VAGINAL CARRIAGE RATE OF GROUP B STREPTOCOCCUS IN PREGNANT WOMEN AND ITS TRANSMISSION TO NEONATES
Abstract
Background: Maternal vaginal colonisation with Group B Streptococcus (GBS, Streptococcusagalactiae) at the time of delivery can cause vertical transmission to the neonate. GBS is the leadingcause of sepsis, meningitis and pneumonia in the infants. Asymptomatic colonisation of the vagina withGBS varies with the geographical location. Methods: This was a cross-sectional study conducted in2009 at Benazir Bhutto Hospital, Rawalpindi, Pakistan. Lower vaginal swabs were obtained from 200pregnant women at the time of admission in the Gynaecology and Obstetrics Department for term,normal vaginal delivery and swabs from the skin of abdomen and ear canals of their respective neonatesimmediately after delivery were collected. Swabs were inoculated on blood agar and incubatedaerobically and on Group B Streptococcus agar (GBS agar) and incubated anaerobically in an anaerobicjar. Identification of GBS was made on the basis of colonial morphology (β-haemolytic colonies onblood agar and orange pigmented colonies on GBS agar), Gram stain, catalase test and conformation wasdone by means of latex agglutination tests. Results: A GBS carriage rate of 8.5% among pregnantwomen before delivery and an acquisition rate of 53% on the abdominal skin and 18% in the ear canalsby the neonates of colonised mothers were found. Conclusions: GBS colonisation in pregnant womenand its transmission to the neonates is present in our population so GBS infections in the prenatal andneonatal period might not be uncommon in Pakistan, so routine screening should be carried out.Keywords: Group B Streptococcus, vaginal carriage rate, pregnant women, transmission to neonatesReferences
Yun HC, Hamza H, Berkowitz LB, Khattak F. Bacterial infections
and pregnancy. BMJ 2007;335:655–72.
Natarajan G, Johnson YR, Zhang F, Chen KM, Worsham MJ.
Real-Time Polymerase Chain Reaction for the rapid detection of
group B streptococcal colonization in neonates. Pediatrics
;118:14–22.
Regan JA, Klebanoff MA, Nugent RP, Eschenbach DA.
Colonization with group B Streptococcus in pregnancy and
adverse outcome. Am J Obstet Gynecol l996;174:1354–60.
Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH,
Lefkowitz LB, et al. Group B streptococcal disease in the era of
intrapartum antibiotic prophylaxis. N Engl J Med 2000;342:15–20.
Prevention of perinatal group B streptococcal disease: a public
perspective. MMWR Morb Mortal Wkly Rep 1996;45:1–24.
Zangwill KM, Schuchat A, Wenger JD. Group B streptococcal
disease in the United States 1990: Report from a multistate active
surveillance system. Mor Mortal Wkly Rep CDC Surveill Summ
;41:25–32.
Al-Sweih N, Maiyegun S, Diejomaoh M, Rotimi V, Khodakhast
F, Hassan N, et al. Streptococcus agalactiae (Group B
Streptococci) carriage in late pregnancy in Kuwait. Med Princ
Pract 2004;13:10–4.
El Beitune P, Duarte G, Maffei CM. Colonization by
Streptococcus agalactiae during pregnancy: maternal and
perinatal prognosis. Braz J Infect 2005;9:4.
Stoll, Barbara J, Schuchat, Anne. Maternal carriage of group B
streptococci in developing countries. Pediatr Infect Dis J
;17:499–503.
Noble MA, Bent JM, West AB. Detection and identification of
group B streptococci by use of pigment production. J Clin Pathol
;36:350–2.
Picard FJ, Bergeron MG. Laboratory detection of group B
Streptococcus for prevention of perinatal disease. Eur J Clin
Microbiol Infect Dis 2004;23:665–71.
Schuchat A. Group B Streptococcus. Lancet 1999;353:51–6.
Schrag SJ, Zell ER, Lynfield R, Roome A, Arnold KE, Craig AS,
et al. A population-based comparison of strategies to prevent
early-onset group B streptococcal disease in neonates. N Engl J
Med 2002;347:233–9.
Rallu F, Barriga P, Scrivo C, Laferrière VM, Laferrière C.
Sensitivities of antigen detection and PCR assays greatly increased
compared to that of the standard culture method for screening for
group B Streptococcus carriage in pregnant women. Journal of
Clinical Microbiology 2006;44:725–8.
Busetti M, D’Agaro P, Campello C. Group B Streptococcus
prevalence in pregnant women from North-Eastern Italy:
advantages of a screening strategy based on direct plating plus
broth enrichment. Journal of Clinical Pathology 2007;60:1140–3.
Rahim F, Jan A, Mohummad J, Iqbal H. Pattern and outcome of
admissions to neonatal unit of Khyber Teaching Hospital,
Peshawar. Pak J Med Sci 2007;23:249–53.
Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A.. Prevention of
perinatal group B streptococcal disease. Revised guidelines from
CDC. MMWR Recomm Rep 2002;51:1–22.
Dyke MK, Phares CR, Lynfield R, Thomas AR, Arnold KE,
Craig AS, et al. Evaluation of universal antenatal screening for
group B Streptococcus. N Engl J Med 2009;360:2626–36.
Logsdon BA, Casto DT. Prevention of group B Streptococcus
infection in neonates. Ann Pharmacother 1997;31:897–906.
J Ayub Med Coll Abbottabad 2010;22(4)
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Bushra.pdf
Orrett FA. Colonization with group B streptococci in pregnancy
and outcome of infected neonates in Trinidad. Pediatr Int
;45:319–23.
Savoia D, Gottimer C, Crocilla C, Zucca M. Streptococcus
agalactiae in pregnant women: phenotypic and genotypic
characters. J Infect 2008;56:120–5.
Annotation. Prevention of early onset group B streptococcal
infection: screen, treat, or observe? Arch Dis Child Fetal Neonatal
Ed 1998;79:F81–2.
Dermer P, Lee C, Eggert J, Few B. A history of neonatal group B
Streptococcus with its related morbidity and mortality rates in the
United States. J Pediatr Nurs 2004;19:357–63.
Ancona RJ, Ferrieri P, Williams PP. Maternal factors that enhance
the acquisition of group B streptococci by newborn infants. J Med
Microbiol 1980;3:273–80.
Votava M, Tejkalová M, Drábková M, Unzeitig V, Braveny I.
Use of GBS media for rapid detection of group B streptococci in
vaginal and rectal swabs from women in labor. Eur J Clin
Microbiol Infect Dis 2001;20:120–2.
Gilbert R. Prenatal screening for group B streptococcal infection:
gaps in the evidence. International J of Epidemiol 2003;33:2–8.
Akhtar T, Zia S, Khatoon J. Group B Streptococcus carriage rate
of pregnant women and newborn infants. Pakistan J Med Res
;23:12–5.
Hafeez A, Ali S, Abbasi SA. Normal vaginal flora in pregnant
women. J Pakistan Ins Med 1997;7:437–40.
NomuraI ML, Passini R Júnior, Oliveira UM. Selective versus
non-selective culture medium for group B Streptococcus detection
in pregnancies complicated by preterm labor or preterm-premature
rupture of membranes. Braz J Infect Dis 2006;10:242–6.
Mani V, Jadhav M, Sivadasan K, Thangavelu CP, Rachel M,
Prabha J. Maternal and neonatal colonization with group B
Streptococcus and neonatal outcome. Indian Pediatr
;21:357–63.
El-Kersh TA, Al-Nuaim LA, Kharfy TA, Al-Shammary FJ, AlSaleh SS, Al-Zamel FA. Detection of genital colonization of
group B streptococci during late pregnancy. Saudi Med J
;23:56–61.
Namavar Jahromi B, Poorarian S, Poorbarfehee S. The prevalence
and adverse effects of group B streptococcal colonization during
pregnancy.Arch Iran Med 2008;11:654–7.
Ayata A, Guvenc H, Felek S, Aygun AD, Kocabay K, Bektas S.
Maternal carriage and neonatal colonization of group B
streptococci in labour are uncommon in Turkey. Pediatr Perinatal
Epidemiol 1994;8:188–92.
Benitz W.E., Gould J.B., Druzin M.L. Risk factors for early-onset
group B streptococcal sepsis: estimation of odds ratios by critical
literature review. Pediatrics 1999;103:77.
Baker CJ. Early onset Group B streptococcal disease. J Paediatr
;93:124–5.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
