Group B streptococcal colonization and transmission dynamics in pregnant women and their newborns in Nigeria: implications for prevention strategies

Medugu, Nubwa; Iregbu, Kenneth; Parker, Robert E.; Plemmons, Jessica A.; Singh, Pallavi; Audu, Lamidi Isah; Efetie, ER; Davies, H. Dele; Manning, Shannon D.

doi:10.1016/j.cmi.2017.02.029

Cited by 32 publications

(48 citation statements)

References 23 publications

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“…GBS was isolated more frequently in young women (aged ≤ 30 years) compared to older women. Similar findings were reported by other authors [20,21].…”

Section: Discussionsupporting

confidence: 93%

Group B Streptococcus Colonization in Pregnancy: Prevalence, Determinants and Antibacterial Susceptibility Pattern in Sagamu, Nigeria

Akadri¹,

Osuolale²,

Shorunmu³

et al. 2019

JAMMR

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Aims:To establish the prevalence, determinants and the antibiotic susceptibility pattern of Group B streptococcus in pregnant women in Sagamu, Ogun State, Nigeria. Study Design: Prospective cross-sectional study Place and Duration of Study: The study was carried out at the antenatal clinic at Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria, between July 2017 and December 2017. Methodology: The study involved 184 pregnant women attending antenatal clinic. Lower vaginal and rectal swabs were collected under aseptic condition and immediately sent to the laboratory for processing. The samples were assayed for the presence of group B streptococcus using Akadri et al.; JAMMR, 29(10): 1-8, 2019; Article no.JAMMR.49367 2 conventional methods. Information on the socio demographic characteristics and details of delivery were recorded on a data capture sheet. Results: The prevalence of Group B streptococcus was 27.7%. The odds of Group B streptococcus colonization was significantly higher among women of low parity (≤ 2) and binary logistic regression analysis showed that parity was predictive of Group B streptococcus colonization (OR 3.7; 95% CI = 1.03-13.46; P=.045). Younger women (age ≤ 30 years) and women carrying term pregnancies had a non significant trend towards higher odds of Group B streptococcus colonization [(OR= 1.22, 95% CI: 0.6-2.3, P = .54) and (OR=1.6, CI: 0.8-3.2; P = .15) respectively]. The resistance of group B streptococcus isolates to penicillin and ampicillin was 39.2% and 37.3% respectively. Conclusion: The group B streptococcus colonization rate in this study is high. Factors such as low parity, young maternal age and term pregnancies are associated with increased odds of colonization. The emergence of resistance to the commonly prescribed antibiotics calls for reevaluation of the current recommendations regarding the antibiotics prophylaxis. Original Research Article

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“…GBS was isolated more frequently in young women (aged ≤ 30 years) compared to older women. Similar findings were reported by other authors [20,21].…”

Section: Discussionsupporting

confidence: 93%

Group B Streptococcus Colonization in Pregnancy: Prevalence, Determinants and Antibacterial Susceptibility Pattern in Sagamu, Nigeria

Akadri¹,

Osuolale²,

Shorunmu³

et al. 2019

JAMMR

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“…The volume of blood collected for culture was reported by 11 studies obtained at least 1 ml of blood from the neonates. One of these studies used new-born weight to determine the volume of blood to collect for culture[ 25 ]. Overall blood culture yield across all studies was 24.5% but ranged from 20% [ 27 ] to 56% [ 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-two of the studies were single center studies carried out in tertiary hospitals. Two studies were done in multiple hospitals: one in three and the other in four hospitals[ 25 , 49 ]. Two studies were carried out at different times in the same rural area while all others were in urban areas[ 27 , 47 ].…”

Section: Resultsmentioning

confidence: 99%

Aetiology of neonatal sepsis in Nigeria, and relevance of Group b streptococcus: A systematic review

et al. 2018

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BackgroundGroup B Streptococcus (GBS) causes invasive infections in neonates and has been implicated as a cause of prelabour rupture of membranes, preterm delivery and stillbirths. The success of phase II trials of polyvalent polysaccharide GBS vaccines indicates that these infections are potentially preventable. Nigeria is the most populous country in Africa with one of the highest birth rates, one of the highest neonatal sepsis incidence rates and one of the highest mortality rates in the world. Therefore, before the possible introduction of preventive strategies such as intrapartum antibiotic prophylaxis or GBS vaccine into Nigeria, it is vital that there is accurate data on the aetiology of neonatal sepsis and on the incidence of GBS neonatal sepsis in particular. The objective of this study was to determine the incidence and aetiology of neonatal sepsis in Nigeria with a focus on GBS sepsis and also to assess the potential impact of a GBS vaccine.MethodsA literature search was conducted on the databases of African journals online, PubMed and Google Scholar for works conducted between 1987 to 2017. Case reports, reviews, and studies not stating specific culture methods or specific bacteria isolated were excluded. Data extracted included; incidence of neonatal sepsis, method of blood culture, blood volume, sample size, bacterial agents isolated and history of antibiotic use. PRISMA guidelines were followed and modified Down’s and Black criteria used to evaluate the quality of studies.ResultsA total of 5,114 studies were reviewed for neonatal sepsis out of which 24 consisting of a total of 2,280 cases were selected for final review. Nine studies met criteria for assessment of hospital based incidence of neonatal sepsis representing 31,305 hospital births. The incidence of neonatal sepsis was 18.2/1000 livebirths with range from 7-55/1000 livebirths while the GBS incidence was 0.06/1000 livebirths with range from 0-2/1000 live births. We discovered various limitations such as identification techniques that could result in underestimation of the true incidence of GBS sepsis. Pathogens such as Klebsiella pneumoniae and Staphylococcus aureus were more commonly isolated than GBS.Implications of key findingsThe hospital based incidence of neonatal sepsis was high at 18.2/1000 live births while that due to GBS was 0.06/1000 live births. The burden of neonatal sepsis, including that attributable to GBS is substantial and could be reduced by preventive strategies such as intrapartum antibiotic prophylaxis or GBS vaccine. There is however very sparse meaningful data currently. Well planned prospective studies with larger sample sizes, more advanced isolation and identification techniques and those following up invasive disease cases for possible short and long term sequelae are needed—not only prior to possible introduction of the vaccine to determine the baseline epidemiology, but also thereafter to monitor its impact on the population. Strategies need to be developed to also reduce the morbidity and mortality attributa...

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“…GBS remains the most common pathogen causing bacterial meningitis in young infants <3 months old ( 3 , 31 ). Several studies have documented that intrapartum antibiotic prophylaxis in pregnant women with GBS colonization has lowered the incidence rate of GBS early-onset disease; however, this has no significant effect on GBS late-onset disease ( 32 , 33 ). In our cohort, GBS accounted for more than half of bacterial meningitis cases, mostly presented as late-onset disease (33 cases, 84.6%) and our previous studies found that more than half of GBS invasive disease cases in the neonatal intensive care unit cause meningitis ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

Neurological Complications in Young Infants With Acute Bacterial Meningitis

Hsu

Kuo

et al. 2018

Front. Neurol.

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We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1–173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7–13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35–27.0, P = 0.019) were independent predictors for final unfavorable outcomes.Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted.

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Group B streptococcal colonization and transmission dynamics in pregnant women and their newborns in Nigeria: implications for prevention strategies

Abstract: These data demonstrate high rates of colonization and transmission in a population that does not use antibiotics to prevent neonatal infections, a strategy that should be considered in the future.

Cited by 32 publications

References 23 publications

Group B Streptococcus Colonization in Pregnancy: Prevalence, Determinants and Antibacterial Susceptibility Pattern in Sagamu, Nigeria

Group B Streptococcus Colonization in Pregnancy: Prevalence, Determinants and Antibacterial Susceptibility Pattern in Sagamu, Nigeria

Aetiology of neonatal sepsis in Nigeria, and relevance of Group b streptococcus: A systematic review

Neurological Complications in Young Infants With Acute Bacterial Meningitis

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