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Published online: 2024-04-17

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Group B Streptococcus colonization status and antibiotic use during labour – a single-centre observational study

Iwona Janczewska1, Joanna Jassem-Bobowicz1, Katarzyna Hinca1, Katarzyna Stefanska2, Iwona Domzalska-Popadiuk1

Abstract

Objectives: Group B streptococcus (GBS) colonization among pregnant women is the leading cause of neonatal infection. Intrapartum antibiotic prophylaxis (IAP) is the most effective method to reduce the incidents of neonatal sepsis. We describe compliance with GBS management and the implementation of IAP in the context of the long-term effect of antibiotics.

Material and methods: The study was conducted among 249 childbearing women hospitalized between January 2022 and February 2022 at University Clinical Center in Gdansk, Poland. The data were obtained from the questionnaire and medical records. We analyzed maternal colonization with GBS, compliance with GBS screening and treatment guidelines, risk factors contributing to GBS colonization, IAP administration, and neonatal congenital infection occurrence.

Results: Of all patients, 240 (96.4%) were screened for GBS, 215 (89.6%) between 35–37 weeks of gestation. Fifty (20%) were GBS-positive, 184 (74%) negative, 15 (6%) had unknown GBS status.

There were no significant differences between the GBS-positive and GBS-negative groups in maternal age, mode of delivery, gestational age at birth, maternal comorbidities, parity, GBS status in previous pregnancies, and the development of infection among infants of both groups, regardless of IAP administration. Of all the studied women, 158 (63.5%) received antibiotics, 91 (36.5%) did not.

The study showed the low positive and the high negative predictive value of the antenatal GBS screening test.

Conclusions: We found that compliance with the universal GBS screening is widespread. The management of women with absent or only partial screening test requires assessing the risk factors before administering IAP.

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References

  1. Azad MB, Konya T, Persaud RR, et al. CHILD Study Investigators. Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study. BJOG. 2016; 123(6): 983–993.
  2. Selma-Royo M, Calatayud Arroyo M, García-Mantrana I, et al. Perinatal environment shapes microbiota colonization and infant growth: impact on host response and intestinal function. Microbiome. 2020; 8(1): 167.
  3. Szubert M, Weteska M, Zgliczynska J, et al. The association between imbalances in vaginal microflora and duration of pregnancy as well as selected maternal and neonatal parameters. Ginekol Pol. 2021 [Epub ahead of print].
  4. Imoto N, Morita H, Amanuma F, et al. Maternal antimicrobial use at delivery has a stronger impact than mode of delivery on bifidobacterial colonization in infants: a pilot study. J Perinatol. 2018; 38(9): 1174–1181.
  5. Patras KA, Nizet V. Group B Streptococcal Maternal Colonization and Neonatal Disease: Molecular Mechanisms and Preventative Approaches. Front Pediatr. 2018; 6: 27.
  6. Brokaw A, Furuta A, Dacanay M, et al. Bacterial and Host Determinants of Group B Streptococcal Vaginal Colonization and Ascending Infection in Pregnancy. Front Cell Infect Microbiol. 2021; 11: 720789.
  7. Seale AC, Bianchi-Jassir F, Russell NJ, et al. Estimates of the Burden of Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children. Clin Infect Dis. 2017; 65(suppl_2): S200–S219.
  8. Nanduri SA, Petit S, Smelser C, et al. Epidemiology of Invasive Early-Onset and Late-Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population-Based Surveillance. JAMA Pediatr. 2019; 173(3): 224–233.
  9. Russell NJ, Seale AC, O'Sullivan C, et al. Risk of Early-Onset Neonatal Group B Streptococcal Disease With Maternal Colonization Worldwide: Systematic Review and Meta-analyses. Clin Infect Dis. 2017; 65(suppl_2): S152–S159.
  10. Frej-Mądrzak M, Jama-Kmiecik A, Sarowska J, et al. Streptococcus agalactiae and Chlamydia trachomatis detection in women without symptoms of infection. Adv Clin Exp Med. 2020; 29(6): 707–713.
  11. Kwatra G, Cunnington MC, Merrall E, et al. Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis. Lancet Infect Dis. 2016; 16(9): 1076–1084.
  12. Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion Summary, Number 797. Obstet Gynecol. 2020; 135(2): 489–492.
  13. Verani JR, McGee L. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010; 59(RR-10): 1–36.
  14. Kotarski J, Heczko PB, Lauterbach R, et al. [Polish Gynecological Society's recommendations regarding diagnosis and prevention of streptococcus agalactiae infection in pregnant women and newborns]. Ginekol Pol. 2008; 79(3): 221–223.
  15. Nogacka A, Salazar N, Suárez M, et al. Impact of intrapartum antimicrobial prophylaxis upon the intestinal microbiota and the prevalence of antibiotic resistance genes in vaginally delivered full-term neonates. Microbiome. 2017; 5(1): 93.
  16. Zhou P, Zhou Y, Liu B, et al. Perinatal Antibiotic Exposure Affects the Transmission between Maternal and Neonatal Microbiota and Is Associated with Early-Onset Sepsis. mSphere. 2020; 5(1).
  17. Steer PJ, Russell AB, Kochhar S, et al. Group B streptococcal disease in the mother and newborn-A review. Eur J Obstet Gynecol Reprod Biol. 2020; 252: 526–533.
  18. Lawn J, Bianchi-Jassir F, Russell N, et al. Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children: Why, What, and How to Undertake Estimates? Clin Infect Dis. 2017; 65(suppl_2): S89–S99.
  19. Zietek M, Jaroszewicz-Trzaska J, Szczuko M, et al. Intrapartum PCR assay is a fast and efficient screening method for Group B Streptococcus detection in pregnancy. Ginekol Pol. 2020; 91(9): 549–553.
  20. Venkatesh KK, Vladutiu CJ, Strauss RA, et al. Association Between Maternal Obesity and Group B Streptococcus Colonization in a National U.S. Cohort. J Womens Health (Larchmt). 2020; 29(12): 1507–1512.
  21. Nadeau HCG, Bisson C, Chen Xi, et al. Vaginal-perianal or vaginal-perineal compared with vaginal-rectal culture-based screening for Group B Streptococci (GBS) colonization during the third trimester of pregnancy: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2022; 22(1): 204.
  22. Edwards RK, Tang Y, Raglan GB, et al. Survey of American obstetricians regarding group B streptococcus: opinions and practice patterns. Am J Obstet Gynecol. 2015; 213(2): 229.e1–229.e7.
  23. Hasperhoven GF, Al-Nasiry S, Bekker V, et al. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis. BJOG. 2020; 127(6): 680–691.
  24. Ficara M, Pietrella E, Spada C, et al. Changes of intestinal microbiota in early life. J Matern Fetal Neonatal Med. 2020; 33(6): 1036–1043.
  25. Stearns JC, Simioni J, Gunn E, et al. Intrapartum antibiotics for GBS prophylaxis alter colonization patterns in the early infant gut microbiome of low risk infants. Sci Rep. 2017; 7(1): 16527.
  26. Santillan DA, Hubb AJ, Nishimura TE, et al. Group B Streptococcus Screening and Treatment Adherence in Pregnancy: A Retrospective Cohort Study and Opportunities for Improvement. AJPM Focus. 2022; 1(2): 100028.
  27. Coker MO, Hoen AG, Dade E, et al. Specific class of intrapartum antibiotics relates to maturation of the infant gut microbiota: a prospective cohort study. BJOG. 2020; 127(2): 217–227.
  28. Corvaglia L, Tonti G, Martini S, et al. Influence of Intrapartum Antibiotic Prophylaxis for Group B Streptococcus on Gut Microbiota in the First Month of Life. J Pediatr Gastroenterol Nutr. 2016; 62(2): 304–308.
  29. İzbudak G, Tozkır E, Cogendez E, et al. Comparison of maternal-neonatal results of vaginal birth after cesarean and elective repeat cesarean delivery. Ginekol Pol. 2021; 92(4): 306–311.
  30. Hussain FN, Al-Ibraheemi Z, Pan S, et al. The Accuracy of Group Beta Rectovaginal Cultures at 35 to 37 Weeks of Gestation in Predicting Colonization Intrapartum. AJP Rep. 2019; 9(3): e302–e309.