1
|
Low JM, Lee JH, Foote HP, Hornik CP, Clark RH, Greenberg RG. Incidence of group B streptococcus early-onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: a multicenter retrospective study. Am J Obstet Gynecol 2024; 230:673.e1-673.e8. [PMID: 37890649 DOI: 10.1016/j.ajog.2023.10.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The difference in the incidence of early-onset sepsis caused by group B streptococcus among term neonates whose mothers received first-line vs second-line intrapartum prophylaxis is poorly described. OBJECTIVE This study aimed to compare the incidence of group B streptococcus early-onset sepsis among term neonates born to mothers who receive first-line, second-line, or no intrapartum antibiotics and to describe the short-term and survival outcomes of neonates who developed group B streptococcus early-onset sepsis stratified by maternal antepartum prophylaxis. STUDY DESIGN This was a retrospective review of electronic medical records. We queried the Pediatrix Medical Group Clinical Data Warehouse to evaluate the outcomes of term neonates born to group B streptococcus positive mothers between 2003 and 2020 and compared the incidence and outcomes of neonates with group B streptococcus early-onset sepsis whose mothers received first-line vs second-line or no intrapartum prophylaxis. RESULTS Among the 496,180 neonates, 104,196 (21%) were born to mothers who were group B streptococcus positive. Of 97,983 mothers who were group B streptococcus positive with adequate prenatal antibiotic documentation, 49,234 (50%), 12,679 (13%), and 36,070 (37%) received first-line, second-line, and no intrapartum prophylaxis, respectively. The incidence of group B streptococcus early-onset sepsis among all neonates with maternal group B streptococcus carriage was 0.22% (231/104,196). Neonates whose mothers received second-line intrapartum antibiotics and no antibiotics had a higher risk for group B streptococcus early-onset sepsis infection than those whose mothers received first-line intrapartum antibiotics (adjusted odds ratio, 4.12; 95% confidence interval, 2.66-6.38 and adjusted odds ratio, 3.80; 95% confidence interval, 2.66-5.44, respectively). There was no statistically significant difference in the risk for group B streptococcus early-onset sepsis among neonates born to mothers who received second-line vs no antibiotics (adjusted odds ratio, 0.92; 95% confidence interval, 0.64-1.33). CONCLUSION Neonates exposed to second-line maternal group B streptococcus prophylaxis had an increased risk for group B streptococcus early-onset sepsis when compared with those exposed to first-line maternal group B streptococcus prophylaxis. There was no statistically significant difference in group B streptococcus early-onset sepsis incidence between second-line antibiotic prophylaxis and no antibiotics in mothers with group B streptococcus carriage.
Collapse
Affiliation(s)
- Jia Ming Low
- Department of Neonatology, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore; Department of Paediatrics, Yong Loo Lin School of Singapore, National University of Singapore, Singapore, Singapore.
| | - Jan Hau Lee
- Children's Intensive Care Unit, KK Women's and Children's Hospital, Singapore, Singapore; Singhealth-Duke NUS Paediatrics Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Henry P Foote
- Department of Pediatrics, Duke University, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | | | - Rachel G Greenberg
- Department of Pediatrics, Duke University, Durham, NC; Duke Clinical Research Institute, Durham, NC
| |
Collapse
|
2
|
俞 元, 陈 平. [Advances in clinical management of neonatal sepsis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:518-522. [PMID: 38802914 PMCID: PMC11135065 DOI: 10.7499/j.issn.1008-8830.2309145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/19/2024] [Indexed: 05/29/2024]
Abstract
Neonatal sepsis, as a significant cause of various complications and adverse outcomes in neonates, remains a serious health burden both domestically and internationally. Strategies such as antibiotic prophylaxis during delivery, the utilization of early-onset sepsis risk calculators, and quality improvement initiatives in neonatal wards are beneficial in alleviating the disease burden of neonatal sepsis. This paper provides a review of the epidemiology, risk factors, and recent advances in clinical management of neonatal sepsis.
Collapse
|
3
|
Lee KW, Yap SF, Murdan S, Zainudin Z, Abdul Hamid H, Emamjomeh M, Mohd Desa MN, Sither Joseph NM, Azmai Amal MN, Amin-Nordin S. Maternal and neonatal group B streptococcus colonisation: A systematic review and the meta-analysis of matched-pair studies. Acta Paediatr 2024; 113:892-911. [PMID: 38351491 DOI: 10.1111/apa.17152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 04/11/2024]
Abstract
AIM To determine the prevalence of group B Streptococcus (GBS) carriage among parturient women and neonates, and the relative risk of vertical transmission, the relative risk of early and late-onset GBS and the pooled incidence of early-late-onset GBS infection. METHODS A systematic search of relevant cohort studies from three electronic databases to identify all relevant studies published up to 7 November 2022. The review was conducted in accordance with PRISMA guidelines. Estimates were pooled using random-effects meta-analyses. RESULTS A total of 54 articles with 355 787 matched pairs of parturient women and neonates from 30 countries were included in the analysis. The pooled prevalence of GBS colonisation was 17.1% among the pregnant women and 1.0% among neonates. The pooled prevalence of vertical transmission of GBS was 4.5% and the pooled relative risk of GBS colonisation of neonates born to mothers with GBS was 9.9. CONCLUSION We support the implementation of targeted intrapartum antibiotic prophylaxis for all women who are positive for GBS as well as women with risks factors for early onset GBS in their infants regardless of their GBS colonisation status.
Collapse
Affiliation(s)
- Kai Wei Lee
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Sook Fan Yap
- Department of Pre-Clinical Sciences, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
- Centre for Research on Communicable Diseases, Universiti Tunku Abdul Rahman, Kajang, Malaysia
| | - Sudaxshina Murdan
- Department of Pharmaceutics, UCL School of Pharmacy, University College London, London, UK
| | - Zurina Zainudin
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Habibah Abdul Hamid
- Department of Obstetric and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohsen Emamjomeh
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Nasir Mohd Desa
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Narcisse Mary Sither Joseph
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohammad Noor Azmai Amal
- Department of Biology, Faculty of Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Syafinaz Amin-Nordin
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Institute of Bioscience, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| |
Collapse
|
4
|
Sonney KM, Tomasini D, Aden JK, Drumm CM. Utility of the Neonatal Early-Onset Sepsis Calculator in a Low-Risk Population. Am J Perinatol 2024; 41:e3164-e3169. [PMID: 37913817 PMCID: PMC11150069 DOI: 10.1055/a-2202-3830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE To compare early-onset sepsis (EOS) risk estimation and recommendations for infectious evaluation and/or empiric antibiotics using a categorical risk assessment versus the Neonatal Early-Onset Sepsis Calculator in a low-risk population. STUDY DESIGN Retrospective chart review of late preterm (≥350/7-366/7 weeks' gestational age) and term infants born at the Brooke Army Medical Center between January 1, 2012 and August 29, 2019. We evaluated those born via cesarean section with rupture of membranes (ROM) < 10 minutes. Statistical analysis was performed to compare recommendations from a categorical risk assessment versus the calculator. RESULTS We identified 1,187 infants who met inclusion criteria. A blood culture was obtained within 72 hours after birth from 234 (19.7%) infants and 170 (14.3%) received antibiotics per routine clinical practice, using categorical risk assessment. Respiratory distress was the most common indication for evaluation, occurring in 173 (14.6%) of patients. After applying the Neonatal Early-Onset Sepsis Calculator to this population, the recommendation was to obtain a blood culture on 166 (14%), to start or strongly consider starting empiric antibiotics on 164 (13.8%), and no culture or antibiotics on 1,021 (86%). Utilizing calculator recommendations would have led to a reduction in frequency of blood culture (19.7 vs. 14%, p < 0.0001) but no reduction in empiric antibiotics (14.3 vs. 13.8%, p = 0.53). There were no cases of culture-proven EOS. CONCLUSION This population is low risk for development of EOS; however, 19.7% received an evaluation for infection and 14.3% received antibiotics. Utilization of the Neonatal Early-Onset Sepsis Risk Calculator would have led to a significant reduction in the evaluation for EOS but no reduction in antibiotic exposure. Consideration of delivery mode and indication for delivery may be beneficial to include in risk assessments for EOS. KEY POINTS · Cesarean section with rupture of membranes at delivery confers low risk for EOS.. · Respiratory distress often triggers an EOS evaluation.. · Delivery mode should be considered in EOS risk..
Collapse
Affiliation(s)
- Kelley M Sonney
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Dakota Tomasini
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - James K Aden
- Department of Pediatrics, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Caitlin M Drumm
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| |
Collapse
|
5
|
[A cross-sectional study on the pathogen composition and antimicrobial resistance in neonates with sepsis in Hebei Province, China]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:350-357. [PMID: 38660898 PMCID: PMC11057296 DOI: 10.7499/j.issn.1008-8830.2309107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To study the pathogen composition and antimicrobial resistance characteristics in neonates with sepsis in the Hebei area, providing a basis for optimizing the management strategies for neonatal sepsis in the region. METHODS The medical data of neonates with sepsis confirmed by blood culture from 23 hospitals in Hebei Province were collected prospectively from November 1, 2021 to December 31, 2022. The pathogen composition and antimicrobial resistance characteristics were analyzed in early-onset sepsis (EOS), community-acquired late-onset sepsis (CALOS), and hospital-acquired late-onset sepsis (HALOS) cases. RESULTS A total of 289 neonates were included, accounting for 292 infection episodes, with 117 (40.1%) EOS, 95 (32.5%) CALOS, and 80 (27.4%) HALOS cases. A total of 294 pathogens were isolated, with 118 (40.1%) from the EOS group, where Escherichia coli (39 strains, 33.0%) and coagulase-negative staphylococci (13 strains, 11.0%) were the most common. In the CALOS group, 95 pathogens were isolated (32.3%), with Escherichia coli (35 strains, 36.8%) and group B Streptococcus (14 strains, 14.7%) being predominant. The HALOS group yielded 81 isolates (27.6%), with Klebsiella pneumoniae (24 strains, 29.6%) and Escherichia coli (21 strains, 25.9%) as the most frequent. Coagulase-negative staphylococci showed over 80% resistance to penicillin antibiotics. Escherichia coli and Klebsiella pneumoniae showed a resistance rate of 2.2% to 75.0% to common β-lactam antibiotics. The resistance rates of predominant Gram-negative bacteria in the HALOS group to common β-lactam antibiotics were higher than those in the CALOS group. CONCLUSIONS In the Hebei region, Escherichia coli is the most common pathogen in both EOS and LOS. There are differences in the composition and antimicrobial resistance of pathogens among different types of neonatal sepsis. The choice of empirical antimicrobial drugs should be based on the latest surveillance data from the region.
Collapse
|
6
|
Ujiie G, Murase M, Asai H, Igawa M, Okuyama A, Seo K, Ichizuka K, Ikeda H. Intrapartum prophylactic efficacy of ampicillin versus clindamycin in preventing vertical transmission of group B Streptococcus. Acta Paediatr 2024. [PMID: 38578153 DOI: 10.1111/apa.17230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
AIM To compare the prophylactic efficacy of ampicillin and clindamycin against vertical transmission of group B Streptococcus from mothers to their infants by evaluating the rates of group B Streptococcus colonisation. METHODS We retrospectively extracted data for mothers who delivered at Showa University Northern Yokohama Hospital between 1 October 2017 and 31 March 2021 and tested positive for antepartum group B Streptococcus, and their infants. The chi-square test was used to compare the rates of group B Streptococcus colonisation, sepsis, and meningitis. We conducted a multivariate logistic regression analysis, including the time interval between membrane rupture and delivery, chorioamnionitis, and maternal intrapartum fever (≥38.0°C). RESULTS Two hundred fifty-nine mothers and their infants were eligible. Ampicillin and clindamycin were administered to 150 and 109 mothers, respectively. In the ampicillin and clindamycin groups, 12.0% (18/150) and 37.6% (41/109) infants were group B Streptococcus positive, respectively. The rate of group B Streptococcus colonisation among infants was significantly lower in the ampicillin group (p < 0.001). Multivariate regression analysis showed similar results (p < 0.001). No sepsis or meningitis cases were observed in either group. CONCLUSION Prophylactic efficacy of clindamycin against the vertical transmission of group B Streptococcus is lower than that of ampicillin.
Collapse
Affiliation(s)
- Gakuto Ujiie
- Children Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Masahiko Murase
- Children Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hideyuki Asai
- Children Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Mio Igawa
- Children Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Ayumi Okuyama
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kohei Seo
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kiyotake Ichizuka
- Department of Obstetrics and Gynecology, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Hirokazu Ikeda
- Children Medical Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| |
Collapse
|
7
|
Sileo FG, Tramontano AL, Sponzilli A, Facchinetti F. Prelabour rupture of the membranes at term: antibiotic overuse in Italy. Minerva Obstet Gynecol 2024; 76:135-141. [PMID: 35829626 DOI: 10.23736/s2724-606x.22.05145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The proper management of women with premature rupture of membrane (PROM) and not spontaneously entering in labour remains controversial. The aim of this study was to identify the current management for women with PROM at term according to the Group B Streptococcus (GBS) status across different Italian hospitals. METHODS Anonymous online survey evaluating: the current practice of women with PROM in terms of management (expectant management vs. induction of labour) and antibiotic prophylaxis according to GBS status. RESULTS In case of negative GBS status, the 82.4% of respondents wait until 24 hours before labour induction. Antibiotics are administered for prophylaxis in 35.3%, 27.5% and 2% at 18, 12 and 24 hours respectively. The remaining 35.3% of respondents are divided between those using antibiotics only with signs of infections or according to different risk factors (i.e. meconium-stained amniotic fluid or suspected infection). Neonates born from a mother with negative GBS status almost never (90.2%) receive prophylactic antibiotics. In case of positive GBS status, induction is started as soon as possible by 49.1% of respondents; the remnants choose to wait 6 (15.7%), 12 (17.6%), 18 (3.9%) and 24 (13.7%) hours. Antibiotics are administered as soon as possible by 78.4% of clinicians. In the neonates, 51% of neonatologist administer antibiotics upon clinical indications (suspected sepsis); 15.7% use antibiotics routinely or with a short interval between maternal antibiotics and delivery (17.6%). CONCLUSIONS The management after PROM is highly heterogeneous with an inappropriate extension of antibiotic prophylaxis in cases with negative GBS status.
Collapse
Affiliation(s)
- Filomena G Sileo
- Unit Prenatal Medicine, Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- International Doctorate School in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Anna L Tramontano
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Sponzilli
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Division of Obstetrics and Gynecology, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy -
| |
Collapse
|
8
|
Spencer EE, Nostrand SV, Arya S. Group B Streptococcus Brain Abscess in a Neonate with Bilateral Otorrhea. AJP Rep 2024; 14:e106-e110. [PMID: 38586436 PMCID: PMC10994689 DOI: 10.1055/a-2275-9482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/19/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Group B streptococcus (GBS) is the leading cause of bacterial sepsis and meningitis in neonates worldwide, but brain abscess secondary to GBS is extremely rare. While temporal brain abscesses have been described as a sequelae of otogenic infections in children and adults, such a presentation has not been described in neonates. Case Description An 8-day-old female infant presented with a fever and irritability along with bilateral purulent otorrhea. Maternal GBS screening was negative, but the delivery was complicated by chorioamnionitis. Workup revealed neutrophilic pleocytosis in the cerebrospinal fluid and culture of the ear drainage was positive for GBS. Magnetic resonance imaging showed a circular lesion with rim enhancement within the left temporal lobe concerning for an abscess. The infant was treated with 14 days of intravenous vancomycin, cefepime, and metronidazole followed by 10 weeks of intravenous ampicillin. The hospital course was complicated by seizures and obstructive hydrocephalus requiring multiple neurosurgical interventions. Conclusion Brain abscess can occur as a sequela of GBS meningitis in neonates, but they are rare. Otogenic infections require prompt evaluation and treatment as they can progress to serious central nervous infections in neonates.
Collapse
Affiliation(s)
- Emily E. Spencer
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Fairborn, Ohio
| | - Sarah Van Nostrand
- Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital and Pediatrix Neonatology of Ohio, Dayton, Ohio
| | - Shreyas Arya
- Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital and Pediatrix Neonatology of Ohio, Dayton, Ohio
| |
Collapse
|
9
|
Wang LA, Baer RJ, Namazy JA, Chambers CD. Maternal penicillin allergy and infant outcomes: Results from a large administrative cohort. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1080-1082.e1. [PMID: 38092226 DOI: 10.1016/j.jaip.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 12/31/2023]
Affiliation(s)
- Laura A Wang
- Department of Pediatrics, Division of Allergy and Immunology, University of Colorado, Aurora, Colo.
| | - Rebecca J Baer
- Department of Pediatrics and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, Calif
| | - Jennifer A Namazy
- Division of Allergy and Immunology, Scripps Clinic, San Diego, Calif
| | - Christina D Chambers
- Department of Pediatrics and Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, Calif
| |
Collapse
|
10
|
Dutra KJ, Lazenby GB, Goje O, Soper DE. Cefazolin as the mainstay for antibiotic prophylaxis in patients with a penicillin allergy in obstetrics and gynecology. Am J Obstet Gynecol 2024:S0002-9378(24)00448-4. [PMID: 38527607 DOI: 10.1016/j.ajog.2024.03.019] [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: 11/16/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 03/27/2024]
Abstract
Cefazolin is the most common antibiotic used for prophylaxis in obstetrics and gynecology. Among those with a penicillin allergy, alternative antibiotics are often chosen for prophylaxis, given fears of cross-reactivity between penicillin and cefazolin. Alternative antibiotics in this setting are associated with adverse sequelae, including surgical site infection, induction of bacterial resistance, higher costs to the healthcare system, and possible Clostridium difficile infection. Given the difference in R1 side chains between penicillin and cefazolin, cefazolin use is safe and should be recommended for patients with a penicillin allergy, including those who experience Immunoglobulin E-mediated reactions such as anaphylaxis. Cefazolin should only be avoided in those who experience a history of a severe, life-threatening delayed hypersensitivity reaction manifested as severe cutaneous adverse reactions (Steven-Johnson Syndrome), hepatitis, nephritis, serum sickness, and hemolytic anemia in response to penicillin administration. In addition, >90% of those with a documented penicillin allergy do not have true allergies on skin testing. Increased referral for penicillin allergy testing should be incorporated into routine obstetric care and preoperative assessment to reduce suboptimal antibiotic prophylaxis use. More education is needed among providers surrounding penicillin allergy assessment and cross-reactivity among penicillins and cephalosporins to optimize antibiotic prophylaxis in obstetrics and gynecology.
Collapse
Affiliation(s)
- Karley J Dutra
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC.
| | - Gweneth B Lazenby
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| | - Oluwatosin Goje
- Department of Subspecialties, Obstetrics and Gynecology Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - David E Soper
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
11
|
Rommelfanger E, Lee E, Sauer C. Administering Intravenous Fluid in the Immediate Postpartum Period Minimizes Ultimate Formula Feeding. Breastfeed Med 2024; 19:109-113. [PMID: 38265433 DOI: 10.1089/bfm.2023.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Background: Human milk is the optimal form of nutrition for infants. Interventions associated with a decreased rate of exposure to infant formula are of benefit. We hypothesized that intravenous (IV) fluids could be associated with a reduction of infant formula when infants are separated from their mother. Methods: Retrospective chart review of term infants admitted to Rady Children's Neonatal Intensive Care Units (NICUs) for possible sepsis who received antibiotic treatment but did not develop sepsis. IV fluid use and formula exposure were analyzed. Results: Six hundred twenty-eight infants met the inclusion criteria. Around 25.6% received IV fluids and 74.4% did not. IV fluid administration was associated with a significantly reduced chance of formula exposure while in the NICU (odds ratio: 0.694, 95% confidence interval: 0.484-0.993; *p = 0.046). Conclusion: This retrospective chart review found that infants transferred to the NICU and separated from their mothers due to chorioamnionitis exposure who received IV fluids were significantly less likely to receive any infant formula than infants who were not administered IV fluids.
Collapse
Affiliation(s)
- Emma Rommelfanger
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California School of Medicine, La Jolla, California, USA
| | - Charles Sauer
- Division of Neonatology, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California, USA
| |
Collapse
|
12
|
Coggins SA, Puopolo KM. Neonatal Group B Streptococcus Disease. Pediatr Rev 2024; 45:63-73. [PMID: 38296778 PMCID: PMC10919294 DOI: 10.1542/pir.2023-006154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Group B Streptococcus (GBS) is an important cause of neonatal sepsis in term and preterm infants. Because GBS colonizes human genitourinary and gastrointestinal tracts, a significant focus of neonatal GBS disease prevention is to interrupt vertical transmission of GBS from mother to infant during parturition. Routine antepartum GBS screening in pregnant women, as well as widespread use of intrapartum antibiotic prophylaxis, have aided in overall reductions in neonatal GBS disease during the past 3 decades. However, neonatal GBS disease persists and may cause mortality and significant short- and long-term morbidity among survivors. Herein, we highlight contemporary epidemiology, microbial pathogenesis, and the clinical presentation spectrum associated with neonatal GBS disease. We summarize obstetric recommendations for antenatal GBS screening, indications for intrapartum antibiotic prophylaxis, and considerations for antibiotic selection. Finally, we review national guidelines for risk assessment and management of infants at risk for GBS disease.
Collapse
MESH Headings
- Infant
- Pregnancy
- Female
- Infant, Newborn
- Humans
- Pregnancy Complications, Infectious/diagnosis
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Streptococcal Infections/diagnosis
- Streptococcal Infections/drug therapy
- Streptococcal Infections/epidemiology
- Infant, Premature
- Anti-Bacterial Agents/therapeutic use
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/therapy
- Streptococcus agalactiae
- Infectious Disease Transmission, Vertical/prevention & control
Collapse
Affiliation(s)
- Sarah A. Coggins
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Karen M. Puopolo
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA, US
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA
- Clinical Futures, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| |
Collapse
|
13
|
Zakerifar M, Goli HR, Kaboosi H, Rahmani Z, Peyravii Ghadikolaii F. Capsular gene distribution and RAPD typing of Streptococcus agalactiae isolated from pregnant women. AMB Express 2024; 14:13. [PMID: 38282173 PMCID: PMC10822826 DOI: 10.1186/s13568-024-01671-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024] Open
Abstract
Streptococcus agalactiae has different virulence factors, from which the capsule has the most significant role in the pathogenesis of this organism. We aimed to investigate the distribution of more prevalent capsular genes among different Random Amplified Polymorphic DNA (RAPD) types of S. agalactiae isolated from pregnant women. A total of 106 isolates were collected from 420 vaginal and rectal swabs obtained from pregnant women. The specimens were transferred using Todd Hewitt Broth and were cultured on a blood agar containing antibiotics. The S. agalactiae isolates were identified by the standard microbiological and biochemical tests. The genomic DNAs of S. agalactiae isolates were extracted using an extraction kit. Then, the PCR method was used to detection of the capsular genes. Moreover, The RAPD PCR was used to genotyping of the isolates. The colonization rate of the pregnant women was 25.23%, and there was a statistically significant correlation between the weeks of gestation and the probability of colonization (p-value < 0.05). Also, 31 (29.24%) and 18 (16.98%) pregnant women had a history of abortion and membrane rupture, respectively. In addition, 20 (18.86%), 32 (30.18%), 4 (3.77%), and 6 (5.66%) isolates carried genes encoding capsular types Ia, Ib, III, and V, respectively. None isolates had the type II capsular gene, and other 44 isolates were non-typeable. Nine clones (clusters) of S. agalactiae were observed in the present study with 70% similarity, and 53 different types were identified among the isolates. Except for capsular types III and V that belonged to clones 3, 5, 7, and 9, other capsular types were detected in different RAPD types. We found that the capsular types Ib and Ia were predominant among pregnant women in this area, indicating their significance for vaccine designation. Also, our isolates showed a lower genotypic diversity in RAPD typing. This may be due to the same sources of most isolates.
Collapse
Affiliation(s)
- Mona Zakerifar
- Department of Microbiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran
| | - Hamid Reza Goli
- Molecular and Cell Biology Research Centre, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
- Department of Medical Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Hami Kaboosi
- Department of Microbiology, Ayatollah Amoli Branch, Islamic Azad University, Amol, Iran.
| | - Zahra Rahmani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | | |
Collapse
|
14
|
Judy AE, Frymoyer A, Ansari J, Drover DR, Carvalho B. Ampicillin Pharmacokinetics in Peripartum and Laboring Women. Am J Perinatol 2024; 41:127-133. [PMID: 34670320 DOI: 10.1055/a-1674-6394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Ampicillin is used for multiple peripartum indications including prevention of neonatal group B streptococcus (GBS) and treatment of chorioamnionitis. Despite its widespread use in obstetrics, existing pharmacokinetic data for ampicillin do not address contemporary indications or dosing paradigms for this population. We sought to characterize the pharmacokinetic profile of ampicillin administered to laboring women. STUDY DESIGN Using whole blood dried blood spot sampling technique, maternal blood samples were collected at specified times from 31 women receiving intravenous (IV) ampicillin for peripartum indications. Women received either a 2-g loading dose with 1-g administered every 4 hours (GBS) or 2-g every 6 hours (chorioamnionitis). Pharmacokinetics were analyzed via a population approach with nonlinear mixed-effect modeling. RESULTS The data were best described by a two-compartment model with first-order elimination, with the following whole blood parameters: central volume of distribution (V1), 75.2 L (95% confidence interval [CI]: 56.3-93.6); clearance (CL), 82.4 L/h (95% CI: 59.7-95.7); intercompartmental clearance (Q), 20.9 L/h (95% CI: 16.2-38.2); and peripheral volume of distribution (V2), 61.1 L (95% CI: 26.1-310.5). Interpatient variation in CL and V1 was large (42.0 and 56.7%, respectively). Simulations of standard dosing strategies demonstrated over 98% of women are predicted to achieve an estimated free plasma concentration above mean inhibitory concentration (MIC) of 0.5 μg/mL for more than 50% of the dosing interval. CONCLUSION Although large variation in the pharmacokinetics of ampicillin in pregnant women exists, as predicted by our model, current standard dosing strategies achieve adequate exposure for GBS in nearly all patients. KEY POINTS · IV ampicillin is widely used in obstetrics.. · Pharmacokinetic studies are lacking.. · Ampicillin pharmacokinetics were established.. · Ampicillin clearance and volume of distribution are high.. · Current ampicillin dosing strategies are sufficient..
Collapse
Affiliation(s)
- Amy E Judy
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Adam Frymoyer
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jessica Ansari
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - David R Drover
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
15
|
Flannery DD, Puopolo KM. EBNEO Commentary: Safety and immunogenicity of GBS vaccine in pregnancy and determination of a serocorrelate for infant protection. Acta Paediatr 2024; 113:157-158. [PMID: 37950357 DOI: 10.1111/apa.17038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
|
16
|
Kharrat R, Ben Ayed N, Ktari S, Regaieg C, Mezghani S, Hmida N, Mahjoubi F, Gargouri A, Hammami A. Group B Streptococcus and Perinatality in the South of Tunisia: Epidemiology, Serotype Distribution, and Antibiotic Susceptibility. Fetal Pediatr Pathol 2024; 43:21-32. [PMID: 38069499 DOI: 10.1080/15513815.2023.2287519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/17/2023] [Indexed: 01/25/2024]
Abstract
INTRODUCTION In the lack of updated Tunisian epidemiological data, we sought to describe the epidemiology of Group B Streptococcus (GBS) in pregnant women and newborns. MATERIALS AND METHODS A retrospective analysis of GBS neonatal invasive infections and a cross-sectional study evaluating the prevalence of maternal GBS colonization were conducted. GBS isolates were tested for antimicrobial susceptibility, serotyped, and assessed for the appurtenance to the hypervirulent ST17 clone. RESULTS Of 98 neonates with GBS, early-onset GBS disease (EOD) comprised 83.7 and 16.3% were late-onset GBS disease (LOD). The prevalence of maternal GBS colonization was 27%. All GBS isolates were susceptible to penicillin. Serotype III predominated (42.6%) for neonatal invasive infections. GBS isolates belonging to the ST17 sequence type were found only as serotype III. CONCLUSION This study documents the frequency of GBS EOD, the high rate of maternal GBS colonization, and the predominance of the hypervirulent clone type III/ST17 in infants.
Collapse
Affiliation(s)
- Rim Kharrat
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nourelhouda Ben Ayed
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Sonia Ktari
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Chiraz Regaieg
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Sonda Mezghani
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Nedia Hmida
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Faouzia Mahjoubi
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Abdellatif Gargouri
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
- Department of Neonatology, Hedi Chaker University Hospital, University of Sfax, Sfax, Tunisia
| | - Adnene Hammami
- Laboratory of Microbiology, Habib Bourguiba University Hospital, University of Sfax, Sfax, Tunisia
- Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| |
Collapse
|
17
|
Liang CS, Sebastian A, McKennan C, Bertoni CB, Hooven TA, Kish M, Schwabenbauer K, Yanowitz T, King BC. Clinical and economic impacts of a modified-observational screening approach to well-appearing infants born to mothers with chorioamnionitis. J Perinatol 2023:10.1038/s41372-023-01858-3. [PMID: 38155229 DOI: 10.1038/s41372-023-01858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE Term infants born to mothers with chorioamnionitis are at risk for early-onset sepsis (EOS). We aimed to measure the impact of changing from a categorical to a modified-observational EOS screening approach on NICU admission, antibiotic utilization, and hospitalization costs. STUDY DESIGN Single-center retrospective pre-post cohort study of full-term infants born to mothers with chorioamnionitis. Primary outcomes included NICU admission, antibiotic utilization, and hospitalization costs. Outcomes were adjusted for demographic variables. Budget-impact analysis was performed using bootstrapping with replication. RESULTS 380 term infants were included (197 categorical; 183 modified-observational). There was a significant decrease in NICU admission and antibiotic utilization (p < 0.05) in the modified-observational cohort but no significant difference in per-patient total hospitalization costs. Budget-impact analysis suggested a high probability of cost savings. CONCLUSION A modified-observational approach to evaluating term infants of mothers with chorioamnionitis can reduce NICU admission and unnecessary antibiotic therapy, and may lead to cost-savings.
Collapse
Affiliation(s)
- Cynthia S Liang
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA.
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA.
| | - Armand Sebastian
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Christopher McKennan
- University of Pittsburgh, School of Arts and Sciences, Department of Statistics, Pittsburgh, PA, USA
| | - C Briana Bertoni
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Thomas A Hooven
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh Richard King Mellon Institute for Pediatric Research, Pittsburgh, PA, USA
| | - Mary Kish
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Kathleen Schwabenbauer
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Toby Yanowitz
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| | - Brian C King
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
- UPMC Magee-Womens Hospital, Pittsburgh, PA, USA
| |
Collapse
|
18
|
McCoy JA, Bromwich K, Gerson KD, Levine LD. Association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis among patients undergoing induction of labor at term. Am J Obstet Gynecol 2023; 229:672.e1-672.e8. [PMID: 37352908 PMCID: PMC10733553 DOI: 10.1016/j.ajog.2023.06.038] [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: 02/01/2023] [Revised: 06/16/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Rectovaginal colonization with Group B Streptococcus during pregnancy has historically been shown to be associated with an increased risk of clinical chorioamnionitis and peripartum infectious morbidity. OBJECTIVE Newer observational data in the era of intrapartum antibiotic prophylaxis suggest a possible reversal of this association; however, it is unclear if this is related to differences in labor management for those with and without Group B Streptococcus colonization. We therefore sought to assess the association between intrapartum antibiotic prophylaxis for Group B Streptococcus colonization and clinical chorioamnionitis within the context of a randomized induction of labor trial with a standardized labor protocol. STUDY DESIGN We performed an exploratory secondary analysis of a randomized trial of patients undergoing term induction at a tertiary care center. Patients received third trimester Group B Streptococcus screening and intrapartum antibiotic prophylaxis as routine care. Group B Streptococcus detection was performed using a carrot broth-enhanced subculture to Group B Streptococcus Detect approach (Hardy Diagnostics, Santa Maria, CA). Labor management was protocolized per the trial. Patients with unknown Group B Streptococcus status or who did not receive intrapartum antibiotic prophylaxis, if indicated, were excluded. The primary outcome was diagnosis of clinical chorioamnionitis, compared between patients who received intrapartum antibiotic prophylaxis for known Group B Streptococcus positive status (by culture, history, or Group B Streptococcus bacteriuria) and those who were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis. Secondary outcomes included postpartum endometritis, wound infection, a composite maternal peripartum infectious morbidity, and neonatal outcomes. RESULTS A total of 491 patients were enrolled in the trial. Of these, 466 had a known Group B Streptococcus status and received or did not receive intrapartum antibiotic prophylaxis accordingly and were included in this analysis: 292 (62.7%) were Group B Streptococcus negative and did not receive intrapartum antibiotic prophylaxis, and 174 (37.3%) were Group B Streptococcus positive and received intrapartum antibiotic prophylaxis. The majority of patients were Non-Hispanic Black (78.1%) and nulliparous (59.7%). There were no differences in demographic, clinical, induction or labor characteristics between groups. Patients who were Group B Streptococcus positive had a 49% lower rate of clinical chorioamnionitis (8.1% vs 14.7%, odds ratio, 0.51; P=.03) and a lower rate of peripartum infectious morbidity (8.1% vs 15.8%, odds ratio, 0.47; P=.02) compared to those who were Group B Streptococcus negative. Infants born to patients who were Group B Streptococcus positive were significantly less likely to be admitted to the neonatal intensive care unit (3.4% vs 15.1%, P<.001). CONCLUSION Although Group B Streptococcus colonization has historically been considered a risk factor for clinical chorioamnionitis, in the era of universal antibiotic prophylaxis for Group B Streptococcus positive patients, our findings support the point that intrapartum antibiotic prophylaxis for Group B Streptococcus positivity is associated with lower rates of clinical chorioamnionitis and peripartum infectious morbidity among patients undergoing induction with protocolized labor management. These findings demonstrate that intrapartum antibiotic prophylaxis for Group B Streptococcus may protect against perinatal infectious morbidity, a phenomenon that warrants further investigation.
Collapse
Affiliation(s)
- Jennifer A McCoy
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Kira Bromwich
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kristin D Gerson
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa D Levine
- Maternal Fetal Medicine Research Program, Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| |
Collapse
|
19
|
Al-Abdi SY, Al-Omran AM, Moustafa NI, Al-Qoweri ZS, El-Nokbasy SA. A Saudi Hospital's Experience in the Management of Well-Appearing Neonates at Increased Risk for Early-Onset Bacterial Sepsis. Cureus 2023; 15:e49570. [PMID: 38156127 PMCID: PMC10754094 DOI: 10.7759/cureus.49570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Early-onset neonatal bacterial sepsis (EOS) is a serious medical condition where pathogenic bacterial species are isolated from the blood of newborns within the first 72 hours of life. Neonatal healthcare providers face challenges in managing well-appearing newborns born at 35 weeks gestational age or more who are at an increased risk of developing EOS. The American Academy of Pediatrics (AAP) has recommended three approaches for managing EOS. One of these approaches includes enhanced observation to observe the progression of the newborn's clinical condition within the first 48 hours after birth. The AAP recommends that birth centers should adopt institutional approaches that are tailored to their specific local resources and structures. It recommends that the chosen approach is evaluated to identify infrequent negative outcomes and to confirm its effectiveness. AIMS To report our experience in managing EOS in newborns born at 35 weeks gestation or later with an increased risk for EOS. METHODS This was a review of electronic medical records from the past five years. We included a sample of newborns born at or after 35 weeks gestational age who were at increased risk of EOS and appeared to be healthy. We implemented universal antenatal culture-based screening for Group B streptococcus (GBS). We followed the recommendations of the AAP in 2012 to manage these newborns. We performed a complete blood count (CBC) with differential and C-reactive protein (CRP) tests to predict EOS. We also considered the newborns symptomatic if they displayed any clinical signs of EOS. RESULTS A total of 806 newborns were included in the study, out of which 27 (3.3%) of them had symptoms of EOS, while the remaining 782 newborns appeared healthy. Predictive blood tests were performed on 281 (34.9%) of the newborns, out of which 126 (44.8%) of them had a positive test result. However, blood cultures were obtained from 134 (16.6%) of the total cohort. Intravenous antibiotics were administered to 33 (4.1%) of the newborns. All symptomatic newborns had a positive predictive blood test result, and two of them had culture-proven EOS. Blood cultures obtained from the remaining 107 asymptomatic newborns were negative. In this context, 140 newborns needed to be pricked for positive predictive blood tests to predict one case of EOS. However, if the positive predictive blood tests were only performed on symptomatic newborns, then only 14 newborns would need to be pricked to predict one case of EOS. CONCLUSION Based on the present study, it is advised to follow the current AAP recommendation against predicting EOS by solely relying on CBC with differential or CRP. The study suggests that the enhanced observation approach is a more sensible option for managing EOS, but this needs to be confirmed in a larger study.
Collapse
|
20
|
Kuld R, Krauth A, Kühr J, Krämer J, Dittrich R, Häberle L, Müller A. Possible Rates of Detection of Neonatal Sepsis Pathogens in the Context of Microbiological Diagnostics in Mothers - Real World Data. Geburtshilfe Frauenheilkd 2023; 83:1382-1390. [PMID: 37928410 PMCID: PMC10624541 DOI: 10.1055/a-2091-0856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/07/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The aim of this study was to identify the rate of detection of neonatal sepsis pathogens in maternal microbiological smears. Study Design This is a retrospective study conducted at a Level 1 perinatal center in the context of routine care from 2014 to 2019. For all premature infants and neonates with neonatal sepsis, the neonatal and maternal microbiological findings were examined to see if there was a match. Results During the study period, a total of 948 premature or newborn infants were identified as having a neonatal infection. Among all of the premature or newborn infants, 209 (22%) met the diagnostic criteria for neonatal sepsis; of these, 157 were premature births and 52 were full-term births. We evaluated the microbiological findings for these 209 mother and child pairs. No pathogens were detected in 27 out of 157 mothers of premature infants (17.1%) and in 31 out of 52 mothers of full-term infants (59.6%). In the premature infant group there were pairs with matching pathogens in 30 out of 130 cases (23.1%, 95% CI: 16.1-31.3), and in the full-term infant group there was a match in 4 out of 21 cases (19%, 95% CI: 5.4-41.9). The number needed to test to have a 90% probability of success for pathogen detection varies between 9 and 11 in the most favorable case and 26 and 32 in the least favorable case, depending on the evaluation method. Conclusion In cases of neonatal sepsis, the sepsis-causing pathogen was successfully detected through prior analysis of a maternal smear in 7% of full-term infants and in 19% of premature infants. The number needed to test was relatively high in all groups. The value of maternal smears for identifying neonatal sepsis-causing pathogens needs to be critically questioned.
Collapse
Affiliation(s)
- Raffael Kuld
- Klinik für Frauenheilkunde und Geburtshilfe, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Krauth
- Klinik für Kinderheilkunde, Franz-Lust-Kinderklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Joachim Kühr
- Klinik für Kinderheilkunde, Franz-Lust-Kinderklinik, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Janine Krämer
- Klinik für Frauenheilkunde und Geburtshilfe, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Ralf Dittrich
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Lothar Häberle
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Müller
- Klinik für Frauenheilkunde und Geburtshilfe, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
21
|
Gupta A, Youssef J, Arora N, Ghaly E, Shilkrut A. Comparison of proposed National Institute of Child Health and Human Development panel recommendations with newborn sepsis risk calculator in term neonates exposed to maternal chorioamnionitis. Pediatr Neonatol 2023; 64:674-678. [PMID: 37407418 DOI: 10.1016/j.pedneo.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/27/2022] [Accepted: 02/01/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Maternal chorioamnionitis (MC) is one of the major risk factors for early-onset neonatal sepsis. Kaiser sepsis risk calculator (SRC) is a validated risk assessment tool for such newborns. The National Institute of Child Health and Human Development (NICHD) workshop on MC has proposed a risk assessment algorithm. The objective of the study was to compare the reduction in antibiotic use in newborns treated with SRC and NICHD algorithm and determine the antibiotic use correlation between them. METHODOLOGY A retrospective chart review was performed on newborns born at ≥ 37 weeks to mothers with MC during the years 2018-2020. The same cohort of newborns was evaluated using SRC and NICHD algorithm to determine whether treatment with antibiotics could have been avoided in some patients. The data were analyzed using a t-test, Chi-square test, and ANOVA. RESULTS During the study period, 101 newborns were born to mothers with chorioamnionitis and received antibiotics. When the newborns were assessed using the SRC, only 16/101 (15.84%) would have received treatment. When NICHD algorithm was applied to the same cohort 71/101 (70.30%) newborns would have received treatment. The two approaches agreed in their assessment for treatment or observation only in 44/101 (43.56%) of the cases. The NICHD treatment group had a higher incidence of chorioamnionitis as seen in placental pathology (94.37% vs. 75.00% for Kaiser, p-0.015). The SRC treatment group however had newborns with significantly lower Apgar score at 1 min (8.21 vs 6.63, p-0.006) and 5-minute (8.69 vs 8.00, p-0.019) and had significantly higher supplemental oxygen requirements at admission (62.50% vs. 21.13%, p < 0.001). CONCLUSION Both SRC and NICHD algorithms expose fewer newborns to antibiotics; however, they differ in the number of newborns that would require antibiotics. Ventilation assistance and lower Apgar scores were associated with higher probability of antibiotic administration.
Collapse
Affiliation(s)
- Arpit Gupta
- Department of Pediatrics, New York Health and Hospital/Metropolitan Hospital Center, NYC, NY, 10029, USA.
| | - Julia Youssef
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, 10595, USA
| | - Nidhi Arora
- Department of Pediatrics, New York Health and Hospital/Metropolitan Hospital Center, NYC, NY, 10029, USA
| | - Emad Ghaly
- Department of Pediatrics, New York Health and Hospital/Metropolitan Hospital Center, NYC, NY, 10029, USA
| | - Alexander Shilkrut
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, 10595, USA
| |
Collapse
|
22
|
Wen Z, Wang C, Bai B, Cao X, Fan K, Hu C, Li P, Deng Q, Yu Z. In Vitro, In Vivo, and In Silico Activities of Ginkgolic Acid C15:1 against Streptococcus agalactiae Clinical Isolates. ACS Infect Dis 2023; 9:1867-1877. [PMID: 37696007 DOI: 10.1021/acsinfecdis.3c00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Streptococcus agalactiae is the major cause of invasive neonatal infections and is a recognized pathogen associated with various diseases in nonpregnant adults. The emergence and spread of antibiotic-resistant S. agalactiae necessitate the development of a novel antibacterial agent. Here, the potential antibacterial activities and mechanisms of ginkgolic acid C15:1 (GA (15:1)) from Ginkgo biloba against clinical S. agalactiae are characterized. The MIC50 and MIC90 values for GA (15:1) against 72 clinical S. agalactiae isolates were 6.25 and 12.5 μM, respectively. GA (15:1) showed a strong bactericidal effect against both planktonic bacteria and bacteria embedded in biofilms as well as significant effectiveness in suppressing the growth of S. agalactiae biofilms. Moreover, GA (15:1) possesses intracellular antibacterial activity and could significantly decrease the bacterial burden in the intraperitoneal infection model of S. agalactiae. Mechanistic studies showed that GA (15:1) triggers membrane damage of S. agalactiae through a unique dual-targeting mechanism of action (MoA). First, GA (15:1) targets phospholipids in the bacterial cytoplasmic membrane. Second, by using mass-spectrometry-based drug affinity responsive target stability (DARTS) and molecular docking, lipoprotein signaling peptidase II (lspA) was identified as a target protein of GA (15:1), whose role is crucial for maintaining bacterial membrane depolarization and permeabilization. Our findings suggest a potential therapeutic strategy for developing GA (15:1) to combat S. agalactiae infections.
Collapse
Affiliation(s)
- Zewen Wen
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Cong Wang
- Department of Microbiology, The First Affiliated Hospital of Jiamusi University, Jiamusi 154003, China
| | - Bing Bai
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Xinyi Cao
- Department of Microbiology, The First Affiliated Hospital of Jiamusi University, Jiamusi 154003, China
| | - Kewei Fan
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Chunyou Hu
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Peiyu Li
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Qiwen Deng
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| | - Zhijian Yu
- Department of Infectious Diseases and Shenzhen Key Laboratory for Endogenous Infections, Huazhong University of Science and Technology Union Shenzhen Hospital, No. 89 Taoyuan Road, Nanshan District, Shenzhen 518052, China
| |
Collapse
|
23
|
Hanze Villavicencio KL, Job MJ, Burghard AC, Taffet A, Banda FM, Vurayai M, Mokomane M, Arscott-Mills T, Mazhani T, Nchingane S, Thomas B, Steenhoff AP, Ratner AJ. Genomic Analysis of Group B Streptococcus Carriage Isolates From Botswana Reveals Distinct Local Epidemiology and Identifies Novel Strains. Open Forum Infect Dis 2023; 10:ofad496. [PMID: 37869411 PMCID: PMC10588617 DOI: 10.1093/ofid/ofad496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023] Open
Abstract
In pregnant people colonized with group B Streptococcus (GBS) in Botswana, we report the presence/expansion of sequence types 223 and 109, a low rate of erythromycin resistance, and 3 novel sequence types. These data highlight the importance of local epidemiologic studies of GBS, a significant source of neonatal disease.
Collapse
Affiliation(s)
- Karen L Hanze Villavicencio
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan J Job
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Anne Claire Burghard
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NewYork, USA
| | - Allison Taffet
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
| | - Francis M Banda
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Moses Vurayai
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Margaret Mokomane
- School of Allied Health Professionals, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Tonya Arscott-Mills
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-UPenn Partnership, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tiny Mazhani
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | - Brady Thomas
- Department of Pediatrics, Stead Family Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Andrew P Steenhoff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Pediatrics & Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Botswana-UPenn Partnership, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
- Global Health Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam J Ratner
- Department of Pediatrics, NewYork University Grossman School of Medicine, New York, New York, USA
- Department of Microbiology, NewYork University Grossman School of Medicine, New York, New York, USA
| |
Collapse
|
24
|
Morgan JA, Hankins ME, Callais NA, Albritton CW, Vanchiere JA, Betcher RE, Lewis DF. Group B Streptococcus Rectovaginal Colonization and Resistance Patterns in HIV-Positive Compared to HIV-Negative Pregnant Patients. Am J Perinatol 2023; 40:1573-1578. [PMID: 34784616 DOI: 10.1055/s-0041-1739356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective of our study is to determine if human immunodeficiency virus (HIV)-positive pregnant patients have a higher rate of group B streptococcus (GBS) rectovaginal colonization compared with HIV-negative pregnant patients. STUDY DESIGN Our study is a multi-site retrospective study performed at Ochsner Louisiana State University-Health Shreveport and Monroe campuses including patients who delivered between December 2011and June 2019. Rates of GBS rectovaginal colonization between HIV-positive pregnant patients were compared with a control group of HIV-negative patients. The control group was age and race matched in a 2:1 fashion. The primary outcome was to investigate rates of GBS rectovaginal colonization. Secondary outcomes included GBS culture antibiotic sensitivities, presence of GBS urinary tract infection, GBS positivity based on HIV viral load, and GBS positivity based on new vs established diagnosis of HIV. Continuous data were analyzed using an unpaired t-test, and categorical data were analyzed using a Chi-squared test. The probability level of <0.05 was set as statistically significant. RESULTS A total of 225 patients were included in the final analysis, 75 HIV-positive and 150 HIV-negative controls. Demographic differences were noted. HIV-positive patients were more likely to deliver preterm and were more likely to deliver via cesarean section. Our primary outcome showed no significant differences in incidence of GBS colonization between HIV-positive patients and control group (n = 31, 41.3% vs n = 46, 30.6%, p = 0.136). Antibiotic resistance patterns showed no significant difference between the two groups. There were no significant differences in GBS positivity based on HIV viral load. CONCLUSION Our study does not show a statistically significant difference in the incidence of GBS colonization between HIV-positive patients and HIV-negative controls. KEY POINTS · HIV-positive pregnant patients do not have an increased risk of GBS rectovaginal colonization.. · HIV-positive pregnant patients have similar rates of GBS colonization regardless of viral load.. · GBS antibiotic sensitivities are similar in HIV-positive and HIV-negative pregnant patients..
Collapse
Affiliation(s)
- John A Morgan
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Miriam E Hankins
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Nicholas A Callais
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Charles W Albritton
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - John A Vanchiere
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Raymond E Betcher
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - David F Lewis
- Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
| |
Collapse
|
25
|
Moore R, Spicer SK, Lu J, Chambers SA, Noble KN, Lochner J, Christofferson RC, Vasco KA, Manning SD, Townsend SD, Gaddy JA. The Utility of Human Milk Oligosaccharides against Group B Streptococcus Infections of Reproductive Tissues and Cognate Adverse Pregnancy Outcomes. ACS CENTRAL SCIENCE 2023; 9:1737-1749. [PMID: 37780357 PMCID: PMC10540283 DOI: 10.1021/acscentsci.3c00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 10/03/2023]
Abstract
Preterm birth affects nearly 10% of all pregnancies in the United States, with 40% of those due, in part, to infections. Streptococcus agalactiae (Group B Streptococcus, GBS) is one of the most common perinatal pathogens responsible for these infections. Current therapeutic techniques aimed to ameliorate invasive GBS infections are less than desirable and can result in complications in both the neonate and the mother. To this end, the need for novel therapeutic options is urgent. Human milk oligosaccharides (HMOs), an integral component of human breast milk, have been previously shown to possess antiadhesive and antimicrobial properties. To interrogate these characteristics, we examined HMO-mediated outcomes in both in vivo and ex vivo models of GBS infection utilizing a murine model of ascending GBS infection, an EpiVaginal human organoid tissue model, and ex vivo human gestational membranes. Supplementation of HMOs resulted in diminished adverse pregnancy outcomes, decreased GBS adherence to gestational tissues, decreased colonization within the reproductive tract, and reduced proinflammatory immune responses to GBS infection. Taken together, these results highlight the potential of HMOs as promising therapeutic interventions in perinatal health.
Collapse
Affiliation(s)
- Rebecca
E. Moore
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Veterans Affairs, Tennessee
Valley Healthcare Systems, Nashville, Tennessee 37212, United States
| | - Sabrina K. Spicer
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37240, United States
| | - Jacky Lu
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| | - Schuyler A. Chambers
- Department of Chemistry, Stanford University, Stanford, California 94305, United States
| | - Kristen N. Noble
- Department
of Pediatrics, Vanderbilt University Medical
Center, Nashville, Tennessee 37232, United States
| | - Jonathan Lochner
- Department
of Pediatrics, Vanderbilt University Medical
Center, Nashville, Tennessee 37232, United States
| | - Rebecca C. Christofferson
- Department of Pathobiological
Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana 70803, United States
| | - Karla A. Vasco
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48824, United States
| | - Shannon D. Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48824, United States
| | - Steven D. Townsend
- Department of Chemistry, Vanderbilt University, Nashville, Tennessee 37240, United States
| | - Jennifer A. Gaddy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
- Department of Veterans Affairs, Tennessee
Valley Healthcare Systems, Nashville, Tennessee 37212, United States
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, United States
| |
Collapse
|
26
|
Yeo KT, Goh GL, Park WY, Wynn JL, Aziz KB. Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Neonates with Early-Onset Infection. Neonatology 2023; 120:796-800. [PMID: 37757759 DOI: 10.1159/000533467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The discriminative utility of the neonatal sequential organ failure assessment (nSOFA) for early-onset sepsis (EOS) mortality in the neonatal intensive care unit (NICU) is unknown. OBJECTIVES The objective of the study was to determine the utility of nSOFA for EOS mortality. METHODS Multicenter, retrospective cohort study of NICU patients with EOS between 2012 and 2023. nSOFA scores of survivors and non-survivors were compared, and area under the receiver operating characteristics curve (AUROC) for mortality was calculated. RESULTS 104 subjects were identified (88 lived, 16 died). AUROC at blood culture collection (T0), 6 h after collection (T6), and the maximum nSOFA at T0 or T6 (T0-6max) were 0.76 (95% CI: 0.62, 0.91), 0.89 (0.80, 0.99), and 0.87 (0.77, 0.97), respectively. Analyses restricted to birthweight (<1.5, <1 kg) or gestational age (<32, <29 week) cutoffs revealed AUROC ranges of 0.86-0.92 for T6 and 0.82-0.84 for T0-6max. CONCLUSIONS The nSOFA showed good-to-excellent discrimination of mortality among infants with EOS in the NICU.
Collapse
Affiliation(s)
- Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore,
- Duke-NUS School of Medicine, Singapore, Singapore,
| | - Guan Lin Goh
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Woo Yeon Park
- Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - James L Wynn
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Khyzer B Aziz
- Biomedical Informatics and Data Science, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
27
|
Barbini MC, Perniciaro S, Bresesti I, Folgori L, Barcellini L, Bossi A, Agosti M. The Management of Neonates ≥34 Weeks' Gestation at Risk of Early Onset Sepsis: A Pilot Study. Antibiotics (Basel) 2023; 12:1306. [PMID: 37627726 PMCID: PMC10451212 DOI: 10.3390/antibiotics12081306] [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: 05/30/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
Early onset sepsis (EOS) is a potentially fatal condition in neonates, and its correct management is still challenging for neonatologists. Early antibiotic administration in the neonatal period may carry short- and long-term risks. Neonatal EOS calculator has been recently introduced as a new strategy to manage infants at risk of sepsis, and has shown promising results. METHODS In this single-center observational retrospective study, 1000 neonates ≥ 34 weeks' gestation were enrolled with the aim to evaluate our standard protocol for the management of suspected EOS compared to the EOS calculator. Outcome measures included the following: (1) incidence of EOS and (2) proportion of infants in need of sepsis evaluations and antibiotics using our standard protocol versus theoretical application of EOS calculator. RESULTS A total of 223/1000 infants underwent blood investigations versus 35/1000 (3.5%) if EOS calculator had been applied (p < 0.0001; k = 0.18). Furthermore, 48/1000 infants received antibiotics with our protocol versus 35/1000 with EOS calculator (p = 0.12; k = 0.58). Three infants had a positive blood culture that EOS calculator would have missed. CONCLUSIONS In our study, EOS calculator could have reduced investigations but not antibiotic therapy. EOS calculator is an effective and promising tool, but further studies are required to improve it.
Collapse
Affiliation(s)
- Maria Cristina Barbini
- Neonatal Intensive Care Unit, “Filippo del Ponte” Hospital, ASST Settelaghi, 21100 Varese, Italy; (M.C.B.); (S.P.); (A.B.); (M.A.)
| | - Simona Perniciaro
- Neonatal Intensive Care Unit, “Filippo del Ponte” Hospital, ASST Settelaghi, 21100 Varese, Italy; (M.C.B.); (S.P.); (A.B.); (M.A.)
| | - Ilia Bresesti
- Neonatal Intensive Care Unit, “Filippo del Ponte” Hospital, ASST Settelaghi, 21100 Varese, Italy; (M.C.B.); (S.P.); (A.B.); (M.A.)
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| | - Laura Folgori
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, ASST FBF Sacco, 20154 Milan, Italy; (L.F.); (L.B.)
| | - Lucia Barcellini
- Department of Pediatrics, “V. Buzzi” Children’s Hospital, ASST FBF Sacco, 20154 Milan, Italy; (L.F.); (L.B.)
| | - Angela Bossi
- Neonatal Intensive Care Unit, “Filippo del Ponte” Hospital, ASST Settelaghi, 21100 Varese, Italy; (M.C.B.); (S.P.); (A.B.); (M.A.)
| | - Massimo Agosti
- Neonatal Intensive Care Unit, “Filippo del Ponte” Hospital, ASST Settelaghi, 21100 Varese, Italy; (M.C.B.); (S.P.); (A.B.); (M.A.)
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy
| |
Collapse
|
28
|
Theophilus RJ, Taft DH. Antimicrobial Resistance Genes (ARGs), the Gut Microbiome, and Infant Nutrition. Nutrients 2023; 15:3177. [PMID: 37513595 PMCID: PMC10383493 DOI: 10.3390/nu15143177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
The spread of antimicrobial resistance genes (ARGs) is a major public health crisis, with the ongoing spread of ARGs leading to reduced efficacy of antibiotic treatments. The gut microbiome is a key reservoir for ARGs, and because diet shapes the gut microbiome, diet also has the potential to shape the resistome. This diet-gut microbiome-resistome relationship may also be important in infants and young children. This narrative review examines what is known about the interaction between the infant gut microbiome, the infant resistome, and infant nutrition, including exploring the potential of diet to mitigate infant ARG carriage. While more research is needed, diet has the potential to reduce infant and toddler carriage of ARGs, an important goal as part of maintaining the efficacy of available antibiotics and preserving infant and toddler health.
Collapse
Affiliation(s)
- Rufus J Theophilus
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| | - Diana Hazard Taft
- Food Science and Human Nutrition Department, University of Florida, Gainesville, FL 32611, USA
| |
Collapse
|
29
|
Alotaibi NM, Alroqi S, Alharbi A, Almutiri B, Alshehry M, Almutairi R, Alotaibi N, Althoubiti A, Alanezi A, Alatawi N, Almutairi H, Alhmadi M, Almutairi R, Alshammari M. Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1279. [PMID: 37512090 PMCID: PMC10383037 DOI: 10.3390/medicina59071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Group B streptococcus (GBS) is the leading cause of infections in neonates with high fatality rates. GBS is caused by the streptococcus bacterium known as streptococcus agalactiae, which is highly contagious and can be transmitted from pregnant women to infants. GBS infection can occur as an early onset or late-onset infection and has different treatment strategies. Antibiotics are effective in treating GBS infections at early stages. The aim of this systematic review was to summarize the clinical characteristics and treatment strategies for GBS, with a focus on antibiotics. Material and Methods: The findings of this review were reported in accordance with the PRISMA 2020 guidelines and a flow diagram of the study selection process, a summary of the included studies, a description of the study characteristics, a summary of the results, a discussion of the implications of the findings, and a conclusion are included. Overall, the authors followed a rigorous methodology to ensure that this review is comprehensive and inclusive of relevant studies on GBS infection and its treatment. Results: Overall, 940 studies were reviewed and only the most relevant 22 studies were included in the systematic review. This review describes the characteristics of patients in different studies related to early onset GBS disease and presents various treatment strategies and outcomes for GBS infection in pediatrics. The studies suggest that preventive measures, risk-based intrapartum antibiotic prophylaxis, and maternal vaccination can significantly reduce the burden of GBS disease, but late-onset GBS disease remains a concern, and more strategies are required to decrease its rate. Improvement is needed in the management of the risk factors of GBS. A conjugate vaccine with a serotype (Ia, Ib, II, III, and V) has been proven effective in the prevention of GBS in neonates. Moreover, penicillin is an important core antibiotic for treating early onset GBS (EOD). Conclusions: This systematic review summarizes the treatment comparison for GBS infections in neonates, with a primary focus on antibiotics. IAP (intrapartum antibiotic prophylaxis) according to guidelines, antenatal screening, and the development of a conjugate vaccine may be effective and could lower the incidence of the disease.
Collapse
Affiliation(s)
- Nawaf M Alotaibi
- Department of Clinical Pharmacy, Northern Border University, Rafhaa 73213, Saudi Arabia
| | - Sharefa Alroqi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Abdulrahman Alharbi
- Department of Pharmaceutical Care, King Faisal Specialist Hospital & Research Centre, Al Madinah Al Munawwarah 42355, Saudi Arabia
| | | | - Manal Alshehry
- Department of Clinical Pharmacy, King Khalid Hospital in IV & Nutrition TPN, Tabuk 32593, Saudi Arabia
| | - Rinad Almutairi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Nada Alotaibi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Atheer Althoubiti
- Hokmaa Taif Medical Complex, Kingdom of Saudi Arabia, Taif 21944, Saudi Arabia
| | - Ashwaq Alanezi
- College of Clinical Pharmacy, King Faisal University, Al-Ahasa 13890, Saudi Arabia
| | - Nouf Alatawi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hanan Almutairi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Munira Alhmadi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Rawan Almutairi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Mohammed Alshammari
- Department of Pharmaceutical Care, Northern Border Cluster, Arar 73311, Saudi Arabia
| |
Collapse
|
30
|
Furuta A, Coleman M, Casares R, Seepersaud R, Orvis A, Brokaw A, Quach P, Nguyen S, Sweeney E, Sharma K, Wallen G, Sanghavi R, Mateos-Gil J, Cuerva JM, Millán A, Rajagopal L. CD1 and iNKT cells mediate immune responses against the GBS hemolytic lipid toxin induced by a non-toxic analog. PLoS Pathog 2023; 19:e1011490. [PMID: 37384812 DOI: 10.1371/journal.ppat.1011490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
Although hemolytic lipids have been discovered from many human pathogens including Group B Streptococcus (GBS), strategies that neutralize their function are lacking. GBS is a leading cause of pregnancy-associated neonatal infections, and adult GBS infections are on the rise. The GBS hemolytic lipid toxin or granadaene, is cytotoxic to many immune cells including T and B cells. We previously showed that mice immunized with a synthetic nontoxic analog of granadaene known as R-P4 had reduced bacterial dissemination during systemic infection. However, mechanisms important for R-P4 mediated immune protection was not understood. Here, we show that immune serum from R-P4-immunized mice facilitate GBS opsonophagocytic killing and protect naïve mice from GBS infection. Further, CD4+ T cells isolated from R-P4-immunized mice proliferated in response to R-P4 stimulation in a CD1d- and iNKT cell-dependent manner. Consistent with these observations, R-P4 immunized mice lacking CD1d or CD1d-restricted iNKT cells exhibit elevated bacterial burden. Additionally, adoptive transfer of iNKT cells from R-P4 vaccinated mice significantly reduced GBS dissemination compared to adjuvant controls. Finally, maternal R-P4 vaccination provided protection against ascending GBS infection during pregnancy. These findings are relevant in the development of therapeutic strategies targeting lipid cytotoxins.
Collapse
Affiliation(s)
- Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Michelle Coleman
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Raquel Casares
- Department of Organic Chemistry, University of Granada, Granada, Spain
| | - Ravin Seepersaud
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Austyn Orvis
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Phoenicia Quach
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Shayla Nguyen
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Erin Sweeney
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Kavita Sharma
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Grace Wallen
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
| | - Rhea Sanghavi
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jaime Mateos-Gil
- Department of Organic Chemistry, University of Granada, Granada, Spain
| | | | - Alba Millán
- Department of Organic Chemistry, University of Granada, Granada, Spain
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
31
|
Stephens K, Charnock-Jones DS, Smith GCS. Group B Streptococcus and the risk of perinatal morbidity and mortality following term labor. Am J Obstet Gynecol 2023; 228:S1305-S1312. [PMID: 37164497 DOI: 10.1016/j.ajog.2022.07.051] [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: 05/15/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 05/12/2023]
Abstract
Streptococcus agalactiae (group B Streptococcus) colonizes the genital tract of approximately 20% of pregnant women. In the absence of intervention, approximately 1% of infants born to colonized mothers exhibit a clinical infection. This has led to implementation of screening and intervention in the form of intrapartum antibiotic prophylaxis in many countries, including the United States. However, screening has not been introduced in a substantial minority of other countries because of the absence of supportive level 1 evidence, the very large number needed to treat to prevent 1 case, and concerns about antimicrobial resistance. Optimal screening would involve rapid turnaround (to facilitate intrapartum testing) and report antibiotic sensitivity, but no such method exists. There is significant scope for a personalized medicine approach, targeting intrapartum antibiotic prophylaxis to cases at greatest risk, but the pathogen and host factors determining the risk of invasive disease are incompletely understood. Epidemiologic data have indicated the potential of prelabor invasion of the uterus by group B Streptococcus, and metagenomic analysis revealed the presence of group B Streptococcus in the placenta in approximately 5% of pregnant women at term before onset of labor and membrane rupture. However, the determinants and consequences of prelabor invasion of the uterus by group B Streptococcus remain to be established. The vast majority (98%) of invasive neonatal disease is caused by 6 serotypes, and hexavalent vaccines against these serotypes have completed phase 2 trials. However, an obstacle to phase 3 studies is conducting an adequately powered trial to demonstrate clinical effectiveness given that early-onset disease affects approximately 1 in 1000 births in the absence of vaccination.
Collapse
Affiliation(s)
- Katie Stephens
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom
| | | | - Gordon C S Smith
- Department of Obstetrics and Gynaecology, University of Cambridge, Cambridge, United Kingdom.
| |
Collapse
|
32
|
Berardi A, Trevisani V, Di Caprio A, Caccamo P, Latorre G, Loprieno S, Foglianese A, Laforgia N, Perrone B, Nicolini G, Ciccia M, Capretti MG, Giugno C, Rizzo V, Merazzi D, Fanaro S, Taurino L, Pulvirenti RM, Orlandini S, Auriti C, Haass C, Ligi L, Vellani G, Tzialla C, Tuoni C, Santori D, Baroni L, China M, Bua J, Visintini F, Decembrino L, Creti R, Miselli F, Bedetti L, Lugli L. Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management? Pathogens 2023; 12:pathogens12040588. [PMID: 37111474 PMCID: PMC10140896 DOI: 10.3390/pathogens12040588] [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: 02/23/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
The effectiveness of "inadequate" intrapartum antibiotic prophylaxis (IAP administered < 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003-2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined "active" when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an "inactive" IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP "adequate" seems the pathogen's antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.
Collapse
Affiliation(s)
- Alberto Berardi
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| | - Viola Trevisani
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Antonella Di Caprio
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Paola Caccamo
- School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy
| | - Giuseppe Latorre
- Neonatal Intensive Care Unit, Ecclesiastical General Hospital F. Miulli, 70021 Acquaviva delle Fonti, Italy
| | - Sabrina Loprieno
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Alessandra Foglianese
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Nicola Laforgia
- Department of Biomedical Science and Human Oncology (DIMO), Neonatal Intensive Care Unit, University Hospital of Bari "Aldo Moro", 70124 Bari, Italy
| | - Barbara Perrone
- Neonatal Intensive Care Unit, Azienda Ospedaliero Universitaria Ospedali Riuniti, 60126 Ancona, Italy
| | | | - Matilde Ciccia
- Neonatal Intensive Care Unit, Women's and Children's Health Department, Maggiore Hospital, 40133 Bologna, Italy
| | - Maria Grazia Capretti
- Neonatal Intensive Care Unit, Women's and Children's Health Department, S. Orsola-Malpighi Hospital, 40138 Bologna, Italy
| | - Chiara Giugno
- Pediatric Unit, Ospedale B. Ramazzini, 41012 Carpi, Italy
| | - Vittoria Rizzo
- Neonatal Intensive Care Unit, Bufalini Hospital, Cesena, 47521 Cesena, Italy
| | - Daniele Merazzi
- Division of Neonatology, "Valduce" Hospital, 22100 Como, Italy
| | - Silvia Fanaro
- Department of Medical Sciences, Pediatric Section, University Hospital, 44124 Ferrara, Italy
| | - Lucia Taurino
- Neonatal Intensive Care Unit, Ospedali Riuniti, 71122 Foggia, Italy
| | - Rita Maria Pulvirenti
- Pediatric and Neonatal Unit, Morgagni-Pierantoni Hospital of Forlì, 47121 Forlì, Italy
| | - Silvia Orlandini
- Neonatal Intensive Care Unit, Carlo Poma Hospital, 46100 Mantova, Italy
| | - Cinzia Auriti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus-Newborn-Infant, "Bambino Gesù" Children's Hospital IRCCS, 00165 Rome, Italy
| | - Cristina Haass
- Neonatal Intensive Unit, San Pietro-Fatebenefratelli Hospital, 00168 Rome, Italy
| | - Laura Ligi
- Neonatal Intensive Unit, San Filippo Neri Hospital, 00135 Rome, Italy
| | - Giulia Vellani
- Neonatal Intensive Unit, ARNAS Civico-Di Cristina-Benfratelli, 90127 Palermo, Italy
| | - Chryssoula Tzialla
- Neonatal and Pediatric Unit, Polo Ospedaliero Oltrepò, ASST Pavia, 27100 Pavia, Italy
| | - Cristina Tuoni
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, 56124 Pisa, Italy
| | - Daniele Santori
- Pediatric and Neonatal Unit, Azienda Ospedaliera Santa Maria degli Angeli, 33170 Pordenone, Italy
| | - Lorenza Baroni
- Neonatal Intensive Care Unit, Santa Maria Nuova Hospital, 42123 Reggio Emilia, Italy
| | | | - Jenny Bua
- Neonatal Intensive Care Unit, Institute for Maternal and Child Health, "IRCCS Burlo Garofolo", 34137 Trieste, Italy
| | | | - Lidia Decembrino
- ASST Pavia, Unità Operativa di Pediatria e Nido, Ospedale Civile, 27029 Vigevano, Italy
| | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Francesca Miselli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Luca Bedetti
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy
| |
Collapse
|
33
|
Yoon Y, So H, Lee JK, Kim D, Jo KJ, Kim HH, Kim YJ, Lee J, Jo DS, Kim YK, Park SE, Chang YS, Kim YJ. Microbiologic Epidemiology of Early-onset Sepsis in Neonates Born at ≥35 0/7 Weeks' Gestation in Korea During 2009-2018. Pediatr Infect Dis J 2023:00006454-990000000-00414. [PMID: 37054389 DOI: 10.1097/inf.0000000000003931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Sepsis within the first 3 days of life remains a leading cause of neonatal mortality and morbidity. However, few studies have addressed the epidemiology of sepsis in late preterm and term neonates, particularly in Asia. We aimed to estimate the epidemiology of early-onset sepsis (EOS) in neonates born at ≥35 0/7 weeks' gestation in Korea. METHODS A retrospective study was conducted in neonates with proven EOS born at ≥35 0/7 weeks' gestation from 2009 to 2018 at seven university hospitals. EOS was defined as identifying bacteria from a blood culture within 72 hours after birth. RESULTS A total of 51 neonates (0.36/1,000 live births) with EOS were identified. The median duration from birth to the first positive blood culture collection was 17 hours (range, 0.2-63.9). Among the 51 neonates, 32 (63%) patients were born by vaginal delivery. The median Apgar score was 8 (range, 2-9) at 1 minute and 9 (range, 4-10) at 5 minutes. The most common pathogen was group B Streptococcus (n = 21; 41.2%), followed by coagulase-negative staphylococci (n = 7; 13.7%) and Staphylococcus aureus (n = 5, 9.8%). Forty-six (90.2%) neonates were treated with antibiotics on the first day of symptom onset, and 34 (73.9%) neonates received susceptible antibiotics. The overall 14-day case-fatality rate was 11.8%. CONCLUSION This is the first multicenter study on the epidemiology of proven EOS in neonates born at ≥35 0/7 weeks' gestation and found that group B Streptococcus was the most common pathogen in Korea.
Collapse
Affiliation(s)
- Yoonsun Yoon
- From the Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyungwan University, Seoul, Korea
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Korea (current affiliation)
| | - Hyejin So
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea (current affiliation)
| | - Joon Kee Lee
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dongsub Kim
- Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Kyo Jin Jo
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun Ho Kim
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonbuk National University, Jeonju, Korea
| | - Yoo-Jin Kim
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jina Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Sun Jo
- Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonbuk National University, Jeonju, Korea
| | - Yun-Kyung Kim
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Yun Sil Chang
- From the Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyungwan University, Seoul, Korea
| | - Yae-Jean Kim
- From the Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyungwan University, Seoul, Korea
- Samsung Advanced Institute for Health Sciences and Technology, Seoul, Korea
| |
Collapse
|
34
|
Rallis D, Giapros V, Serbis A, Kosmeri C, Baltogianni M. Fighting Antimicrobial Resistance in Neonatal Intensive Care Units: Rational Use of Antibiotics in Neonatal Sepsis. Antibiotics (Basel) 2023; 12:antibiotics12030508. [PMID: 36978375 PMCID: PMC10044400 DOI: 10.3390/antibiotics12030508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Antibiotics are the most frequently prescribed drugs in neonatal intensive care units (NICUs) due to the severity of complications accompanying neonatal sepsis. However, antimicrobial drugs are often used inappropriately due to the difficulties in diagnosing sepsis in the neonatal population. The reckless use of antibiotics leads to the development of resistant strains, rendering multidrug-resistant pathogens a serious problem in NICUs and a global threat to public health. The aim of this narrative review is to provide a brief overview of neonatal sepsis and an update on the data regarding indications for antimicrobial therapy initiation, current guidance in the empirical antimicrobial selection and duration of therapy, and indications for early discontinuation.
Collapse
Affiliation(s)
- Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
- Correspondence: ; Tel.: +30-(26)-51099326
| | - Anastasios Serbis
- Department of Paediatrics, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Chrysoula Kosmeri
- Department of Paediatrics, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| |
Collapse
|
35
|
Comini J, Vines-Douglas G, Loeza M. Emerging Perinatal Infections. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
|
36
|
Wadilo F, Hailemeskel E, Kedir K, El-Khatib Z, Asogba PC, Seyoum T, Landis FC, Howe R, Boltena MT. Prevalence of Group B Streptococcus maternal colonization, serotype distribution, and antimicrobial resistance in Sub-Saharan Africa: A systematic review and meta-analysis. J Glob Antimicrob Resist 2023; 32:134-144. [PMID: 36813256 DOI: 10.1016/j.jgar.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/03/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE Group B Streptococcus (GBS)-associated maternal, perinatal, and neonatal mortality and morbidity disproportionately affects Sub-Saharan Africa (SSA). This systematic review and meta-analysis aimed to address the estimated prevalence, antimicrobial susceptibility, and serotype distribution of GBS isolates in SSA. METHODS This study was done according to PRISMA guidelines. MEDLINE/PubMed, CINAHL (EBSCO), Embase, SCOPUS, Web of Sciences databases, and Google Scholar were used to retrieve both published and unpublished articles. STATA software version 17 was used for data analysis. Forest plots using the random-effect model were used to present the findings. Heterogeneity was assessed using Cochrane chi-square (I2) statistics, while the Egger intercept was used to assess publication bias. RESULTS Fifty-eight studies that fulfilled the eligibility criteria were included for meta-analysis. The pooled prevalence of maternal rectovaginal colonization and vertical transmission of GBS were 16.06, 95% CI [13.94, 18.30] and 43.31%, 95% CI [30.75, 56.32], respectively. The highest pooled proportion of antibiotic resistance to GBS was observed in gentamicin (45.58%, 95% CI [4.12%, 91.23]), followed by erythromycin, (25.11%, 95% CI [16.70, 34.49]). The lowest antibiotic resistance was observed in vancomycin (3.84%, 95% CI [0.48, 9.22]). Our findings indicate that serotypes Ia/Ib/II/ III/and V cover almost 88.6% of serotypes in SSA. CONCLUSIONS The estimated high prevalence and resistance to different antibiotic classes observed in GBS isolates from SSA suggests the need for implementation of effective intervention efforts.
Collapse
Affiliation(s)
- Fiseha Wadilo
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia; Woliata Sodo University, Wolaita Sodo, South West Ethiopia Peoples' Region, Ethiopia; Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Elifaged Hailemeskel
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia; Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia; Radboud Institute for Health Science, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Kiya Kedir
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Ziad El-Khatib
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Montreal, Québec, Canada; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Tamrayehu Seyoum
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | | | - Rawliegh Howe
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia; Ethiopian Evidence Based Health Care Center, A Joanna Briggs Institute's Center of Excellence, Institute of Health, Jimma University, Ethiopia.
| |
Collapse
|
37
|
Montaner Ramón A, Castilla Fernández Y, Frick MA, Camba Longueira F, Céspedes Domínguez MC, Ribes Bautista C, Castillo Salinas F. How to assess early-onset neonatal sepsis? Comparison of three detection strategies. An Pediatr (Barc) 2023; 98:92-98. [PMID: 36710085 DOI: 10.1016/j.anpede.2022.10.009] [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: 05/24/2022] [Accepted: 10/19/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Early-onset neonatal sepsis (EONS) can cause significant morbidity and mortality, especially if it is not detected early. Given the decrease in its incidence in the past few decades, it is important to find a balance between reducing the use of diagnostic tests and continuing to detect affected patients. We compared 3 detection strategies in patients with risk factors (RFs) for infection: laboratory screening (S1), the Neonatal Sepsis Risk Calculator (S2) and clinical observation (S3). PATIENTS AND METHODS Retrospective observational study in neonates born at 34 weeks of gestation or later and with RFs or symptoms compatible with EONS. We analysed outcomes in our unit with the use of laboratory screening (S1) and compared them with the other two strategies (S2 and S3) to contemplate whether to modify our protocol. RESULTS The study included 754 patients, and the most frequent RFs were prolonged rupture of membranes (35.5%) and maternal colonization by Streptococcus agalactiae (38.5%). Strategies S2 and S3 would decrease the performance of laboratory tests (S1, 56.8% of patients; S2, 9.9%; S3, 22.4%; P < 0.01), hospital admissions (S1, 11%; S2, 6.9%; S3, 7.9%; P < 0.01) and the use of antibiotherapy (S1, 8.6%; S2, 6.7%; S3, 6.4%; P < 0.01). Sepsis was diagnosed in 13 patients, and it would have been detected with S2 and S3 except in 1 patient who had asymptomatic bacteriemia by Enterococcus faecalis. No patient with mild and self-limited symptoms in whom antibiotherapy was not started received a diagnosis of sepsis later on. CONCLUSION Close clinical observation seems to be a safe option and could reduce the use of diagnostic tests, hospital admission and unnecessary antibiotherapy. The watchful waiting approach in patients with mild and self-limiting symptoms in the first hours post birth does not appear to be associated with failure to identify sepsis.
Collapse
Affiliation(s)
| | | | - María Antoinette Frick
- Unidad de Patología Infecciosa e Inmunodeficiencias de Pediatría, Hospital Universitari Vall D'hebron, Barcelona, Spain
| | | | | | | | | |
Collapse
|
38
|
Thao V, Sharpe EE, Dholakia R, Ahn HH, Moriarty JP, Borah BJ, Gill MC, Theiler RN. Evaluating the cost-effectiveness of testing pregnant women for penicillin allergy. PLoS One 2023; 18:e0280151. [PMID: 36662778 PMCID: PMC9858404 DOI: 10.1371/journal.pone.0280151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 12/20/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION True penicillin allergy is rare and is commonly incorrectly reported. In fact, less than five percent of patients who report a penicillin allergy will have a currently active clinically-significant IgE- or T-cell-mediated hypersensitivity when appropriately tested. Penicillin is the agent of choice for intrapartum antibiotic prophylaxis to reduce the risk of group B streptococcus early-onset disease in the newborn. Inaccurate penicillin allergy status may lead to inappropriate antibiotic use, as most alternative drugs are more expensive and broader spectrum than penicillin. Penicillin allergy testing has been found to be safe in pregnancy and cost-effective in other patient populations. OBJECTIVE To evaluate the cost-effectiveness of penicillin allergy testing and appropriate antibiotic treatment (test then treat strategy) compared to usual care among pregnant women. METHODS We developed a decision tree to evaluate the cost of providing appropriate care via a test then treat strategy for pregnant women who report a penicillin allergy, compared to usual care. RESULTS Using the test then treat strategy the additional cost to ensure appropriate care for all pregnant women who report a penicillin allergy, was $1122.38 per person. Adopting a test then treat strategy increased the number of appropriate antibiotic use from 7,843/10,000 to 10,000/10,000 simulations. CONCLUSION Our results show that a test then treat strategy for pregnant women who report a penicillin allergy is a good-value intervention.
Collapse
Affiliation(s)
- Viengneesee Thao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Emily E. Sharpe
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ruchita Dholakia
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Hannah H. Ahn
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - James P. Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bijan J. Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, United States of America
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Margaret C. Gill
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Regan N. Theiler
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, United States of America
| |
Collapse
|
39
|
Abstract
Early-onset sepsis can cause significant morbidity and mortality in newborn infants. Risk factors for sepsis include birth to mothers with inadequately treated maternal group B Streptococcus colonization, intra-amniotic infection, maternal temperature greater than 100.4°F (>38°C), rupture of membranes greater than 18 hours, and preterm labor. The organisms that most commonly cause early-onset sepsis include group B Streptococcus, Escherichia coli, and viridans streptococci. Infants often present within the first 24 hours after birth with clinical signs of sepsis, with respiratory distress as the most common presenting symptom. However, infants can also have respiratory distress from noninfectious etiologies. Therefore, when physicians are faced with asymptomatic infants with risk factors or infants with respiratory distress without risk factors, there is a delicate balance between empirically treating with antibiotics and observing these infants without treating.
Collapse
Affiliation(s)
- Courtney Briggs-Steinberg
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Philip Roth
- Division of Neonatology, Department of Pediatrics, Staten Island University Hospital, Northwell Health, Staten Island, NY.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| |
Collapse
|
40
|
Hadfield BR, Rowley J, Puyol F, Johnson MA, Ali M, Neuhoff BK, Lyman R, Saravia A, Svatek M, Sherburne K, Cantey JB. Quality Improvement Through Nurse-initiated Kaiser Sepsis Calculator at a County Hospital. Hosp Pediatr 2023; 13:31-38. [PMID: 36537146 DOI: 10.1542/hpeds.2022-006554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Suspected early onset sepsis drives most antibiotic use in the newborn nursery. The Kaiser Sepsis Calculator (KSC) is a validated tool that safely decreases laboratory evaluation and antibiotic administration in infants aged ≥34 weeks. Our quality improvement aim was a nurse-initiated, KSC-based program to decrease blood cultures (BCx) and complete blood counts (CBC) by 10% from March 2021 to October 2021 among chorioamnionitis-exposed infants born ≥35 weeks' gestation. A secondary aim was to decrease antibiotic administration by 10%. METHODS The KSC was implemented for infants at University Health, a county hospital affiliate of the University of Texas Health Science Center San Antonio, with a level I nursery and level IV NICU. The multidisciplinary project included pediatric hospitalists, neonatologists, family practitioners, maternal-fetal medicine physicians, fellows, residents, and nurses. All infants born 6 months before (August 2020-January 2021) and 7 months after protocol implementation (March 2021-September 2021) were analyzed. RESULTS A total of 53 chorioamnionitis-exposed infants were included from the preintervention period and 51 from the postintervention period. CBC utilization decreased from 96% to 27%, BCx utilization decreased from 98% to 37%, and antibiotic utilization fell from 25% to 16%. In no cases were antibiotics prescribed against the KSC, and to our knowledge, no early onset sepsis diagnoses or infection-related hospital readmissions were missed. CONCLUSIONS The multidisciplinary implementation of the KSC led to a reduction in testing, exceeding our initial goal. A nurse-initiated protocol reduced BCx, CBC, and antibiotic utilization among chorioamnionitis-exposed infants.
Collapse
Affiliation(s)
- Brandon R Hadfield
- Division of Neonatology, Departments of Pediatrics and.,University of Texas Health San Antonio, San Antonio, Texas
| | - Justin Rowley
- University of Texas Health San Antonio, San Antonio, Texas
| | - Franz Puyol
- University of Texas Health San Antonio, San Antonio, Texas
| | | | - Murtaza Ali
- University of Texas Health San Antonio, San Antonio, Texas
| | - Barbara K Neuhoff
- Obstetrics and Gynecology.,University of Texas Health San Antonio, San Antonio, Texas
| | - Rachel Lyman
- University of Texas Health San Antonio, San Antonio, Texas
| | - Alma Saravia
- Division of Neonatology, Department of Pediatrics, University Health System, San Antonio, Texas
| | - Mandy Svatek
- University of Texas Health San Antonio, San Antonio, Texas
| | | | - Joseph B Cantey
- Division of Neonatology, Departments of Pediatrics and.,Division of Allergy, Immunology, and Infectious Diseases.,University of Texas Health San Antonio, San Antonio, Texas
| |
Collapse
|
41
|
Debnath S, Koppel R, Saadi N, Potak D, Weinberger B, Zanos TP. Prediction of intrapartum fever using continuously monitored vital signs and heart rate variability. Digit Health 2023; 9:20552076231187594. [PMID: 37448783 PMCID: PMC10336767 DOI: 10.1177/20552076231187594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives Neonatal early onset sepsis (EOS), bacterial infection during the first seven days of life, is difficult to diagnose because presenting signs are non-specific, but early diagnosis before birth can direct life-saving treatment for mother and baby. Specifically, maternal fever during labor from placental infection is the strongest predictor of EOS. Alterations in maternal heart rate variability (HRV) may precede development of intrapartum fever, enabling incipient EOS detection. The objective of this work was to build a predictive model for intrapartum fever. Methods Continuously measured temperature, heart rate, and beat-to-beat RR intervals were obtained from wireless sensors on women (n = 141) in labor; traditional manual vital signs were taken every 3-6 hours. Validated measures of HRV were calculated in moving 5-minute windows of RR intervals: standard deviation of normal-to-normal intervals (SDNN) and root mean square of successive differences (RMSSD) between normal heartbeats. Results Fever (>38.0 °C) was detected by manual or continuous measurements in 48 women. Compared to afebrile mothers, average SDNN and RMSSD in febrile mothers decreased significantly (p < 0.001) at 2 and 3 hours before fever onset, respectively. This observed HRV divergence and raw recorded vitals were applied to a logistic regression model at various time horizons, up to 4-5 hours before fever onset. Model performance increased with decreasing time horizons, and a model built using continuous vital signs as input variables consistently outperformed a model built from episodic vital signs. Conclusions HRV-based predictive models could identify mothers at risk for fever and infants at risk for EOS, guiding maternal antibiotic prophylaxis and neonatal monitoring.
Collapse
Affiliation(s)
- Shubham Debnath
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Robert Koppel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Queens, NY, USA
| | - Nafeesa Saadi
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Queens, NY, USA
| | - Debra Potak
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Queens, NY, USA
| | - Barry Weinberger
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Neonatal-Perinatal Medicine, Cohen Children's Medical Center, Queens, NY, USA
| | - Theodoros P Zanos
- Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| |
Collapse
|
42
|
Leante-Castellanos JL, Pizarro-Ruiz AM, Olmo-Sánchez MP, Martínez-Martínez MJ, Doval-Calvo D. Results of a strategy based on clinical observation of newborns at risk of early-onset neonatal sepsis. Early Hum Dev 2023; 176:105714. [PMID: 36701928 DOI: 10.1016/j.earlhumdev.2023.105714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND Serial clinical observation of asymptomatic newborns at risk of early-onset sepsis is an alternative option for which there is limited scientific evidence. AIMS To evaluate the rate of protocol compliance, the impact on blood tests, percentage of hospitalizations and subsequent procedures, and course of diagnosed early-onset sepsis cases of a protocol based on serial clinical observation. METHODS Retrospective observational study comparing an 18-month period under this protocol against a previous protocol based on laboratory tests. SUBJECTS 6895 asymptomatic newborns with over 35 weeks of gestation. OUTCOME MEASURES number of evaluations performed on each subject at risk, percentage of patients undergoing blood draws and hospitalization rates. RESULTS Some of the evaluations included in the protocol were omitted in 51.6 % of the newborns undergoing the physical examinations. The implementation of this new approach was associated with a decrease in the percentage of patients undergoing blood draws from 16.8 % to 0.7 % (p < 0.001) with no differences in the progression of the five cases of sepsis studied in each period. The serial clinical observation protocol was associated with a significant increase in hospitalizations for suspected infection, although with no difference in the rate of lumbar punctures performed or antibiotic treatments administered. CONCLUSION Compliance with the serial clinical observation protocol can be difficult. This approach often detects newborns with abnormal clinical data that are not explained by early-onset sepsis. Clinical observation is a safe option that minimizes the rate of blood draws.
Collapse
Affiliation(s)
- José L Leante-Castellanos
- Saint Anthony Catholic University, Murcia, Spain; Neonatology Department, Hospital Santa Lucía, Cartagena, Murcia, Spain.
| | | | | | | | | |
Collapse
|
43
|
Absalon J, Simon R, Radley D, Giardina PC, Koury K, Jansen KU, Anderson AS. Advances towards licensure of a maternal vaccine for the prevention of invasive group B streptococcus disease in infants: a discussion of different approaches. Hum Vaccin Immunother 2022; 18:2037350. [PMID: 35240933 PMCID: PMC9009955 DOI: 10.1080/21645515.2022.2037350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Group B streptococcus (Streptococcus agalactiae, GBS) is an important cause of life-threatening disease in newborns. Pregnant women colonized with GBS can transmit the bacteria to the developing fetus, as well as to their neonates during or after delivery where infection can lead to sepsis, meningitis, pneumonia, or/and death. While intrapartum antibiotic prophylaxis (IAP) is the standard of care for prevention of invasive GBS disease in some countries, even in such settings a substantial residual burden of disease remains. A GBS vaccine administered during pregnancy could potentially address this important unmet medical need and provide an adjunct or alternative to IAP for the prevention of invasive GBS disease in neonates. A hurdle for vaccine development has been relatively low disease rates making efficacy studies difficult. Given the well-accepted inverse relationship between anti-GBS capsular polysaccharide antibody titers at birth and risk of disease, licensure using serological criteria as a surrogate biomarker represents a promising approach to accelerate the availability of a GBS vaccine.
Collapse
Affiliation(s)
- Judith Absalon
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - Raphael Simon
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - David Radley
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | | | - Kenneth Koury
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | | | | |
Collapse
|
44
|
Miselli F, Frabboni I, Di Martino M, Zinani I, Buttera M, Insalaco A, Stefanelli F, Lugli L, Berardi A. Transmission of Group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence. Ther Adv Infect Dis 2022; 9:20499361221142732. [PMID: 36569815 PMCID: PMC9780763 DOI: 10.1177/20499361221142732] [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: 07/06/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Group B streptococcus (GBS) late-onset disease (LOD, occurring from 7 through 89 days of life) is an important cause of sepsis and meningitis in infants. The pathogenesis and modes of transmission of LOD to neonates are yet to be elucidated. Established risk factors for the incidence of LOD include maternal GBS colonisation, young maternal age, preterm birth, HIV exposure and African ethnicity. The mucosal colonisation by GBS may be acquired perinatally or in the postpartum period from maternal or other sources. Growing evidence has demonstrated the predominant role of maternal sources in the transmission of LOD. Intrapartum antibiotic prophylaxis (IAP) to prevent early-onset disease reduces neonatal GBS colonisation during delivery; however, a significant proportion of IAP-exposed neonates born to GBS-carrier mothers acquire the pathogen at mucosal sites in the first weeks of life. GBS-infected breast milk, with or without presence of mastitis, is considered a potential vehicle for transmitting GBS. Furthermore, horizontal transmission is possible from nosocomial and other community sources. Although unfrequently reported, nosocomial transmission of GBS in the neonatal intensive care unit is probably less rare than is usually believed. GBS disease can sometime recur and is usually caused by the same GBS serotype that caused the primary infection. This review aims to discuss the dynamics of transmission of GBS in the neonatal LOD.
Collapse
Affiliation(s)
- Francesca Miselli
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Ilaria Frabboni
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Marianna Di Martino
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Isotta Zinani
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Martina Buttera
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Anna Insalaco
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Francesca Stefanelli
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | | |
Collapse
|
45
|
Multicenter Evaluation of the Cepheid Xpert GBS LB XC Test. J Clin Microbiol 2022; 60:e0135622. [PMID: 36472424 PMCID: PMC9769564 DOI: 10.1128/jcm.01356-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Early-onset neonatal sepsis due to Streptococcus agalactiae (group B Streptococcus [GBS]) infection is one of the leading causes of newborn mortality and morbidity. The latest guidelines published in 2019 recommended universal screening of GBS colonization among all pregnant women and intrapartum antibiotic prophylaxis for positive GBS. The updated procedures allow rapid molecular-based GBS screening using nutrient broth-enriched rectovaginal samples. Commercially available molecular assays for GBS diagnosis target mainly the cfb gene, which encodes a hemolysin protein responsible for producing the Christie-Atkins-Munch-Petersen (CAMP) factor. cfb is considered a conserved gene in essentially all GBS isolates. However, false-negative GBS results on Cepheid Xpert GBS and GBS LB tests due to deletions in or near the region that encodes cfb were reported recently. Therefore, the new Xpert GBS LB XC test was developed. This study is a multicenter evaluation of the new test for GBS identification from nutrient broth-enriched rectal/vaginal samples from antepartum women. A total of 621 samples were prospectively enrolled. The samples were tested with the Xpert GBS LB XC test, the composite comparator method, which included the Hologic Panther Fusion GBS test combined with bacterial culture, followed by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification, and bacterial culture alone, followed by MALDI-TOF MS identification. The respective sensitivity and specificity of the Xpert GBS LB XC test were 99.3% and 98.7% compared to the composite comparator method and 99.1% and 91.8% compared to bacterial culture alone with MALDI-TOF MS identification. Overall, the Xpert GBS LB XC test performed comparatively to the composite comparator method and is equivalent to traditional bacterial culture followed by MALDI-TOF MS.
Collapse
|
46
|
Group B Streptococcus: Virulence Factors and Pathogenic Mechanism. Microorganisms 2022; 10:microorganisms10122483. [PMID: 36557736 PMCID: PMC9784991 DOI: 10.3390/microorganisms10122483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Group B Streptococcus (GBS) or Streptococcus agalactiae is a major cause of neonatal mortality. When colonizing the lower genital tract of pregnant women, GBS may cause premature birth and stillbirth. If transmitted to the newborn, it may result in life-threatening illnesses, including sepsis, meningitis, and pneumonia. Moreover, through continuous evolution, GBS can use its original structure and unique factors to greatly improve its survival rate in the human body. This review discusses the key virulence factors that facilitate GBS invasion and colonization and their action mechanisms. A comprehensive understanding of the role of virulence factors in GBS infection is crucial to develop better treatment options and screen potential candidate molecules for the development of the vaccine.
Collapse
|
47
|
Choi Y, Han HS, Chong GO, Le TM, Nguyen HDT, Lee OEM, Lee D, Seong WJ, Seo I, Cha HH. Updates on Group B Streptococcus Infection in the Field of Obstetrics and Gynecology. Microorganisms 2022; 10:microorganisms10122398. [PMID: 36557651 PMCID: PMC9780959 DOI: 10.3390/microorganisms10122398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a Gram-positive bacterium that is commonly found in the gastrointestinal and urogenital tracts. However, its colonization during pregnancy is an important cause of maternal and neonatal morbidity and mortality worldwide. Herein, we specifically looked at GBS in relation to the field of Obstetrics (OB) along with the field of Gynecology (GY). In this review, based on the clinical significance of GBS in the field of OBGY, topics of how GBS is being detected, treated, and should be prevented are addressed.
Collapse
Affiliation(s)
- Yeseul Choi
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hyung-Soo Han
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Physiology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
| | - Gun Oh Chong
- Clinical Omics Institute, Kyungpook National University, Daegu 41405, Republic of Korea
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Tan Minh Le
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Hong Duc Thi Nguyen
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Olive EM Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Donghyeon Lee
- Graduate Program, Department of Biomedical Science, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- BK21 Four Program, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Won Joon Seong
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Incheol Seo
- Department of Immunology, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| | - Hyun-Hwa Cha
- Department of Obstetrics and Gynecology, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
- Correspondence: (I.S.); (H.-H.C.)
| |
Collapse
|
48
|
Hong Z, Jing R, Hui L, Kang X, Chunmei Z, Yang W, Baojian Z, Xin D, Xiaoping Y. A cohort study of intrapartum group B streptococcus prophylaxis on atopic dermatitis in 2-year-old children. BMC Pediatr 2022; 22:693. [PMID: 36460975 PMCID: PMC9716662 DOI: 10.1186/s12887-022-03758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To understand the occurrence of atopic dermatitis (AD) in children aged 2 years on exposure to maternal group B streptococcus (GBS) antibiotic prophylaxis (IAP). DESIGN Retrospective cohort study of 2909 mother-child pairs. SETTING Taixing People's Hospital in Eastern China. PARTICIPANTS Term infants born 2018-2019, followed longitudinally from birth to 2 years. EXPOSURES The GBS-IAP was defined as therapy with intravenous penicillin G or ampicillin or cefazolin ≥ 4 h prior to delivery to the mother. Reference infants were defined as born without or with other intrapartum antibiotic exposure. OUTCOMES The logistic regression models were employed to analyze the effect of intrapartum GBS prophylaxis on AD in 2-year-old children during delivery. Analysis was a priori stratified according to the mode of delivery and adjusted for relevant covariates. RESULTS The cohorts showed that preventive GBS-IAP was potentially associated with increased incidence of AD in children delivered vaginally according to logistic regression models before and after covariate-adjusted treatment (OR: 6.719,95% CI: 4.730-9.544,P < 0.001;aOR: 6.562,95% CI: 4.302-10.008, P < 0.001). CONCLUSION Prophylactic treatment of intrapartum GBS may raise the risk of AD in vaginally delivered children. These findings highlight the need to better understand the risk between childhood AD and current GBS-IAP intervention strategies.
Collapse
Affiliation(s)
- Zhang Hong
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| | - Ren Jing
- grid.452253.70000 0004 1804 524XChildren’s Hospital of Soochow University, Soochow, Jiangsu China
| | - Li Hui
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| | - Xu Kang
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| | - Zhang Chunmei
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| | - Wang Yang
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| | - Zhou Baojian
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| | - Ding Xin
- grid.452253.70000 0004 1804 524XChildren’s Hospital of Soochow University, Soochow, Jiangsu China
| | - Yin Xiaoping
- grid.459988.1Taixing People’s Hospital, Taizhou, Jiangsu China
| |
Collapse
|
49
|
Egge JA, Anderson RH, Schimelpfenig MD. Care of the Well Newborn. Pediatr Rev 2022; 43:676-690. [PMID: 36450636 DOI: 10.1542/pir.2022-005511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Care of the newborn infant is a critical skill for general pediatricians and other providers in the practice of pediatric medicine. Optimal care relies on a thorough understanding of risk factors that may be present during the pregnancy and delivery, as well as the ability to recognize and address unanticipated problems in the postnatal period. This article focuses on antenatal care of the newborn, issues that present in the immediate postdelivery period, and care of the newborn after discharge. It also includes updated information on current topics in pediatric practice, such as the importance of vaccination, parental hesitancy in accepting common medical interventions, and updated guidelines related to the coronavirus disease 2019 pandemic. At the conclusion of the article, the reader should have a general understanding of antenatal risk factors that could affect the transition from the intrauterine environment and have the knowledge to address common issues that arise in the care of newborn infants.
Collapse
Affiliation(s)
- Justin A Egge
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| | | | - Michelle D Schimelpfenig
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD.,Department of Pediatrics, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD
| |
Collapse
|
50
|
Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances. Obstet Gynecol Surv 2022; 77:753-762. [PMID: 36477387 DOI: 10.1097/ogx.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats. Objective The objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines. Evidence Acquisition Original research articles, review articles, and guidelines on GBS were reviewed. Results The following recommendations are based on review of the evidence and professional society guidelines. Screening for GBS should occur between 36 weeks and the end of the 37th week. The culture swab should go 2 cm into the vagina and 1 cm into the anus. Patients can perform their own swabs as well. Penicillin allergy testing has been shown to be safe in pregnancy. Patients with GBS in the urine should be treated at term with antibiotic prophylaxis, independent of the colony count of the culture. Patients who are GBS-positive with preterm and prelabor rupture of membranes after 34 weeks are not candidates for expectant management, as this population has higher rates of neonatal infectious complications. Patients with a history of GBS colonization in prior pregnancy who are GBS-unknown in this current pregnancy and present with labor should receive intrapartum prophylaxis. Work on the GBS vaccine continues. Conclusions Although all of the efforts and focus on neonatal early-onset GBS infection have led to lower rates of disease, GBS still remains a major cause of neonatal morbidity and mortality requiring continued vigilance from obstetric providers.
Collapse
|