/29/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To compare the diagnostic performance of BD MAX and GenomEra PCR assays for a rapid PCR detection of vaginal carriage of group B streptococci at delivery. Methods This is a retrospective laboratory analysis of vaginal swab samples taken intrapartum from a randomly selected cohort of pregnant women giving birth at a single childbirth and maternity unit. Results Ninety-one culture-positive and 279 culture-negative vaginal samples were included from a cohort of 902 women. One-hundred-and-two specimens were found positive with the BD MAX and 84 with the GenomEra PCR assay. No statistically significant difference was observed compared to culture, sensitivity of BD MAX 84.6% (77/91) [95%CI 75.5–91.3] and of GenomEra 71.4% (65/91) [95%CI 61.0–80.4]. When compared to a combined reference standard, no statistically significant differences were seen between culture, BD MAX and GenomEra PCR assays. The sensitivities were 82.7% (91/110) [95%CI 74.3–89.3], 87.3% (96/110) [95%CI 79.6–92.9], and 79.1% (87/110) [95%CI 70.3–86.3], respectively. Conclusion Both PCR assays performed comparably to culture of the intrapartum vaginal samples. In particular, the GenomEra assay is potentially an easy and rapid on-site PCR test for intrapartum detection of vaginal carriage of group B streptococci at a maternity ward to identify women who should receive intrapartum antibiotic prophylaxis.
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18
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Streptococcus agalactiae Strains with Chromosomal Deletions Evade Detection with Molecular Methods. J Clin Microbiol 2019; 57:JCM.02040-18. [PMID: 30760532 DOI: 10.1128/jcm.02040-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/03/2019] [Indexed: 01/28/2023] Open
Abstract
Surveillance of circulating microbial populations is critical for monitoring the performance of a molecular diagnostic test. In this study, we characterized 31 isolates of Streptococcus agalactiae (group B Streptococcus [GBS]) from several geographic locations in the United States and Ireland that contain deletions in or adjacent to the region of the chromosome that encodes the hemolysin gene cfb, the region targeted by the Xpert GBS and GBS LB assays. PCR-negative, culture-positive isolates were recognized during verification studies of the Xpert GBS assay in 12 laboratories between 2012 and 2018. Whole-genome sequencing of 15 GBS isolates from 11 laboratories revealed four unique deletions of chromosomal DNA ranging from 181 bp to 49 kb. Prospective surveillance studies demonstrated that the prevalence of GBS isolates containing deletions in the convenience sample was <1% in three geographic locations but 7% in a fourth location. Among the 15 isolates with chromosomal deletions, multiple pulsed-field gel electrophoresis types were identified, one of which appears to be broadly dispersed across the United States.
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19
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Spiel MH, Hacker MR, Haviland MJ, Mulla B, Roberts E, Dodge LE, Young BC. Racial disparities in intrapartum group B Streptococcus colonization: a higher incidence of conversion in African American women. J Perinatol 2019; 39:433-438. [PMID: 30635596 PMCID: PMC6391200 DOI: 10.1038/s41372-018-0308-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/18/2018] [Accepted: 10/24/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To compare the incidence of group B Streptococcus (GBS) conversion from a negative antepartum to a positive intrapartum culture among women who self-identify as non-Hispanic black, Hispanic, or non-Hispanic white. STUDY DESIGN This was a prospective cohort study of women with a negative rectovaginal GBS culture obtained within 35 days of enrollment. An intrapartum rectovaginal swab was collected and cultured for GBS. Data were compared with chi-square, Fisher's exact, or Wilcoxon rank-sum test. Modified Poisson regression was used. RESULTS We enrolled 737 women; 75.4% were non-Hispanic white, 17.6% were non-Hispanic black, and 6.9% were Hispanic. Non-Hispanic black women were more likely to convert to GBS positive than non-Hispanic white women, 9.2% as compared to 5.3% (RR: 2.0; 95% CI: 1.02-3.8). CONCLUSION The increased incidence of positive intrapartum GBS cultures among non-Hispanic black women suggests that non-Hispanic black race is a risk factor for GBS conversion in the late third trimester.
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Affiliation(s)
- Melissa H Spiel
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Michele R Hacker
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Miriam J Haviland
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Bethany Mulla
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Roberts
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Laura E Dodge
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Brett C Young
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA, USA.
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20
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Virranniemi M, Raudaskoski T, Haapsamo M, Kauppila J, Renko M, Peltola J, Risteli L, Laatio L. The effect of screening-to-labor interval on the sensitivity of late-pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study. Acta Obstet Gynecol Scand 2019; 98:494-499. [DOI: 10.1111/aogs.13522] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 12/08/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Minna Virranniemi
- PEDEGO Research Center; University of Oulu and Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Tytti Raudaskoski
- PEDEGO Research Center; University of Oulu and Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
| | - Mervi Haapsamo
- Department of Obstetrics & Gynecology; Rovaniemi Central Hospital; Rovaniemi Finland
| | - Jaana Kauppila
- Department of Clinical Microbiology; Northern Finland Laboratory Center; Oulu Finland
| | - Marjo Renko
- PEDEGO Research Center; University of Oulu and Department of Children and Adolescents; Oulu University Hospital; Oulu Finland
- Tampere Center for Child Health Research; University of Tampere and Tampere University Hospital; Tampere Finland
| | | | - Leila Risteli
- Department of Clinical Chemistry; Northern Finland Laboratory Center; Oulu Finland
| | - Liisa Laatio
- PEDEGO Research Center; University of Oulu and Department of Obstetrics and Gynecology; Oulu University Hospital; Oulu Finland
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21
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Zhu Y, Huang J, Lin XZ, Chen C. Group B Streptococcus Colonization in Late Pregnancy and Invasive Infection in Neonates in China: A Population-Based 3-Year Study. Neonatology 2019; 115:301-309. [PMID: 30808831 DOI: 10.1159/000494133] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND As no population-based studies of group B Streptococcus (GBS) colonization rates in late pregnancy (at 35-37 weeks of gestation) have been conducted in China, the incidence of and risk factors for neonatal early-onset GBS disease (GBS-EOD) in China remains poorly understood. OBJECTIVES To determine the GBS colonization rate in late pregnancy and neonatal GBS infection in Xiamen, China, and to assess the effectiveness of intrapartum antibiotic prophylaxis (IAP) for the prevention of neonatal GBS-EOD. METHODS A total of 49,908 pregnant women were enrolled between April 1, 2014 and March 31, 2017. Bacterial culture was used to diagnose GBS infection in both pregnant women and neonates. Women with GBS colonization received IAP during parturition or rupture of fetal membranes. RESULTS The GBS colonization rate was 13.89% (6,933/49,908); 50,772 neonates were born to 49,908 pregnant women, of whom 75 (1.48 per 1,000) were diagnosed with GBS-EOD. The incidence of GBS-EOD among neonates born to GBS-positive mothers (8.77‰; 62/7,068) was 29 times higher than that of neonates born to GBS-negative mothers (0.30‰; 13/43,704). Logistic regression analysis indicated that gestational bacteriuria, GBS disease in infants from previous pregnancies, and chorioamnionitis were risk factors for GBS-EOD (p = 0.007, p = 0.000, and p = 0.018, respectively). IAP effectively protected against neonatal GBS-EOD (p = 0.011). CONCLUSIONS GBS colonization was detected in nearly 14% of late pregnant women. The IAP for reducing GBS-EOD was effective. Therefore, universal screening of maternal GBS and subsequent IAP for those with GBS colonization should be implemented in China.
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Affiliation(s)
- Yao Zhu
- Department of Neonatology, Maternal and Child Care Hospital of Xiamen, Xiamen, China
| | - Jing Huang
- Department of Neonatology, Maternal and Child Care Hospital of Xiamen, Xiamen, China
| | - Xin-Zhu Lin
- Department of Neonatology, Maternal and Child Care Hospital of Xiamen, Xiamen, China,
| | - Chao Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Fay K, Almendares O, Robinson-Dunn B, Schrag S. Antenatal and intrapartum nucleic acid amplification test use for group B Streptococcus screening-United States, 2016. Diagn Microbiol Infect Dis 2018; 94:157-159. [PMID: 30642719 DOI: 10.1016/j.diagmicrobio.2018.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/29/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
Perinatal group B Streptococcus (GBS) disease prevention guidelines in 2010 allowed for processing of screening specimens by nucleic acid amplification tests (NAATs); however, the extent of NAAT use is unknown. A 2016 laboratory survey sent to 10 surveillance sites found that 18.7% of responding laboratories offered NAAT for GBS screening (antenatal only: 7.3%; intrapartum only: 4.1%; both: 3.4%).
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Affiliation(s)
- Katherine Fay
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Olivia Almendares
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
| | - Barbara Robinson-Dunn
- Department of Clinical Pathology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI, 48073, USA.
| | - Stephanie Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30329, USA.
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23
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Hu S, Zhong H, Huang W, Zhan W, Yang X, Tang B, Chen K, Wang J, Hu T, Zhang C, Zhou Z, Luo M. Rapid and visual detection of Group B streptococcus using recombinase polymerase amplification combined with lateral flow strips. Diagn Microbiol Infect Dis 2018; 93:9-13. [PMID: 30122509 DOI: 10.1016/j.diagmicrobio.2018.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/17/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
Abstract
Conventional culture method for detecting Group B streptococcus (GBS), a common pathogen of neonatal meningitis and sepsis, is time-consuming and unsensitive. Even though real-time fluorescence PCR-based molecular method is more accurate, it need special instrument and elaborate protocol. Here, we established a novel molecular method combining recombinase polymerase amplification with lateral flow strips for detecting GBS. The cAMP factor (cfb) gene is a highly specific and sensitive biomarker to identify GBS and is detectable by using 100 genomic copies as the amplification template. Clinical performance of this assay was evaluated by testing 130 samples, in comparison with culture method and real-time fluorescence PCR, and the results achieved 100% accuracy, which were the same with those of real-time fluorescence PCR, and were better than those of culture method with false-negative detection. This study provides a rapid and visual method, with clinical potential, for the detection of GBS infection of patients.
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Affiliation(s)
- Siqi Hu
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China
| | - Huamin Zhong
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Weiwei Huang
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wenli Zhan
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaohan Yang
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Bin Tang
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Keyi Chen
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jicheng Wang
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Tingting Hu
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Changbin Zhang
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China
| | - Zhenwen Zhou
- Clinical Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Mingyong Luo
- Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou Medical University, Guangzhou, China; Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, China.
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24
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Carrillo-Ávila JA, Gutiérrez-Fernández J, González-Espín AI, García-Triviño E, Giménez-Lirola LG. Comparison of qPCR and culture methods for group B Streptococcus colonization detection in pregnant women: evaluation of a new qPCR assay. BMC Infect Dis 2018; 18:305. [PMID: 29976153 PMCID: PMC6034337 DOI: 10.1186/s12879-018-3208-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 06/25/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Streptococcus Group B (GBS) colonization in pregnant women is the most important risk factor for newborn disease due to vertical transmission during delivery. GBS colonization during pregnancy has been implicated as a leading cause of perinatal infections. Traditionally, pregnant women are screened for GBS between 35 and 37 weeks of gestation. However, antenatal culture-based screening yields no information on GBS colonization status and offers low predictive value for GBS colonization at delivery. Numerous assays have been evaluated for GBS screening in an attempt to validate a fast and efficient method. The aim of this study was to compare bacteria isolation by culture and two qPCR techniques, targeting sip and cfb genes, respectively, for detecting colonizing GBS. METHODS Cultures - the gold-standard technique, a previous qPCR technique targeting the sip gene, and a new proposed qPCR assay targeting the cfb gene were evaluated as diagnostic tools on 320 samples. RESULTS Considering cultures as the gold standard, the evaluated qPCR method detected 75 out of 78 samples, representing a sensitivity of 93.58% (95% confidence interval (CI), 90.89-96.27) and specificity of 94.62% (95% CI, 91.78-97.46). However, an additional analysis was performed for true positives that included not only samples showing positives by culture but samples showing positive for both qPCR assays. The sensitivity and specificity were recalculated including these discrepant samples and a total of 89 samples were considered as positive, giving a prevalence of 27.81%. With this new analysis, the qPCR targeting the cfb gene showed a sensitivity of 95.5% (95% CI, 88.65-98.59) and specificity of 99.13% (95% CI, 96.69-99.97). CONCLUSIONS The new qPCR method is a sensitive and specific assay for detecting GBS colonization and represents a valuable tool for identifying candidates for intrapartum antibiotic prophylaxis. Cultures should be retained as the reference and the routine technique because of its specificity and cost analysis ratio, but it would be convenient to introduce PCR techniques to check negative culture samples or when an urgent detection is required to reduce risk of infection among infants.
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Affiliation(s)
- J. A. Carrillo-Ávila
- Laboratorio de Microbiología, Universidad de Granada-Instituto de Investigación Biosanitaria de Granada, Av. de la Investigación n°11, 18071 Granada, Spain
| | - J. Gutiérrez-Fernández
- Laboratorio de Microbiología, Universidad de Granada, Hospital General Virgen de las Nieves- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - A. I. González-Espín
- Hospital Materno Infantil de Jaén, Avenida de Ejército Español s/n, 23007 Jaén, Spain
| | - E. García-Triviño
- Hospital Materno Infantil de Jaén, Avenida de Ejército Español s/n, 23007 Jaén, Spain
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25
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Chang FW, Lee CI, Fan HC, Su HY, Liu YL, Chen CY. The impact of prenatal group B streptococcus screening as a national health policy in Taiwan. Taiwan J Obstet Gynecol 2018; 56:648-651. [PMID: 29037552 DOI: 10.1016/j.tjog.2017.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE There was no national data on group B streptococcus (GBS) infections in Taiwan. Until 2012, when prenatal GBS screening was introduced to obstetric practices as a national health policy aimed at reducing neonatal GBS infections. The purpose of this study was to examine the impact of this national health policy on the incidence of maternal GBS colonization and neonatal GBS infection rate. Relatedly, the clinical characteristics of neonatal GBS infection were investigated to determine the correlations between the incidence of maternal GBS colonization and the neonatal GBS infection rate. MATERIALS AND METHODS This population-based nationwide study used data for 2012-2013 from the National Health Insurance Research Database of Taiwan. A total of 789 newly diagnosed pregnant women with genital GBS infection were recruited. RESULTS The maternal GBS screening rate was 93.2%. The maternal colonization rate of GBS was around 8.2%, and the incidence of neonatal GBS infection was 22.6%. The data indicate that no sepsis was developed in any of the cases, while fever was found in 3 cases (3/179, 1.7%) and UTI was found in 1 case (1/179, 0.6%). CONCLUSIONS We conclude that a policy calling for universal maternal rectovaginal cultures for GBS with intrapartum antibiotic prophylaxis is a good national policy for reducing morbidity due to GBS infections in neonates in Taiwan.
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Affiliation(s)
- Fung-Wei Chang
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC; Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chun-I Lee
- Department of Obstetrics and Gynecology, Chung-Shan Medical University Hospital, Taichung, Taiwan, ROC
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Wuchi, Taichung, Taiwan, ROC; Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Wuchi, Taichung, Taiwan, ROC; Department of Nursing, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC
| | - Her-Young Su
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yung-Liang Liu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cheng-Yu Chen
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan, ROC.
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26
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Feuerschuette OHM, Silveira SK, Cancelier ACL, da Silva RM, Trevisol DJ, Pereira JR. Diagnostic yield of real-time polymerase chain reaction in the diagnosis of intrapartum maternal rectovaginal colonization by group B Streptococcus: a systematic review with meta-analysis. Diagn Microbiol Infect Dis 2018; 91:99-104. [PMID: 29454653 DOI: 10.1016/j.diagmicrobio.2018.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/06/2018] [Accepted: 01/17/2018] [Indexed: 11/17/2022]
Abstract
Group B Streptococcus is the leading etiologic factor of neonatal sepsis. Intrapartum real-time polymerase chain reaction (RT-PCR) may allow faster and more accurate detection of maternal colonization. The aim of this study was to determine the sensitivity and specificity of RT-PCR when compared to the reference standard culture in selective broth media collected from rectovaginal tract from laboring women. We selected 15 studies that included 6368 women. Papers selection, data extraction, and quality assessment were carried out by two independent researchers. The prevalence of maternal colonization was 23.8% by RT-PCR and 22.1% by culture. The meta-analysis demonstrated an RT-PCR sensitivity of 93.7% (CI 92.1-95.3), and specificity of 97.6% (CI 97.0-98.1). This result is above the cutoff point defined by the Centers for Disease Control and Prevention for clinical usefulness. In conclusion, RT-PCR for GBS screening in labor ward is a promising tool; however, further well-designed studies to justify its use are needed.
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Affiliation(s)
- Otto Henrique May Feuerschuette
- Programa de Pós-graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina UNISUL, Av. José Acácio Moreira, 787 - Dehon, Tubarão, SC, Brazil, CEP-88704-900; Hospital Universitário Ernani Polydoro São Thiago HU-UFSC, Universidade Federal de Santa Catarina, R. Profa. Maria Flora Pausewang, s/n - Trindade, Florianópolis-SC, Brazil, CEP-88036-800.
| | - Sheila Koettker Silveira
- Hospital Universitário Ernani Polydoro São Thiago HU-UFSC, Universidade Federal de Santa Catarina, R. Profa. Maria Flora Pausewang, s/n - Trindade, Florianópolis-SC, Brazil, CEP-88036-800.
| | - Ana Carolina Labor Cancelier
- Programa de Pós-graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina UNISUL, Av. José Acácio Moreira, 787 - Dehon, Tubarão, SC, Brazil, CEP-88704-900.
| | - Rosemeri Maurici da Silva
- Programa de Pós-Graduação em Ciências Médicas, UFSC, Universidade Federal de Santa Catarina, R. Profa. Maria Flora Pausewang, s/n - Trindade, Florianópolis-, SC, Brazil, CEP- 88036-800.
| | - Daisson José Trevisol
- Programa de Pós-graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina UNISUL, Av. José Acácio Moreira, 787 - Dehon, Tubarão, SC, Brazil, CEP-88704-900.
| | - Jefferson Ricardo Pereira
- Programa de Pós-graduação em Ciências da Saúde, Universidade do Sul de Santa Catarina UNISUL, Av. José Acácio Moreira, 787 - Dehon, Tubarão, SC, Brazil, CEP-88704-900.
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Intrapartum group B Streptococcus screening in the labor ward by Xpert® GBS real-time PCR. Eur J Clin Microbiol Infect Dis 2017; 37:265-270. [PMID: 29082442 DOI: 10.1007/s10096-017-3125-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
Group B Streptococcus (GBS) is the leading cause of neonatal infections in industrialized countries. Intrapartum antibiotic prophylaxis (IAP) given to colonized parturients is a key step for the prevention of neonatal early-onset infection. We compared the performances of Xpert® GBS polymerase chain reaction (PCR) (Cepheid, Sunnyvale, CA, USA) as a point-of-care system in labor wards to standard culture for intrapartum GBS detection. Pregnant women with a GBS-positive antenatal screening were prospectively included. A vaginal double swab was collected at the time of delivery for point-of-care Xpert® GBS PCR and GBS culture. A total of 565 pregnant women were included. Valid Xpert® GBS results were obtained for 488 (86.4%) women on the first attempt. Repeat testing improved the PCR success to 516 (91.3%) women. Among the 305 women positive for GBS by culture at delivery, only 238 (78.0%) were positive by Xpert® GBS PCR, cycle thresholds being correlated to culture quantification. Among 260 women negative for GBS culture, 56 (21.5%) were positive by Xpert® GBS PCR, including 50 where IAP was initiated before vaginal sampling. Overall, among the 565 women with GBS antenatal positive culture, only 335 (59.3%) were still positive at delivery whatever the technique used, resulting in unnecessary IAP for 40% of them. This large cohort study comparing intrapartum to antepartum GBS detection provides evidence that (i) Xpert® GBS PCR might be a valuable solution for intrapartum GBS detection compared to culture-based strategies and (ii) laboratory training of non-specialized staff is mandatory to reach the performances required for point-of-care tests.
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28
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Cho CY, Tang YH, Chen YH, Wang SY, Yang YH, Wang TH, Yeh CC, Wu KG, Jeng MJ. Group B Streptococcal infection in neonates and colonization in pregnant women: An epidemiological retrospective analysis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 52:265-272. [PMID: 28882582 DOI: 10.1016/j.jmii.2017.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/03/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Group B Streptococcus (GBS) infection is one of the major causes of neonatal morbidity and mortality. Universal GBS screening with intrapartum antibiotic prophylaxis (IAP) in pregnant women were initiated in 2012 in Taiwan. This study aimed to analyze the most recent maternal GBS colonization rate and the changes in neonatal GBS infection rate from 2011 to 2016. METHODS All pregnant women and their live born neonates between January 2011 and June 2016 were retrospectively reviewed. Whether GBS screening was done, screening results, presence of risk factors, the use of antibiotics, and neonatal outcome were analyzed. In addition, hospitalized neonates diagnosed with GBS infections were retrieved for comparison of early onset disease (EOD) (<7 days) and late onset disease (LOD) (≥7 days). RESULTS A total of 9535 women delivered babies during the study period. The maternal GBS screening rate was 71.0% and the colonization rate was 22.6%. The overall neonatal invasive GBS infection rate was 0.81 per 1000 live births and the vertical transmission rate was 1.2%. After 2012, the invasive neonatal GBS infection rate declined from 1.1-1.6‰ to 0.6-0.7‰ in 2014 and thereafter, the GBS EOD incidence rate declined from 2.8‰ to 0.0-0.6‰, but the LOD incidence rate remained approximately 0.7‰. Infants with EOD had strong association with obstetric risk factors. CONCLUSIONS Taiwan's universal GBS screening with IAP program reduced the incidence rate of neonatal GBS EOD to be lower than 1‰ after 2012. Pediatricians still should pay attention to infants with GBS LOD since its incidence rate remained unchanged.
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Affiliation(s)
- Ching-Yi Cho
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Pediatric Infectious Disease, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsuan Tang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Hsuan Chen
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Szu-Yao Wang
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Hsin Yang
- School of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ting-Hao Wang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chang-Ching Yeh
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Keh-Gong Wu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Pediatric Infectious Disease, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Mei-Jy Jeng
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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29
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Ramesh Babu S, McDermott R, Farooq I, Le Blanc D, Ferguson W, McCallion N, Drew R, Eogan M. Screening for group B Streptococcus (GBS) at labour onset using PCR: accuracy and potential impact - a pilot study. J OBSTET GYNAECOL 2017; 38:49-54. [PMID: 28764569 DOI: 10.1080/01443615.2017.1328490] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This pilot study assessed the diagnostic accuracy and potential impact of a rapid PCR-based screening test for the detection of group B Streptococcus (GBS) at the onset of labour for the purpose of optimising intrapartum antibiotic prophylaxis (IAP). Vaginal and rectal swabs from a convenience sample of 158 women were analysed by conventional broth-enriched culture and a rapid PCR test. Overall, GBS carriage was 18.98% by culture and 19.62% by PCR. PCR for the detection of GBS had a sensitivity of 93.1%, specificity of 96.67% and area under the curve (AUC) of 0.95. Only 19.3% GBS-positive women received IAP. Three-fourths of babies born to GBS-positive mothers did not receive surveillance for early-onset GBS disease. Of the women who received IAP, only 32.5% were GBS carriers. Seventy-four percent of the GBS-positive mothers delivered more than 5 h after recruitment, which gives adequate swab to delivery interval for appropriate antibiotic prophylaxis in labour. Impact statement What is already known about this subject: Appropriate intra-partum treatment of colonized mothers reduces the risk of GBS transmission to neonates. Universal ante partum screening of pregnant women or IAP based on risk factors in labour for GBS prevention fail to accurately identify and treat the woman who actually harbors GBS in the birth canal in labour. A PCR based rapid test, allows for real-time assessment of GBS carriage in labour. WHAT THIS STUDY ADDS This study highlights the fact that a large number of GBS carriers in labour, who could potentially infect their babies, do not receive IAP, and most of their babies do not receive added surveillance in the neonatal period for EOGBS disease. It also confirms that PCR testing at onset of labour is a highly sensitive and reliable test that identifies the women who are GBS carriers in labour and hence need IAP. What the implications are of these findings for clinical practice and/or further research: Timely provision of IAP for the appropriate woman is possible by adopting universal GBS screening at the onset of labor using GBS-PCR. This would involve additional costs to health care facilities and added work to laboratory personnel.
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Affiliation(s)
- Sandhya Ramesh Babu
- a Department of Obstetrics and Gynaecology , Rotunda Hospital , Dublin , Ireland
| | - Rachel McDermott
- a Department of Obstetrics and Gynaecology , Rotunda Hospital , Dublin , Ireland
| | - Irum Farooq
- a Department of Obstetrics and Gynaecology , Rotunda Hospital , Dublin , Ireland
| | - David Le Blanc
- b Department of Laboratory Medicine , Rotunda Hospital , Dublin , Ireland
| | - Wendy Ferguson
- c Department of Neonatology , Rotunda Hospital , Dublin , Ireland
| | - Naomi McCallion
- c Department of Neonatology , Rotunda Hospital , Dublin , Ireland
| | - Richard Drew
- d Department of Microbiology , Rotunda Hospital , Dublin , Ireland.,e Irish Meningitis and Sepsis Reference Laboratory , Temple Street Children's University Hospital , Dublin , Ireland.,f Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Maeve Eogan
- a Department of Obstetrics and Gynaecology , Rotunda Hospital , Dublin , Ireland
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30
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Intrapartum PCR assay versus antepartum culture for assessment of vaginal carriage of group B streptococci in a Danish cohort at birth. PLoS One 2017; 12:e0180262. [PMID: 28678829 PMCID: PMC5497980 DOI: 10.1371/journal.pone.0180262] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/13/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to compare the performances of two strategies for predicting intrapartum vaginal carriage of group B streptococci (GBS). One strategy was based on an antepartum culture and the other on an intrapartum polymerase chain reaction (PCR). We conducted a prospective observational study enrolling 902 pregnant women offered GBS screening before delivery by two strategies. The Culture-strategy was based on vaginal and rectal cultures at 35–37 weeks’ gestation, whereas the PCR-strategy was based on PCR assay on intrapartum vaginal swab samples. An intrapartum vaginal culture for GBS was used as the reference standard from which the performances of the 2 strategies were evaluated. The reference standard showed a GBS-prevalence of 12%. The culture-strategy performed with a sensitivity of 82%, specificity of 91%, positive predictive value (PPV) of 55%, negative predictive value (NPV) of 98%, and Likelihood ratio (LH+) of 9.2. The PCR-strategy showed corresponding values as sensitivity of 83%, specificity of 97%, PPV of 78%, NPV of 98%, and LH+ of 27.5. We conclude that in a Danish population with a low rate of early-onset neonatal infection with GBS, the intrapartum PCR assay performs better than the antepartum culture for identification of GBS vaginal carriers during labor.
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31
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Cools P, Melin P. Group B Streptococcus and perinatal mortality. Res Microbiol 2017; 168:793-801. [PMID: 28435137 DOI: 10.1016/j.resmic.2017.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 12/12/2022]
Abstract
The World Health Organization estimates that every year, one million neonatal deaths occur because of neonatal infection. Furthermore, an equal number of stillbirths are thought to be caused by infections. Here we discuss the role of Streptococcus agalactiae (group B Streptococcus, GBS) in neonatal disease and stillbirth.
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Affiliation(s)
- Piet Cools
- Laboratory Bacteriology Research, Department of Microbiology, Immunology and Clinical Chemistry, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Pierrette Melin
- Clinical Microbiology, National Reference Centre for Streptococcus agalactiae, University Hospital of Liège, Faculty of Medicine, Liege University, Liège, Belgium
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32
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McKenna JP, Cox C, Fairley DJ, Burke R, Shields MD, Watt A, Coyle PV. Loop-mediated isothermal amplification assay for rapid detection of Streptococcus agalactiae (group B streptococcus) in vaginal swabs - a proof of concept study. J Med Microbiol 2017; 66:294-300. [PMID: 28126051 DOI: 10.1099/jmm.0.000437] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Neonatal sepsis caused by Streptococcus agalactiae [group B streptococcus (GBS)] is a life-threatening condition, which is preventable if colonized mothers are identified and given antibiotic prophylaxis during labour. Conventional culture is time consuming and unreliable, and many available non-culture diagnostics are too complex to implement routinely at point of care. Loop-mediated isothermal amplification (LAMP) is a method that, enables the rapid and specific detection of target nucleic acid sequences in clinical materials without the requirement for extensive sample preparation. METHODOLOGY A prototype LAMP assay targeting GBS sip gene is described. RESULTS The assay was 100 % specific for GBS, with a limit of detection of 14 genome copies per reaction. The clinical utility of the LAMP assay for rapid direct molecular detection of GBS was determined by testing a total of 157 vaginal swabs with minimal sample processing using a rapid lysis solution. Compared to a reference quantitative real-time PCR assay, the direct LAMP protocol had a sensitivity and specificity of 95.4 and 100 %, respectively, with positive and negative predictive values of 100 and 98.3 %, respectively. Positive and negative likelihood ratios were infinity and 0.05, respectively. The direct LAMP method required a mean time of 45 min from the receipt of a swab to generation of a confirmed result, compared to 2 h 30 min for the reference quantitative real-time PCR test. CONCLUSION The direct LAMP protocol described is easy to perform, facilitating rapid and accurate detection of GBS in vaginal swabs. This test has a potential for use at point of care.
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Affiliation(s)
- James Patrick McKenna
- Regional Virus Laboratory, Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Ciara Cox
- Regional Virus Laboratory, Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Derek John Fairley
- Regional Virus Laboratory, Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Rachael Burke
- Regional Virus Laboratory, Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK.,Centre for Experimental Medicine, Queens University Belfast, Belfast, UK
| | - Michael D Shields
- Centre for Experimental Medicine, Queens University Belfast, Belfast, UK.,Royal Belfast Hospital for Sick Children, Belfast Health and Social Care Trust, Belfast, UK
| | - Alison Watt
- Regional Virus Laboratory, Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
| | - Peter Valentine Coyle
- Regional Virus Laboratory, Department of Microbiology, Belfast Health and Social Care Trust, Belfast, UK
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Borghesi A, Stronati M, Fellay J. Neonatal Group B Streptococcal Disease in Otherwise Healthy Infants: Failure of Specific Neonatal Immune Responses. Front Immunol 2017; 8:215. [PMID: 28326082 PMCID: PMC5339282 DOI: 10.3389/fimmu.2017.00215] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/15/2017] [Indexed: 12/26/2022] Open
Abstract
Only a small proportion of newborn infants exposed to a pathogenic microorganism develop overt infection. Susceptibility to infection in preterm infants and infants with known comorbidities has a likely multifactorial origin and can be often attributed to the concurrence of iatrogenic factors, environmental determinants, underlying pathogenic processes, and probably genetic predisposition. Conversely, infection occurring in otherwise healthy full-term newborn infants is unexplained in most cases. Microbial virulence factors and the unique characteristics of the neonatal immune system only partially account for the interindividual variability in the neonatal immune responses to pathogens. We here suggest that neonatal infection occurring in otherwise healthy infants is caused by a failure of the specific protective immunity to the microorganism. To explain infection in term and preterm infants, we propose an extension of the previously proposed model of the genetic architecture of infectious diseases in humans. We then focus on group B streptococcus (GBS) disease, the best characterized neonatal infection, and outline the potential molecular mechanisms underlying the selective failure of the immune responses against GBS. In light of the recent discoveries of pathogen-specific primary immunodeficiencies and of the role of anticytokine autoantibodies in increasing susceptibility to specific infections, we hypothesize that GBS disease occurring in otherwise healthy infants could reflect an immunodeficiency caused either by rare genetic defects in the infant or by transmitted maternal neutralizing antibodies. These hypotheses are consistent with available epidemiological data, with clinical and epidemiological observations, and with the state of the art of neonatal physiology and disease. Studies should now be designed to comprehensively search for genetic or immunological factors involved in susceptibility to severe neonatal infections.
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Affiliation(s)
- Alessandro Borghesi
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
- Neonatal Intensive Care Unit, San Matteo Hospital, Pavia, Italy
| | - Mauro Stronati
- Neonatal Intensive Care Unit, San Matteo Hospital, Pavia, Italy
| | - Jacques Fellay
- School of Life Sciences, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
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Park SY, Kim SY, Choi WJ, Kim SH, Hong SG. Diagnostic Accuracy and Detection Rate of Real-Time PCR for Detection of Group B Streptococcal Colonization in Pregnant Women: Systemic Review of Literature and Meta-Analysis. ANNALS OF CLINICAL MICROBIOLOGY 2017. [DOI: 10.5145/acm.2017.20.2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sun Young Park
- Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - So Young Kim
- Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Won Jung Choi
- Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Seok-Hyun Kim
- Division of New Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Seong Geun Hong
- Department of Laboratory Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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Lee DH, Shin H, Kim S. Rapid Detection of Group B StreptococcusUsing ChromID STRB and PCR in the Pregnant Women. ANNALS OF CLINICAL MICROBIOLOGY 2017. [DOI: 10.5145/acm.2017.20.4.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dong-Hyun Lee
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Hyoshim Shin
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
- Department of Laboratory Medicine, Changwon Gyeongsang National University Hospital, Changwon, Korea
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Group B Streptococci Screening Before Repeat Cesarean Delivery: A Cost-Effectiveness Analysis. Obstet Gynecol 2016; 129:111-119. [PMID: 27926650 DOI: 10.1097/aog.0000000000001800] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of universal group B streptococci (GBS) screening in women with a singleton pregnancy planning a repeat cesarean delivery. METHODS We conducted a decision analysis from a health care perspective to compare the cost-effectiveness of GBS screening for women planning a repeat cesarean delivery. With universal screening, all GBS-positive women who labored before a scheduled cesarean delivery received antibiotic prophylaxis. With no screening, women who presented in labor received antibiotics based on risk-based criteria. Neonates born to women colonized with GBS were at risk for early-onset GBS disease, disability, and death. We assumed a GBS prevalence of 25%, that 26.6% of women labored between 35 weeks of gestation and their scheduled time for cesarean delivery, and that 3.3% who planned a repeat cesarean delivery instead delivered vaginally. The primary outcome was cost per neonatal quality-adjusted life-year gained, with a cost-effectiveness threshold of $100,000 per quality-adjusted life-year. Neonatal quality of life was assessed using five health states (healthy, mild, moderate, or severe disability, and death) with a life expectancy of 79 years for healthy neonates. One-way sensitivity and Monte Carlo analyses were used to evaluate the results. RESULTS In the base case, universal GBS screening in women planning a repeat cesarean delivery was not cost-effective compared with no screening, costing $114,445 per neonatal quality-adjusted life-year gained. The cost to prevent an adverse outcome from GBS exceeded $400,000. If greater than 28% of women were GBS-positive, greater than 29% labored before their scheduled delivery, or greater than 10% delivered vaginally, universal screening became cost effective. CONCLUSION Universal GBS screening in women with a singleton pregnancy planning a repeat cesarean delivery may not be cost-effective in all populations. However, in populations with a high GBS prevalence, women at high risk of laboring before their scheduled cesarean delivery, or women who may ultimately opt for a vaginal delivery, GBS screening may be cost effective.
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Gouvea MIS, Joao EC, Teixeira MDLB, Read JS, Fracalanzza SEL, Souza CTV, Souza MJD, Torres Filho HM, Leite CCF, do Brasil PEAA. Accuracy of a rapid real-time polymerase chain reaction assay for diagnosis of group B Streptococcus colonization in a cohort of HIV-infected pregnant women. J Matern Fetal Neonatal Med 2016; 30:1096-1101. [PMID: 27333822 DOI: 10.1080/14767058.2016.1205021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There are limited data regarding Xpert performance to detect Group B Streptococcus (GBS) in HIV-infected pregnant women. We evaluated the accuracy of a rapid real-time polymerase chain reaction (PCR) test in a cohort of HIV-infected women. METHODS At 35-37 weeks of pregnancy, a pair of combined rectovaginal swabs were collected for two GBS assays in a cohort of sequentially included HIV-infected women in Rio de Janeiro: (1) culture; and (2) real-time PCR assay [GeneXpert GBS (Cepheid, Sunnyvale, CA)]. Using culture as the reference, sensitivity, specificity, positive and negative-likelihood ratios were estimated. RESULTS From June 2012 to February 2015, 337 pregnant women met inclusion criteria. One woman was later excluded, due to failure to obtain a result in the index test; 336 were included in the analyses. The GBS colonization rate was 19.04%. Sensitivity and specificity of the GeneXpert GBS assay were 85.94% (95% CI: 75.38-92.42) and 94.85% (95% CI: 91.55-96.91), respectively. Positive and negative predictive values were 79.71% (95% CI: 68.78-87.51) and 96.63% (95% CI: 93.72-98.22), respectively. CONCLUSIONS GeneXpert GBS is an acceptable test for the identification of GBS colonization in HIV-infected pregnant women and represents a reasonable option to detect GBS colonization in settings where culture is not feasible.
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Affiliation(s)
- Maria Isabel S Gouvea
- a Infectious Diseases Department, Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil.,b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
| | - Esau C Joao
- a Infectious Diseases Department, Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil
| | - Maria de Lourdes B Teixeira
- a Infectious Diseases Department, Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil.,b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
| | - Jennifer S Read
- c Department of Epidemiology and Biostatistics , University of California at San Francisco , San Francisco , CA , USA
| | - Sergio E L Fracalanzza
- d Laboratório de Bacteriologia Médica do Instituto de Microbiologia Prof. Paulo de Góes , Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil
| | - Claudia T V Souza
- b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
| | - Maria José de Souza
- e Department of Bacteriology , Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil , and
| | - Helio M Torres Filho
- f Laboratório Richet , Núcleo de Apoio à Pesquisa Clínica , Rio de Janeiro , Brazil
| | - Cassiana C F Leite
- f Laboratório Richet , Núcleo de Apoio à Pesquisa Clínica , Rio de Janeiro , Brazil
| | - Pedro E A A do Brasil
- b Instituto Nacional de Infectologia Evandro Chagas - Fiocruz , Rio de Janeiro , Brazil
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Detection of Group B Streptococcus Directly from Collected ESwab Samples by Use of the BD Max GBS Assay. J Clin Microbiol 2016; 54:1660-1663. [PMID: 27053670 PMCID: PMC4879306 DOI: 10.1128/jcm.00445-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/31/2016] [Indexed: 12/25/2022] Open
Abstract
Group B Streptococcus detection directly from Copan ESwab collected samples, using the BD Max GBS assay, was evaluated on receipt in the laboratory and after 24 h at room temperature. Results were compared to those using Lim broth enrichment PCR and culture. No significant difference was observed between 24 h ESwab and Lim broth PCRs.
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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. [PMID: 26811897 PMCID: PMC4727807 DOI: 10.1371/journal.pone.0148052] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/12/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND One million neonates die each year in low- and middle-income countries because of neonatal sepsis; group B Streptococcus (GBS) and Escherichia coli are the leading causes. In sub-Saharan Africa, epidemiological data on vaginal GBS and E. coli carriage, a prerequisite for GBS and E. coli neonatal sepsis, respectively, are scarce but necessary to design and implement prevention strategies. Therefore, we assessed vaginal GBS and E. coli carriage rates and risk factors and the GBS serotype distribution in three sub-Saharan countries. METHODS A total of 430 women from Kenya, Rwanda and South Africa were studied cross-sectionally. Vaginal carriage of GBS and E. coli, and GBS serotype were assessed using molecular techniques. Risk factors for carriage were identified using multivariable logistic regression analysis. RESULTS Vaginal carriage rates in reference groups from Kenya and South Africa were 20.2% (95% CI, 13.7-28.7%) and 23.1% (95% CI, 16.2-31.9%), respectively for GBS; and 25.0% (95% CI, 17.8-33.9%) and 27.1% (95% CI, 19.6-36.2%), respectively for E. coli. GBS serotypes Ia (36.8%), V (26.3%) and III (14.0%) were most prevalent. Factors independently associated with GBS and E. coli carriage were Candida albicans, an intermediate vaginal microbiome, bacterial vaginosis, recent vaginal intercourse, vaginal washing, cervical ectopy and working as a sex worker. GBS and E. coli carriage were positively associated. CONCLUSIONS Reduced vaginal GBS carriage rates might be accomplished by advocating behavioral changes such as abstinence from sexual intercourse and by avoidance of vaginal washing during late pregnancy. It might be advisable to explore the inclusion of vaginal carriage of C. albicans, GBS, E. coli and of the presence of cervical ectopy in a risk- and/or screening-based administration of antibiotic prophylaxis. Current phase II GBS vaccines (a trivalent vaccine targeting serotypes Ia, Ib, and III, and a conjugate vaccine targeting serotype III) would not protect the majority of women against carriage in our study population.
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Bacterial Infections. MOLECULAR PATHOLOGY IN CLINICAL PRACTICE 2016. [PMCID: PMC7123846 DOI: 10.1007/978-3-319-19674-9_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Molecular techniques have revolutionized the detection and identification of microorganisms. Real-time PCR has allowed for the rapid and accurate detection of MRSA, VRE, and group B Streptococcus. The identification of difficult and slow-growing organisms has been expedited by sequence-based methods such as 16S rRNA gene sequencing. Rapid identification of organisms and detection of resistance markers directly from positive blood culture bottles has become a reality. Finally, a transformation is taking place with the introduction of MALDI-TOF into clinical laboratories that promises to improve the accuracy and speed of bacterial and fungal identifications by days. The advantages of these methodologies and their associated clinical applications, along with their inherent pitfalls and problems, are elucidated in this chapter.
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Comparison of the AmpliVue, BD Max System, and illumigene Molecular Assays for Detection of Group B Streptococcus in Antenatal Screening Specimens. J Clin Microbiol 2015; 53:1938-41. [PMID: 25788551 DOI: 10.1128/jcm.00261-15] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/15/2015] [Indexed: 11/20/2022] Open
Abstract
The performances of the AmpliVue, BD Max, and illumigene group B Streptococcus (GBS) nucleic acid amplification tests (NAATs) were compared to that of enriched culture for detection of GBS in antenatal screening specimens. Two hundred specimens were tested simultaneously with the NAATs, following 18 to 24 h of Lim broth enrichment; 15% of specimens were culture positive for GBS, whereas 31.5% were positive by at least one NAAT. All three NAATs were more sensitive (sensitivity, 90.9 to 100%) than culture (sensitivity, 53.6%).
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Tanaka K, Iwashita M, Matsushima M, Wachi Y, Izawa T, Sakai K, Kobayashi Y. Intrapartum group B Streptococcus screening using real-time polymerase chain reaction in Japanese population. J Matern Fetal Neonatal Med 2015; 29:130-4. [PMID: 25471089 DOI: 10.3109/14767058.2014.989496] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the diagnostic accuracy of a commercial real-time polymerase chain reaction (PCR) assay for group B streptococcus (GBS) colonization status and to compare results of the intrapartum PCR with the antepartum conventional GBS culture in Japanese pregnant women. METHODS This prospective observational study enrolled Japanese pregnant women at 35-37 weeks' gestation. Paired recto-vaginal swabs were obtained for PCR and conventional culture, both at 35-37 weeks' gestation and at admission for delivery. Performance of PCR was analyzed by comparing with the culture results. Furthermore, using the intrapartum culture results as the gold standard, the test of both the antepartum culture and the intrapartum PCR were characterized. RESULTS We prospectively enrolled 79 pregnant women at 35-37 weeks' gestation, and the intrapartum results were obtained from 73 of those women. The sensitivity of PCR was 86.2%, and concordance rate with the conventional culture was 96.7% overall. Compared with the intrapartum culture, the sensitivity and the specificity of the intrapartum PCR were 83.3% and 98.4%, respectively, while the sensitivity and the specificity of the antepartum culture were 100.0% and 95.1%. CONCLUSIONS The intrapartum real-time PCR assay for GBS screening has the accuracy similar to the antepartum conventional culture method.
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Affiliation(s)
- Kei Tanaka
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
| | - Mitsutoshi Iwashita
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
| | - Miho Matsushima
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
| | - Yuichi Wachi
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
| | - Tomoko Izawa
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
| | - Keiji Sakai
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
| | - Yoichi Kobayashi
- a Department of Obstetrics and Gynecology , School of Medicine, Kyorin University , Tokyo , Japan
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Ahmadzia HK, Heine RP. Diagnosis and management of group B streptococcus in pregnancy. Obstet Gynecol Clin North Am 2014; 41:629-47. [PMID: 25454995 DOI: 10.1016/j.ogc.2014.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Group B streptococcus (GBS) can cause significant maternal and neonatal morbidity. Over the past 30 years, reductions in early-onset GBS neonatal sepsis in the United States have been attributable to the guidelines from the Centers for Disease Control and Prevention for antepartum screening and treating this organism during labor. This article highlights the clinical implications, screening, diagnosis, prophylactic interventions, and future therapies for mothers with GBS during the peripartum period.
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Affiliation(s)
- Homa K Ahmadzia
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC 3967, Durham, NC 27710, USA
| | - R Phillips Heine
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, DUMC 3967, Durham, NC 27710, USA.
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Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP, Hakansson S, Hod M, Hughes R, Kurtzer M, Poyart C, Shinwell E, Stray-Pedersen B, Wielgos M, El Helali N. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med 2014; 28:766-82. [PMID: 25162923 DOI: 10.3109/14767058.2014.934804] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecology-obstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.
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Affiliation(s)
- G C Di Renzo
- Department of Ob/Gyn and Centre for Perinatal and Reproductive Medicine, Santa Maria della Misericordia University Hospital , Perugia , Italy
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Martinez de Tejada B. Antibiotic use and misuse during pregnancy and delivery: benefits and risks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7993-8009. [PMID: 25105549 PMCID: PMC4143845 DOI: 10.3390/ijerph110807993] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/25/2014] [Accepted: 07/28/2014] [Indexed: 11/17/2022]
Abstract
Although pregnancy is considered as a physiological state, most pregnant women in developed countries receive multiple medications to prevent maternal or neonatal complications, with antibiotics among the most frequently prescribed. During pregnancy, antibiotics are often prescribed in the context of preterm labor, intrapartum fever, prevention of neonatal Group B Streptococcus fever, and cesarean section. Outside this period, they are commonly prescribed in the community setting for respiratory, urinary, and ear, nose and throat infection symptoms. Whereas some of the current indications have insightful reasons to justify their use, potential risks related to overuse and misuse may surpass the benefits. Of note, the recent 2014 World Health Assembly expressed serious concern regarding antibiotic resistance due to antibiotic overuse and misuse and urged immediate action to combat antibiotic resistance on a global scale. Most studies in the obstetrics field have focused on the benefits of antibiotics for short-term maternal and neonatal complications, but with very little (if any) interest in long-term consequences.
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Antepartum screening for group B Streptococcus by three FDA-cleared molecular tests and effect of shortened enrichment culture on molecular detection rates. J Clin Microbiol 2014; 52:3429-32. [PMID: 25009049 DOI: 10.1128/jcm.01081-14] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Neonatal Streptococcus agalactiae infections cause significant morbidity and mortality, and antenatal screening is recommended. We compared three U.S. Food and Drug Administration (FDA)-cleared nucleic acid amplification tests (NAATs) to culture using 314 vaginal/rectal swabs after 18 to 24 h (recommended period) and 4 to 8 h (shortened period) of broth enrichment. Agreement of the NAATs with each other was high (97.1% to 98.4%), but culture was less sensitive than all NAATs (67% to 73%). A shortened period of broth culture enrichment resulted in 1 false-negative result in 68 (1.5%). The NAATs performed comparably and were more sensitive than culture.
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47
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Emonet S, Schrenzel J, Martinez de Tejada B. Molecular-based screening for perinatal group B streptococcal infection: implications for prevention and therapy. Mol Diagn Ther 2014; 17:355-61. [PMID: 23832874 DOI: 10.1007/s40291-013-0047-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Group B streptococci (GBS) are a leading cause of infectious neonatal morbidity and mortality. Timely and accurate identification of colonized pregnant women is imperative to implement intrapartum antibioprophylaxis (IAP) to reduce the risk of early neonatal sepsis. Current guidelines recommend screening for GBS carriage with vaginal-rectal cultures. However, cultures require 24-72 h, thus precluding their use for intrapartum screening and these are only performed at 35-37 weeks gestation. New rapid molecular-based tests can detect GBS within hours. They have the potential to be used intrapartum and to allow for selective IAP in women carrying GBS. An advantage is that they can sometimes be performed by non-laboratory staff in the labor suite, thus avoiding delays in sample transfers to the microbiology laboratory. Another possible use of molecular-based assays is for the diagnosis of neonatal sepsis, where tests with a short turnaround time and high sensitivity and specificity are crucial. In this situation, the detection of microorganisms once antibiotic therapy has already been started is important, as treatment is started immediately once sepsis is suspected without waiting for microbiological confirmation. In this article, we discuss the state-of-the-art molecular-based tests available for GBS screening during pregnancy, as well as their implications for IAP for the diagnosis and prevention of neonatal sepsis.
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Affiliation(s)
- Stéphane Emonet
- Department of Genetics and Laboratory Medicine, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
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48
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Abstract
Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.
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Estimation of Group B Streptococcus Colonization in High-Risk Neonates by PCR and Standard Culture. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2014. [DOI: 10.5812/pedinfect.17345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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50
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Daher RK, Stewart G, Boissinot M, Bergeron MG. Isothermal Recombinase Polymerase Amplification Assay Applied to the Detection of Group B Streptococci in Vaginal/Anal Samples. Clin Chem 2014; 60:660-6. [DOI: 10.1373/clinchem.2013.213504] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Group B streptococcal infections are the leading cause of sepsis and meningitis in newborns. A rapid and reliable method for the detection of this pathogen at the time of delivery is needed for the early treatment of neonates. Isothermal amplification techniques such as recombinase polymerase amplification have advantages relative to PCR in terms of the speed of reaction and simplicity.
METHODS
We studied the clinical performance of recombinase polymerase amplification for the screening of group B streptococci in vaginal/anal samples from 50 pregnant women. We also compared the limit of detection and the analytical specificity of this isothermal assay to real-time PCR (RT-PCR).
RESULTS
Compared to RT-PCR, the recombinase polymerase amplification assay showed a clinical sensitivity of 96% and a clinical specificity of 100%. The limit of detection was 98 genome copies and the analytical specificity was 100% for a panel of 15 bacterial and/or fungal strains naturally found in the vaginal/anal flora. Time-to-result for the recombinase polymerase amplification assay was <20 min compared to 45 min for the RT-PCR assay; a positive sample could be detected as early as 8 min.
CONCLUSIONS
We demonstrate the potential of isothermal recombinase polymerase amplification assay as a clinically useful molecular diagnostic tool that is simple and faster than PCR/RT-PCR. Recombinase polymerase amplification offers great potential for nucleic acid–based diagnostics at the point of care.
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Affiliation(s)
- Rana K Daher
- Centre de recherche du CHU de Québec, Centre de recherche en infectiologie de l'Université Laval (CRI), Quebec, Canada
- Département de microbiologie-immunologie, faculté de médecine, Université Laval, Quebec, Canada
| | - Gale Stewart
- Centre de recherche du CHU de Québec, Centre de recherche en infectiologie de l'Université Laval (CRI), Quebec, Canada
| | - Maurice Boissinot
- Centre de recherche du CHU de Québec, Centre de recherche en infectiologie de l'Université Laval (CRI), Quebec, Canada
| | - Michel G Bergeron
- Centre de recherche du CHU de Québec, Centre de recherche en infectiologie de l'Université Laval (CRI), Quebec, Canada
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