Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Benitz, William Ε.; Gould, Jeffrey B.; Druzin, Maurice L.

doi:10.1542/peds.103.6.e78

Cited by 76 publications

(52 citation statements)

References 97 publications

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“…Early onset neonatal sepsis is normally related to vaginal carriage in the motherand subsequent colonization during birth in approximately 70-75% of infants (3). Intrapartum prophylaxis has been established to lead to a 70% decline in the incidence of GBS disease, however, early-onset GBS disease (in infants <7 days old) remains a leading cause of illness and death among newborns (3,4).…”

Section: Introductionmentioning

confidence: 99%

Group B Streptococcus Carriage during Late Pregnancy in Ile-Ife, Nigeria

Onipede¹,

Adefusi²,

Adeyemi³

et al. 2012

Af J Clin Exp Micro

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This study determined the prevalence of Group B Streptococcus (GBS) in late pregnancy and the antimicrobial susceptibility of isolated GBS as well as the impact of GBS infections on pregnancy related clinical outcome with a view of providing an epidemiological baseline data for policy formulation in the teaching hospital. It is an observational and cross-sectional hospital based study. One hundred and fifty pregnant women from 35-40 weeks of gestation were purposively selected and included in the study from May to December 2010. Vaginal swab samples were aseptically collected from the subjects after informed consent. The samples were assayed for presence of GBS. The susceptibility pattern of the isolated GBS to different antibiotics were assessed using disc diffusion and agar dilution techniques based on the Clinical and Laboratory Standards institute(CLSI) standards. The result showed prevalence of 11.3% GBS vaginal colonization which increased with age. There was no significant association between GBS colonization status and age (p >0.05)), gestational age (p >0.05)), gravidity (p >0.05) and obstetric risk factors (p >0.05)). There was no incidence of GBS infection observed. Although, all (17) the GBS isolates were 100% resistance to penicillin, ampicillin, cefoxitin and clindamycin. Resistance to cefotaxime (11.8%), erythromycin (64.7%) and vancomycin 70.6% were observed. Group B Streptococcus colonization in vagina in late pregnancy has been established in the antenatal clinic of the teaching hospital with the attendant risk to the fetus in the population of those affected. There were high and multiple resistance patterns of the GBS isolates to different antibiotics in this study. This calls for a review of the present hospital policy to include the routine screening of GBS during antenatal visits and surveillance.

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Section: Introductionmentioning

confidence: 99%

Group B Streptococcus Carriage during Late Pregnancy in Ile-Ife, Nigeria

Onipede¹,

Adefusi²,

Adeyemi³

et al. 2012

Af J Clin Exp Micro

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“…Hall et al (10) demonstrated that treatment during pregnancy (antepartum prophylaxis) reduced maternal GBS colonization transiently, but colonization recurred at delivery. For postpartum prophylaxis, universal administration of penicillin to neonates shortly after birth reduced the early-onset GBS infection by 68%, but it was also associated with a 40% increase in overall mortality and therefore is not recommended (2). The most successful approach to block vertical transmission of GBS from mother to infant is intrapartum prophylaxis (4 h prior to delivery) of colonized women.…”

mentioning

confidence: 99%

Removal of Group B Streptococci Colonizing the Vagina and Oropharynx of Mice with a Bacteriophage Lytic Enzyme

Cheng

Nelson

Zhu

et al. 2005

Antimicrob Agents Chemother

197

165

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Group B streptococci (GBS) are the leading cause of neonatal meningitis and sepsis worldwide. The current treatment strategy is limited to intrapartum antibiotic prophylaxis in pregnant women to prevent early-onset neonatal diseases, but considering the potential for antibiotic resistance, the risk of losing control over the disease is high. To approach this problem, we have developed a bacteriophage (phage) lytic enzyme to remove colonizing GBS. Bacteriophage muralytic enzymes, termed lysins, are highly evolved molecules designed to degrade the cell wall of host bacteria to release phage particles from the bacterial cytoplasm. Several different lysins have been developed to specifically kill bacterial pathogens both on mucosal surfaces and in blood and represent a novel approach to control infection. A lysin cloned from a phage infecting GBS was found to contain two putative catalytic domains and one putative binding domain, which is similar to the domain organization of some staphylococcal phage lysins. The lysin (named PlyGBS) was recombinantly expressed in Escherichia coli, and purified PlyGBS efficiently killed all tested GBS serotypes in vitro. In a mouse model, a single dose of PlyGBS significantly reduced bacterial colonization in both the vagina and oropharynx. As an alternative strategy for intrapartum antibiotic prophylaxis, this approach may be used to reduce vaginal GBS colonization in pregnant women before delivery or to decontaminate newborns, thus reducing the incidence of GBSassociated neonatal meningitis and sepsis.Group B streptococci (GBS), or Streptococcus agalactiae, are the leading cause of neonatal sepsis and meningitis in the United States and Europe (1). First identified as a pathogen in bovine mastitis, GBS were later found to colonize the human genital and lower gastrointestinal tract, where the organism can be transmitted perinatally to the fetus. In addition to newborn infections, GBS can also cause substantial morbidity and mortality in adults, particularly those who are immunocompromised or elderly (6). GBS are classified into nine serotypes based on differences in the polysaccharide capsule (24). Historically, the most commonly reported serotype associated with diseases is type III; however, recent epidemiological studies found that serotype V now accounts for approximately 30% of nonpregnant adults (11) and 14 to 23% of pregnant women and neonates (30).The efficacy of antibiotic administration during various stages of pregnancy in order to reduce the rate of early-onset GBS infection in neonates has been tested. Hall et al. (10) demonstrated that treatment during pregnancy (antepartum prophylaxis) reduced maternal GBS colonization transiently, but colonization recurred at delivery. For postpartum prophylaxis, universal administration of penicillin to neonates shortly after birth reduced the early-onset GBS infection by 68%, but it was also associated with a 40% increase in overall mortality and therefore is not recommended (2). The most successful approach to block vertical tr...

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“…Decision analysis models 9,10 have the advantages of allowing extrapolation to large populations and manipulation of underlying assumptions. However, they are heavily dependent on the accuracy of the assumptions used.…”

Section: Discussionmentioning

confidence: 99%