Bacterial Load and Molecular Markers Associated With Early-onset Group B Streptococcus

Seedat, Farah; Brown, Colin S; Stinton, Chris; Patterson, Joän M.; Geppert, Julia; Freeman, Karoline; Tan, Bee K.; Johnson, Samantha; Fraser, Hannah; Uthman, Olalekan A.; Robinson, Esther; McCarthy, Noel D.; Clarke, Aileen; Taylor‐Phillips, Sian

doi:10.1097/inf.0000000000002050

Cited by 14 publications

(14 citation statements)

References 42 publications

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“…Recently, a number of virulence factors and GBS lineages such as hypervirulence clonal complex 17 [28] and surface proteins (eg, Rib, Alp, and Pilus proteins) [29] have been implicated in increased disease risk and colonization persistence. Additionally, the initial inoculum (the woman’s bacterial load at the point of transmission) has also been associated with an increased risk of EOGBS [30]. Additional insights such as these could allow targeted implementation of IAP to only those women who carry the variants of GBS that are most likely to cause EOGBS, thus reducing the IAP currently offered to all women with GBS colonization.…”

Section: Testing Strategies For Bacterial Load/virulence—colonizationmentioning

confidence: 99%

Uncertainties in Screening and Prevention of Group B Streptococcus Disease

Doare

Heath

Plumb³

et al. 2018

Clinical Infectious Diseases

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In autumn 2016, the UK Department of Health (now Department of Health and Social Care) convened 2 meetings to discuss how to address research evidence gaps in order to minimize the impact of infant group B streptococcus (GBS) disease in the United Kingdom. At that meeting, a number of research priorities were highlighted, including improving the screening for GBS colonization in pregnant women, offering intrapartum antibiotic prophylaxis and point-of-care testing, and understanding the effect of widespread intrapartum antibiotic use on long-term infant health. Further discussions involved investigating the feasibility of a large prospective study of pregnant women and their infants in order to understand the role of antibodies in the protection against GBS disease in infancy following maternal exposure to GBS colonization. Here, we summarize the research uncertainties identified at that meeting.

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Section: Testing Strategies For Bacterial Load/virulence—colonizationmentioning

confidence: 99%

Uncertainties in Screening and Prevention of Group B Streptococcus Disease

Doare

Heath

Plumb³

et al. 2018

Clinical Infectious Diseases

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“…The characteristics of each study that reported (n = 13) (Fettweis et al, 2014;Ghartey et al, 2014;Romero et al, 2014a;Romero et al, 2014b;Bisanz et al, 2015;MacIntyre et al, 2015;Kindinger et al, 2017;Brown et al, 2018;Hočevar et al, 2019;Purkayastha et al, 2019;Romero et al, 2019;Tabatabaei et al, 2019;Al-Memar et al, 2020) or did not report GBS (n = 32) (Dominguez-Bello et al, 2010;Hernández-Rodríguez et al, 2011;Aagaard et al, 2012;Frank et al, 2012;Hyman et al, 2012;Hyman et al, 2014;Walther-António et al, 2014;Baldwin et al, 2015;DiGiulio et al, 2015;Huang et al, 2015;Brumbaugh et al, 2016;Jayaprakash et al, 2016;Lauder et al, 2016;Nelson et al, 2016;Subramaniam et al, 2016;Callahan et al, 2017;Freitas et al, 2017;Nasioudis et al, 2017b;Nasioudis et al, 2017a; Roesch et al, 2017;Stout et al, 2017;Goltsman et al, 2018;Leizer et al, 2018;Matsumoto et al, 2018;Wylie et al, 2018;Chen et al, 2019;Dobbler et al, 2019;He et al, 2019;Jefferson et al, 2019...…”

Section: Study Characteristics and Results Of Individual Studiesmentioning

confidence: 99%

“…Evaluation of culture-based GBS screening previously determined that GBS transmission to neonates is more likely when maternal colonization is heavy, as determined by the number of colonies grown at the time of screening ( Berardi et al., 2014 ; Seedat et al., 2018 ). However, it is unclear how well clinical culture-based microbial assessments correlate with the detection of clinically relevant pathogens in sequencing-based vaginal microbiome studies.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is unclear how well clinical culture-based microbial assessments correlate with the detection of clinically relevant pathogens in sequencing-based vaginal microbiome studies. Furthermore, much of the research investigating risk of neonatal GBS infection related to maternal bacterial load was completed in the 1980s and has not been evaluated using sequencing-based methods ( Seedat et al., 2018 ). Future studies that concurrently evaluate the accuracy of GBS reporting within microbial communities via metagenomic sequencing approaches and culture-based methods are needed.…”

Section: Discussionmentioning

confidence: 99%

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Group B Streptococcus and the vaginal microbiome among pregnant women: a systematic review

Lim

Rajagopal

Jeong

et al. 2021

PeerJ

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Background Vaginal microbiome studies frequently report diversity metrics and communities of microbiomes associated with reproductive health outcomes. Reports of Streptococcus agalactiae (also known as Group B Streptococcus or GBS), the leading cause of neonatal infectious morbidity and mortality, are notably lacking from the studies of the vaginal microbiome, despite being a known contributor to preterm birth and other complications. Therefore, the purpose of this systematic review was to explore the frequency of GBS reporting in vaginal microbiome literature pertaining to pregnancy and to examine methodological bias that contributes to differences in species and genus-level microbiome reporting. Lack of identification of GBS via sequencing-based approaches due to methodologic or reporting bias may result incomplete understanding of bacterial composition during pregnancy and subsequent birth outcomes. Methodology A systematic review was conducted following the PRISMA guideline. Three databases (PubMed, CINAHL, and Web of Science) were used to identify papers for review based on the search terms “vaginal microbiome”, “pregnancy”, and “16S rRNA sequencing”. Articles were evaluated for methods of DNA extraction and sequencing, 16S region, taxonomy classification database, number of participants or vaginal specimens, and pregnancy trimester. Results Forty-five research articles reported employing a metagenomic approach or 16S approach for vaginal microbiome analysis during pregnancy that explicitly reported taxonomic composition and were included in this review. Less than 30% of articles reported the presence of GBS (N = 13). No significant differences in methodology were identified between articles that reported versus did not report GBS. However, there was large variability across research methods used for vaginal microbiome analysis and species-level bacterial community reporting. Conclusion Considerable differences in study design and data formatting methods may contribute to underrepresentation of GBS, and other known pathogens, in existing vaginal microbiome literature. Previous studies have identified considerable variation in methodology across vaginal microbiome studies. This study adds to this body of work because in addition to laboratory or statistical methods, how results and data are shared (e.g., only analyzing genus level data or 20 most abundant microbes), may hinder reproducibility and limit our understanding of the influence of less abundant microbes. Sharing detailed methods, analysis code, and raw data may improve reproducibility and ability to more accurately compare microbial communities across studies.

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“…Screening for ASB a few weeks before term may identify women with extensive vaginal colonization with GBS, i.e. those who might benefit from treatment with antibiotics during labor to prevent EOGBS 5,6 …”

Section: Introductionmentioning

confidence: 99%

Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35–37 weeks of pregnancy

Khalil

Uldbjerg

Thorsen

et al. 2020

Intl J Gynecology & Obste

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Objective To evaluate whether systematic antepartum screening for Group B Streptococci (GBS) by urine culture improves the risk factor‐based selection of pregnant women for intrapartum GBS screening with a rapid polymerase chain reaction (PCR) assay. Methods A prospective observational study was conducted between April 2013 and June 2014. GBS colonization judged by urine culture at 35–37 weeks of gestation was compared with the result of a vaginal GBS PCR test at labor as outcome. The results of urine culture were used as exposure variable. The PCR test was performed on intrapartum vaginal samples. Results Screening for urine GBS in 902 unselected pregnant Danish women at 35–37 weeks of gestation predicted intrapartum PCR GBS status with a sensitivity of 33.6%. A positive predictive value of 41.2% was seen among women with low GBS counts (<104 CFU/mL) and 83.3% among women with high GBS counts (≥104 CFU/mL). Systematic GBS screening of urine at 35–37 weeks of gestation added 30.9% extra women for intrapartum GBS PCR screening in the study group. Conclusion Systematic antepartum GBS screening of urine should be implemented in order to improve risk stratification for early onset GBS by offering laboring women an intrapartum GBS PCR test.

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Bacterial Load and Molecular Markers Associated With Early-onset Group B Streptococcus

Abstract: Acknowledging the difficulty of natural history studies, well-controlled studies are needed to assess the predictive value of pathogen subtype and heavy load; they may be useful for better-targeted prevention.

Cited by 14 publications

References 42 publications

Uncertainties in Screening and Prevention of Group B Streptococcus Disease

Uncertainties in Screening and Prevention of Group B Streptococcus Disease

Group B Streptococcus and the vaginal microbiome among pregnant women: a systematic review

Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35–37 weeks of pregnancy

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