Invasive Group B Streptococcal Infections in Finland: A Population-based Study

Lyytikäinen, Outi; Nuorti, J. Pekka; Halmesmäki, Erja; Carlson, Petteri; Uotila, Jukka; Vuento, Risto; Ranta, Tapio; Sarkkinen, Hannu; Ämmälä, Martti; Kostiala, Anja A. I.; Järvenpää, Anna‐Liisa

doi:10.3201/eid0904.020481

Cited by 43 publications

(34 citation statements)

References 16 publications

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“…1) at any observation point and a cumulative carriage rate of 54% (42 of 77) over the entire observation period. These figures are considerably higher than those (Ͻ15%) previously reported from Denmark and from several other countries (16,20,22,24,25,36). Results comparable to ours have been reported from the United States (5,14,28).…”

Section: Discussioncontrasting

confidence: 52%

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Dynamics of Streptococcus agalactiae Colonization in Women during and after Pregnancy and in Their Infants

et al. 2004

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The population dynamics of Streptococcus agalactiae (group B streptococci [GBS]) colonization of the vagina and anorectal area was investigated in a cohort of 77 Danish women during and after their pregnancy by a new sensitive method. The mean carriage rate among individual observations was 36%, and the cumulative carriage rate over the entire observation period was 54%. Examination of more than 1,500 GBS isolates by pulsed-field gel electrophoresis demonstrated that the GBS population was remarkably homogeneous and stable in each carrier. Virtually all carriers were colonized by a single GBS clone on all occasions spanning up to 2 years. Repeated detection of the same clone even in women who were recorded as intermittent carriers suggests that the actual carrier rate exceeds 50% but that fluctuations in the GBS proportions of the flora occasionally preclude their detection. Newborns and young infants usually carried the same GBS clone as their mothers. However, only twice were identical clones of GBS detected in different women in contrast to the observed clonal relationships of clinical isolates. These observations strongly suggest differences in the properties and epidemiology of virulent GBS clones compared to clones commonly carried by healthy individuals.Infection by Streptococcus agalactiae (group B streptococci [GBS]) is still a common cause of neonatal diseases such as pneumonia, septicemia, and meningitis, although the incidence has declined in some countries as a result of active prevention efforts. The overall incidence of early-onset disease in 1998 to 2000 was 0.5 to 0.6 cases per 1,000 live births (12,25,30,32), although there are geographical and racial differences (11). An incidence of 0.24 per 1,000 live births of proven GBS infections in neonates and young infants has been reported for Denmark in the past (8). It is generally accepted that bacterial colonization of the child during its passage through the birth canal is the main cause of early-onset infections among children aged less than 7 days. Intrapartum chemoprophylaxis offered to pregnant carriers is, therefore, the strategy now recommended by the Centers for Disease Control to reduce neonatal GBS infection (13). GBS also causes invasive infections in nonpregnant and pregnant adults (6, 35), although the incidences are lower than for newborns.The carriage rates of GBS among pregnant and nonpregnant women and the rate of neonatal acquisition of GBS has been examined in the past (for reviews, see references 4, 13, and 33). However, relatively little is known about the kinetics of GBS colonization among individual carriers.The main purpose of the present longitudinal study was to evaluate the prevalence of GBS colonization among pregnant and nonpregnant women by using a new sensitive differential agar medium (mixed blood [MB] agar) (19) and to examine the complexity and stability of the GBS population in individual women and their newborns. This was achieved by determination of the carriage and the clonal diversity of GBS defined by pulsed...

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Section: Discussioncontrasting

confidence: 52%

“…The overall incidence of early-onset disease in 1998 to 2000 was 0.5 to 0.6 cases per 1,000 live births (12,25,30,32), although there are geographical and racial differences (11). An incidence of 0.24 per 1,000 live births of proven GBS infections in neonates and young infants has been reported for Denmark in the past (8).…”

mentioning

confidence: 99%

Dynamics of Streptococcus agalactiae Colonization in Women during and after Pregnancy and in Their Infants

et al. 2004

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“…Neonates born preterm are at the highest risk of EOD and their mothers receive IAP based on the risk-factor strategy, irrespective of their colonization status. However, in a study in Finland, only 35 % of newborns with EOD had risk factors [12], thus demonstrating that this strategy is clearly not effective. Conversely, because colonization with GBS concerns fewer than 20 % of pregnant women, there is a risk of overtreatment when using the risk-factor strategy.…”

Section: Introductionmentioning

confidence: 98%

Molecular-based Screening for Perinatal Group B Streptococcal Infection: Implications for Prevention and Therapy

2013

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Group B streptococci (GBS) are a leading cause of infectious neonatal morbidity and mortality. Timely and accurate identification of colonized pregnant women is imperative to implement intrapartum antibioprophylaxis (IAP) to reduce the risk of early neonatal sepsis. Current guidelines recommend screening for GBS carriage with vaginal-rectal cultures. However, cultures require 24-72 h, thus precluding their use for intrapartum screening and these are only performed at 35-37 weeks gestation. New rapid molecular-based tests can detect GBS within hours. They have the potential to be used intrapartum and to allow for selective IAP in women carrying GBS. An advantage is that they can sometimes be performed by non-laboratory staff in the labor suite, thus avoiding delays in sample transfers to the microbiology laboratory. Another possible use of molecular-based assays is for the diagnosis of neonatal sepsis, where tests with a short turnaround time and high sensitivity and specificity are crucial. In this situation, the detection of microorganisms once antibiotic therapy has already been started is important, as treatment is started immediately once sepsis is suspected without waiting for microbiological confirmation. In this article, we discuss the state-of-the-art molecular-based tests available for GBS screening during pregnancy, as well as their implications for IAP for the diagnosis and prevention of neonatal sepsis.

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“…1,2 In contrast, screening based on risk factors for GBS disease and/or testing for maternal GBS colonisation is established practice in North America, Australasia and many parts of Europe. 3 During the 1990s, there was widespread controversy about whether to offer screening based on culture for maternal vaginal colonisation with GBS or to use risk factors such as preterm onset of labour, prolonged rupture of membranes, GBS bacteriuria during pregnancy, intrapartum pyrexia and a previous baby with GBS disease.…”

Section: Recommendations For Further Researchmentioning

confidence: 99%

“…Stage III: Effect on EOGBS (n) given maternal colonisation (N) Tuppurainen (1989) The probability of EOGBS given baby colonisation in trial j, p j (2) , was then…”

Section: Stage II Modelmentioning

confidence: 99%

Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost-effectiveness and expected value of information analyses

Colbourn¹,

Asseburg²,

Bojke³

et al. 2007

Health Technol Assess

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Invasive Group B Streptococcal Infections in Finland: A Population-based Study

Cited by 43 publications

References 16 publications

Dynamics of Streptococcus agalactiae Colonization in Women during and after Pregnancy and in Their Infants

Dynamics of Streptococcus agalactiae Colonization in Women during and after Pregnancy and in Their Infants

Molecular-based Screening for Perinatal Group B Streptococcal Infection: Implications for Prevention and Therapy

Prenatal screening and treatment strategies to prevent group B streptococcal and other bacterial infections in early infancy: cost-effectiveness and expected value of information analyses

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