[Group B streptococcus maternal and neonatal colonization in preterm rupture of membranes and preterm labor].

Divisão de Obstetrícia, Departamento de Tocoginecologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas, SP, Brasil.
Revista brasileira de ginecologia e obstetrićia: revista da Federação Brasileira das Sociedades de Ginecologia e Obstetrícia 08/2009; 31(8):397-403. DOI: 10.1590/S0100-72032009000800005
Source: PubMed

ABSTRACT To identify the prevalence and risk factors of maternal colonization by group B streptococcus (GBS) in pregnant women with premature labor (PL) and/or premature membrane rupture (PMR).
Two anal and two vaginal swabs were collected from 203 pregnant women with diagnosis of PL or PMR assisted at the practice along one year. Pregnant women with imminent labor at admission were excluded. One swab of each source was placed in a transfer milieu and sent for culture in blood-agar plates; the two remaining swabs were incubated for 24 hours in Todd-Hewitt milieu for further sowing in blood-agar plates. Risk factors were analyzed by the chi-square test, Student's t-test (p-value set at 0.05 and 95% confidence interval) and logistic regression. The following variables were analyzed: age, race, parity and mother schooling; culture results by source and type of culture; admission diagnosis; gestational age at admission; asymptomatic bacteriuria; gestational age at delivery; type of delivery; neonatal GBS colonization rate and immediate neonatal condition.
Prevalence of maternal GBS colonization was 27.6% (56 cases). The colonization rates according to gestational complications were 30% for PMR, 25.2% for PL and 17.8% for PL + PMR. Univariate analysis has shown that the variables Caucasian race, low level of schooling and bacteriuria were associated with higher colonization rates. Multivariate analysis showed that the presence of urinary infection was the only variable associated with maternal colonization. The GBS detection rate was significantly higher with the use of a selective milieu and collection from both anal and vaginal sources. The neonatal colonization rate was 3.1%. Two cases of early sepsis by GBS occurred in the sample, with prevalence of 10.8 cases per one thousand live births and 50% mortality rate.
The studied sample showed high maternal colonization rates by Streptococcus agalactiae. To increase GBS detection rate, it is necessary to use a selective culture milieu and to combine anal-rectal and vaginal cultures. There was a high incidence of early neonatal sepsis.

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    ABSTRACT: The Streptococcus agalactiae colonization prevalence and its susceptibility to antimicrobials in pregnant women at University Hospital of Santa Maria (HUSM) were evaluated from June to December 2009. The vaginal-rectal material was inoculated into tubes containing Todd-Hewitt broth with subsequent subculture on blood agar. The GBS identification was made through presumptive tests, confirmed by serological test and its susceptibility was evaluated. The occurrence ofGBS maternal-fetal transmission in the colonized pregnant women was researched. The GBS colonization was 11.11%. All strains were susceptible to penicillin, ampicillin, and vancomycin. Two strains (50%) were intermediate to clindamycin and one (25%) intermediate to erythromycin. A newborn whose mother was colonized had early-onset neonatal infection by GBS. By this, it is very important the research about the colonization by GBS in all pregnant women from 35 to 37 weeks of gestation and the use of intrapartum antibiotic prophylaxis for colonized pregnant women. RESUMO Avaliou-se a prevalência de colonização pelo Streptococcus agalactiae e o seu perfil de sensibilidade frente aos antimicrobianos em gestantes no Hospital Universitário de Santa Maria (HUSM), de junho a dezembro de 2009. O material vaginal-retal foi inoculado em tubos contendo caldo Todd-Hewitt com posterior subcultura em ágar sangue. A identificação do EGB foi realizada através de testes presuntivos, confirmadas por teste sorológico e avaliado seu perfil de sensibilidade. Pesquisou-se ocorrência de transmissão materno-fetal do EGB nas gestantes colonizadas. A prevalência de colonização foi de 11,11%. Todas as cepas foram sensíveis à penicilina, ampicilina e vancomicina. Duas cepas (50%) foram intermediárias à clindamicina e uma (25%) intermediária à eritromicina. Um recém-nascido de mãe colonizada teve infecção neonatal de início precoce por EGB. Confirma-se a importância da pesquisa de colonização por EGB em todas as gestantes entre 35ª e 37ª semana de gestação e uso de quimioprofilaxia intraparto nas gestantes colonizadas.
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    ABSTRACT: Group B streptococcus colonization in pregnant women usually has no symptoms, but it is one of the major factors of newborn infection in developed countries. In Iran, there is a little information about the prevalence of maternal colonization and newborns infected by group B streptococcus. In order to find the necessary information to create a protocol for prevention and treatment of group B streptococcus infection in newborns, we conducted a study of its prevalence among Iranian pregnant women and its vertical transmission to their newborns. This is a cross-sectional descriptive and analytic study performed at Prenatal Care Clinic of the Sarem Hospital from 2009 to 2011. The pregnant women with the gestational age of 35-37 weeks were enrolled in the study. The vaginal culture for group B streptococcus was done for 980 mothers based on our protocol. Among 980 mothers, 48 were shown positive vaginal culture; however, 8 cases among these 48 mothers were positive for both vaginal and urine culture. Babies with mothers showing positive vaginal culture were screened for infection using complete blood count /blood culture (B/C) and C-reactive protein (CRP). Then, a complete sepsis workup was performed for babies with any signs of infection in the first 48 hours after birth, and they received antibiotic therapy if necessary. All collected data were analyzed (SPSS version 15). Among 980 pregnant women with vaginal culture, 48 cases had positive group B streptococcus cultures among which 8 mothers also had positive group B streptococcus urine culture. Our findings revealed that 22 (50%) symptomatic neonates were born from the mothers with positive vaginal culture for group B streptococcus. About 28 of them (63%) had absolute neutrophil count more than normal, and 4 (9.1 %) newborns were omitted from the study. Therefore, 50% of neonates showed clinical feature, whereas para-clinical test was required to detect the infection for the rest of neonates who showed no signs or symptoms. The colonization of group B streptococcus in Iranian women is significant, while 50% of newborns from mother with positive vaginal culture were symptomatic after birth; therefore, screening of newborns for group B streptococcus infection is recommended to become a routine practice in all healthcare centers in Iran.
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