1
|
Boonsilp S, Nealiga MJ, Wangchuk K, Homkaew A, Wongsuk T, Thuncharoon H, Suksomchit P, Wasipraphai D, Chaturongakul S, Dubbs P. Differential Interaction between Invasive Thai Group B Streptococcus Sequence Type 283 and Caco-2 Cells. Microorganisms 2022; 10:microorganisms10101917. [PMID: 36296194 PMCID: PMC9611625 DOI: 10.3390/microorganisms10101917] [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: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
The emergence in Southeast Asia of invasive group B Streptococcus (GBS) infections in adults by sequence type (ST) 283 is suggested to be associated with fish consumption. Genotyping of 55 GBS clinical isolates revealed that 33/44 invasive isolates belonged to ST283/capsular polysaccharide type (CPS) III. This included 15/16 isolates recovered from younger adults aged 16–36 years. Seven ST283/CPSIII isolates from the blood, cerebrospinal fluid, or joint fluid were selected by the patient’s age at random to perform interaction studies with intestinal epithelial Caco-2 monolayers. The invasion efficiency profiles from this study classified these isolates into two groups; a higher invasion efficiency group 1 recovered from patients aged between 23 and 36 years, and a lower invasion efficiency group 2 recovered from the elderly and neonate. Intracellular survival tests revealed that only group 1 members could survive inside Caco-2 cells up to 32 h without replication. Additionally, all isolates tested were able to traverse across polarized Caco-2 monolayers. However, the timing of translocation varied among the isolates. These results indicated the potential of GBS invasion via the gastrointestinal tract and showed phenotypic variations in invasiveness, intracellular survival, and translocation efficiency between genetically closely related ST283 isolates infecting young adults and those infecting the elderly.
Collapse
Affiliation(s)
- Siriphan Boonsilp
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Marea Jikka Nealiga
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Kinley Wangchuk
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Anchalee Homkaew
- Microbiological Unit, Central Laboratory and Blood Bank, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | - Thanwa Wongsuk
- Department of Clinical Pathology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok 10300, Thailand
| | | | - Paveesuda Suksomchit
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Daranee Wasipraphai
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Soraya Chaturongakul
- Molecular Medical Biosciences Cluster, Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Padungsri Dubbs
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
- Center for Emerging Bacterial Infections, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
- Correspondence:
| |
Collapse
|
2
|
Disease Burden of Group B Streptococcus Among Infants in Sub-Saharan Africa: A Systematic Literature Review and Meta-analysis. Pediatr Infect Dis J 2016; 35:933-42. [PMID: 27213263 PMCID: PMC6858852 DOI: 10.1097/inf.0000000000001233] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Group B streptococcus (GBS) is a leading neonatal sepsis pathogen globally. Investment in GBS disease prevention, such as maternal vaccination, requires evidence of disease burden, particularly in high infant mortality regions like sub-Saharan Africa. We aimed to provide such evidence by conducting a systematic literature review and meta-analysis to estimate maternal colonization proportion, GBS disease incidence and GBS serotype distribution. METHODS MEDLINE, MEDLINE in process and Cochrane Library were searched for studies published during 1990-2014, pertaining to sub-Saharan Africa. Eligible studies were used to estimate the proportion of pregnant women colonized with GBS, early-onset GBS disease incidence, late-onset GBS disease incidence and respective serotype distributions. Random effects meta-analysis was conducted to estimate weighted means and confidence intervals (CIs). RESULTS We identified 17 studies of colonization, 9 of disease incidence, and 6 of serotype distribution meeting inclusion criteria. 21.8% (95% CI: 18.3, 25.5) of expectant women were colonized with GBS. The incidence of early-onset GBS disease was 1.3 per 1000 births (95% CI: 0.81, 1.9), that of late-onset GBS disease 0.73 per 1000 births (95% CI: 0.48, 1.0). The most common disease-causing serotype was 3, followed by 1a. Serotypes 1b, 2 and 5 were next most common in frequency. CONCLUSION Despite methodological factors leading to underestimation, GBS disease incidence appears high in sub-Saharan Africa. A small number of GBS serotypes cause almost all disease. GBS disease burden in sub-Saharan Africa suggests that safe, effective and affordable GBS disease prevention is needed.
Collapse
|
3
|
Kiechle FL, Arcenas RC, Rogers LC. Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory. Clin Chim Acta 2013; 427:131-6. [PMID: 23732401 PMCID: PMC7124233 DOI: 10.1016/j.cca.2013.05.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 05/24/2013] [Accepted: 05/25/2013] [Indexed: 12/31/2022]
Abstract
Benchmarks and metrics related to laboratory test utilization are based on evidence-based medical literature that may suffer from a positive publication bias. Guidelines are only as good as the data reviewed to create them. Disruptive technologies require time for appropriate use to be established before utilization review will be meaningful. Metrics include monitoring the use of obsolete tests and the inappropriate use of lab tests. Test utilization by clients in a hospital outreach program can be used to monitor the impact of new clients on lab workload. A multi-disciplinary laboratory utilization committee is the most effective tool for modifying bad habits, and reviewing and approving new tests for the lab formulary or by sending them out to a reference lab. Laboratory test overutilization is 2.9% to 56% of all lab tests ordered. Guidelines may have a positive publication bias. Choosing Wisely is 35 medical subspecialty groups targeting overused tests or therapies. Utilization of disruptive technologies requires time for appropriate use to be established. Client test utilization by speciality can help predict needs to meet future outreach growth.
Collapse
Affiliation(s)
- Frederick L Kiechle
- Memorial Healthcare System, Pathology Consultants of South Broward, LLP, Department of Pathology, 3501 Johnson Street, Hollywood, FL 33021, USA.
| | | | | |
Collapse
|
4
|
How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr 2012; 2012:120139. [PMID: 22319539 PMCID: PMC3272815 DOI: 10.1155/2012/120139] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/15/2011] [Accepted: 11/29/2011] [Indexed: 01/23/2023] Open
Abstract
Neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). These definitions have contributed greatly to diagnosis and treatment by identifying which microorganisms are likely to be responsible for sepsis during these periods and the expected outcomes of infection. This paper focuses on the tools that microbiologist can offer to diagnose and eventually prevent neonatal sepsis. Here, we discuss the advantages and limitation of the blood culture, the actual gold standard for sepsis diagnosis. In addition, we examine the utility of molecular techniques in the diagnosis and management of neonatal sepsis.
Collapse
|
5
|
El Aila NA, Tency I, Claeys G, Saerens B, De Backer E, Temmerman M, Verhelst R, Vaneechoutte M. Genotyping of Streptococcus agalactiae (group B streptococci) isolated from vaginal and rectal swabs of women at 35-37 weeks of pregnancy. BMC Infect Dis 2009; 9:153. [PMID: 19747377 PMCID: PMC2753344 DOI: 10.1186/1471-2334-9-153] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 09/11/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Group B streptococci (GBS), or Streptococcus agalactiae, are the leading bacterial cause of meningitis and bacterial sepsis in newborns. Here we compared different culture media for GBS detection and we compared the occurrence of different genotypes and serotypes of GBS isolates from the vagina and rectum. METHODS Streptococcus agalactiae was cultured separately from both rectum and vagina, for a total of 150 pregnant women, i) directly onto Columbia CNA agar, or indirectly onto ii) Granada agar resp. iii) Columbia CNA agar, after overnight incubation in Lim broth. RESULTS Thirty six women (24%) were colonized by GBS. Of these, 19 harbored GBS in both rectum and vagina, 9 only in the vagina and 8 exclusively in the rectum. The combination of Lim broth and subculture on Granada agar was the only culture method that detected all GBS positive women. Using RAPD-analysis, a total of 66 genotypes could be established among the 118 isolates from 32 women for which fingerprinting was carried out. Up to 4 different genotypes in total (rectal + vaginal) were found for 4 women, one woman carried 3 different genotypes vaginally and 14 women carried two 2 different genotypes vaginally. Only two subjects were found to carry strains with the same genotype, although the serotype of both of these strains was different.Eighteen of the 19 subjects with GBS at both sites had at least one vaginal and one rectal isolate with the same genotype.We report the presence of two to four different genotypes in 22 (61%) of the 36 GBS positive women and the presence of identical genotypes in both sites for all women but one. CONCLUSION The combination of Lim broth and subculture on Granada medium provide high sensitivity for GBS detection from vaginal and rectal swabs from pregnant women. We established a higher genotypic diversity per individual than other studies, with up to four different genotypes among a maximum of 6 isolates per individual picked. Still, 18 of the 19 women with GBS from both rectum and vagina had at least one isolate from each sampling site with the same genotype.
Collapse
Affiliation(s)
- Nabil Abdullah El Aila
- Laboratory Bacteriology Research, Department of Clinical Chemistry, Microbiology & Immunology, University of Ghent, Ghent, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Aziz N, Baron EJ, D'Souza H, Nourbakhsh M, Druzin ML, Benitz WE. Comparison of rapid intrapartum screening methods for group B streptococcal vaginal colonization. J Matern Fetal Neonatal Med 2009; 18:225-9. [PMID: 16318971 DOI: 10.1080/14767050500278048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare optical immunoassay (OIA) and rapid polymerase-chain reaction (PCR) with enrichment broth culture for intrapartum detection of vaginal group B streptococcal (GBS) colonization. METHODS Paired vaginal swabs from 315 consecutive term pregnant women at the time of presentation for delivery to a university medical center were tested for GBS by OIA, PCR, and culture. Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS Vaginal colonization was identified by culture in 56 subjects (17.8%). The sensitivity of OIA (7.1%, 95% confidence interval 5.1-9.5%) was significantly less than that of unenhanced rapid PCR (62.5%, 95% CI 48.5-74.8%). CONCLUSIONS Neither PCR nor OIA is sufficiently sensitive for intrapartum detection of vaginal GBS colonization. Rapid PCR is more sensitive, but further improvements in technique to increase sensitivity will be necessary if PCR is to have a useful role in the management of women at time of presentation for delivery.
Collapse
Affiliation(s)
- Natali Aziz
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA 94025, USA
| | | | | | | | | | | |
Collapse
|
7
|
|
8
|
Gill CJ, Mantaring JBV, Macleod WB, Mendoza M, Mendoza S, Huskins WC, Goldmann DA, Hamer DH. Impact of enhanced infection control at 2 neonatal intensive care units in the Philippines. Clin Infect Dis 2009; 48:13-21. [PMID: 19025496 PMCID: PMC3866590 DOI: 10.1086/594120] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The growing burden of neonatal mortality associated with hospital-acquired neonatal sepsis in the developing world creates an urgent need for cost-effective infection-control measures in resource-limited settings. METHODS Using a before-and-after comparison design, we measured how rates of staff hand-hygiene compliance, colonization with drug-resistant pathogens (defined as ceftazidime- and/or gentamicin-resistant gram-negative bacilli and drug-resistant gram-positive cocci), bacteremia, and overall mortality changed after the introduction of a simplified package of infection-control measures at 2 neonatal intensive care units (NICUs) in Manila, The Philippines. RESULTS Of all 1827 neonates admitted to the NICU, 561 (30.7%) arrived from delivery already colonized with drug-resistant bacteria. Of the 1266 neonates who were not already colonized, 578 (45.6%) became newly colonized with drug-resistant bacteria. Of all 1827 neonates, 358 (19.6%) became bacteremic (78.2% were infected with gram-negative bacilli) and 615 (33.7%) died. Of 2903 identified drug-resistant colonizing bacteria, 85% were drug-resistant gram-negative bacilli (predominantly Klebsiella species, Pseudomonas species, and Acinetobacter species) and 14% were methicillin-resistant Staphylococcus aureus. Contrasting the control period with the intervention period at each NICU revealed that staff hand-hygiene compliance improved (NICU 1: relative risk, 1.3; 95% confidence interval 1.1-1.5; NICU 2: relative risk, 1.6; 95% confidence interval, 1.4-2.0) and that overall mortality decreased (NICU 1: relative risk, 0.5; 95% confidence interval, 0.4-0.6; NICU 2: relative risk, 0.8; 95% confidence interval, 0.7-0.9). However, rates of colonization with drug-resistant pathogens and of sepsis did not change significantly at either NICU. DISCUSSION Nosocomial transmission of drug-resistant pathogens was intense at these 2 NICUs in The Philippines; transmission involved mostly drug-resistant gram-negative bacilli. Infection-control interventions are feasible and are possibly effective in resource-limited hospital settings.
Collapse
Affiliation(s)
- Christopher J Gill
- Center for International Health and Development, Department of International Health, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Comparison of carrot broth- and selective Todd-Hewitt broth-enhanced PCR protocols for real-time detection of Streptococcus agalactiae in prenatal vaginal/anorectal specimens. J Clin Microbiol 2008; 46:3615-20. [PMID: 18799703 DOI: 10.1128/jcm.01262-08] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The reporting of accurate Streptococcus agalactiae screening results in a short time frame is of tremendous clinical benefit. A total of 203 consecutive primary vaginal/anorectal specimens were cultured in selective Todd-Hewitt broth (LIM broth) and with the StrepB carrot broth kit (carrot broth). One-day broth cultures were subjected to both centrifugation and clarification of a 500-mul aliquot prior to sample lysis (protocol A) and direct lysis of a 50-mul aliquot (protocol B). The lysates were subsequently analyzed by the BD GeneOhm StrepB assay. The results were compared to the carrot broth culture results derived from visualization of pigment on day 1 or from a subculture of carrot broth. Thirty-four carrot broth cultures (16.7%) generated diagnostic pigment following overnight incubation; an additional 26 (12.8%) were positive for S. agalactiae upon subculture. Carrot broth-enhanced PCR by the use of either protocol A or protocol B trended toward a higher rate of positive results (33.0%) than the rate observed by either the LIM broth-enhanced PCR (30.5%) or full carrot broth culture analysis (29.6%). In the context of the result on day 1, both carrot broth- and LIM broth-enhanced PCRs generated more true-positive results (P < 0.001) than carrot broth culture visualization. The predictive values for both protocols of carrot broth- or LIM broth-enhanced PCR were >/=95.4%. Whereas protocol A resolved the results for 99.8% of the specimens in the evaluation upon initial testing, a 5.7% initial unresolved rate and a 1.5% final unresolved rate were determined by the use of protocol B. The use of carrot broth within a rapid and highly accurate molecular reflex testing algorithm can limit follow-up testing to cultures without evidence of pigmentation.
Collapse
|
10
|
Self-collected versus health professional-collected genital swabs to identify the prevalence of group B streptococcus: A comparison of patient preference and efficacy. Eur J Obstet Gynecol Reprod Biol 2008; 139:43-5. [DOI: 10.1016/j.ejogrb.2007.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Revised: 10/23/2007] [Accepted: 12/17/2007] [Indexed: 11/23/2022]
|
11
|
Atkins KL, Atkinson RM, Shanks A, Parvin CA, Dunne WM, Gross G. Evaluation of Polymerase Chain Reaction for Group B Streptococcus Detection Using an Improved Culture Method. Obstet Gynecol 2006; 108:488-91. [PMID: 16946205 DOI: 10.1097/01.aog.0000228961.42272.31] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The administration of antibiotic prophylaxis to laboring women who harbor Group B streptococci (GBS) depends on identification of carriers. We sought to evaluate the diagnostic accuracy of real-time polymerase chain reaction (PCR) for detection of GBS using a more stringent culture method. METHODS Two swabs were used simultaneously to obtain rectovaginal GBS samples from consenting women. One swab was analyzed using a stringent, validated culture technology, which included direct plating onto selective agar and inoculation of a selective broth. The other swab was used for a commercial real-time PCR assay, which uses amplification to detect the presence of the cfb gene sequence of GBS DNA. We calculated the assay accuracy using sensitivity and specificity. RESULTS A total of 233 samples were available. Both the culture and PCR methods were positive for 59 and negative for 157 patients. The culture method was positive and PCR was negative in 9 patients. The culture was negative and the PCR positive for 8 patients. The sensitivity of the PCR assay was 86.8% and specificity was 95.2%. The positive predictive value was 88.1% and the negative predictive value was 94.6%. CONCLUSION Although a rapid PCR assay may be useful to determine GBS status in the urgent intrapartum setting, the false-negative rate of 13.2% for the real-time PCR assay prohibits its use for standard GBS screening in the office.
Collapse
Affiliation(s)
- Kristin L Atkins
- Department of Obstetrics & Gynecology, Washington University in St. Louis, Saint Louis, Missouri 63110, USA.
| | | | | | | | | | | |
Collapse
|
12
|
Ruef C. Klinische Bedeutung der Antibiotikaresistenz in Gynäkologie und Geburtshilfe. ACTA ACUST UNITED AC 2004; 45:19-27. [PMID: 15644637 DOI: 10.1159/000081713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Antibiotic resistance of microorganisms that cause infections of the urogenital tract is a clinically relevant problem in obstetrics and gynecology. Due to methodological difficulties, resistance testing is rarely used for the management of these infections. Therefore, solid epidemiological data on resistance rates of most involved pathogens are scarce. Antibiotic resistance of several microorganisms appears to be increasing in various areas of the world, mainly Trichomonas vaginalis and Gardnerella vaginalis (metronidazole),Streptococcus agalactiae (macrolides, clindamycin), Mycoplasma hominis (tetracyclines, intrinsically macrolide resistant). In addition,isolated cases of clinical infections caused by multi-resistant Chlamydia trachomatis have been reported. The presence of antibiotic resistance should therefore be considered in patients with an unfavorable course despite adequate antibiotic therapy. In light of the growing problem of antibiotic resistance and the large gaps in our knowledge in this particular area, research efforts in the field of anti-biotic resistance in gynecological infections should be markedly intensified.
Collapse
Affiliation(s)
- Christian Ruef
- Abteilung Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich, Zürich, Schweiz.
| |
Collapse
|
13
|
Abstract
Group B streptococci (GBS) emerged dramatically in the 1970s as the leading cause of neonatal infection and as an important cause of maternal uterine infection. We review the epidemiology, diagnosis, and therapy of GBS perinatal infection. In 1996, the first national consensus guidelines were released. Since then, there has been a 70% reduction in early-onset neonatal GBS infection, but no decrease in late-onset neonatal GBS disease. In 2002, new national guidelines were released recommending 1) solely a screen-based prevention strategy, 2) a new algorithm for patients with penicillin allergy, and 3) more specific practices in certain clinical scenarios. Yet many clinical issues remain, including implementation of new diagnostic techniques, management of preterm rupture of membranes, use of alternative antibiotic approaches, improvement of compliance, prevention of low birth weight infants, emergence of resistant organisms, and vaccine development.
Collapse
Affiliation(s)
- Ronald S Gibbs
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Denver, Colorado 80262, USA.
| | | | | |
Collapse
|
14
|
Schrag SJ, Schuchat A. Easing the burden: characterizing the disease burden of neonatal group B streptococcal disease to motivate prevention. Clin Infect Dis 2004; 38:1209-11. [PMID: 15127329 DOI: 10.1086/382889] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 01/05/2004] [Indexed: 11/03/2022] Open
|