Prevention of Early‐onset Neonatal Group B Streptococcal Disease

doi:10.1111/1471-0528.14821

Cited by 130 publications

(45 citation statements)

References 59 publications

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“…However, the rate of GBS infections has decreased significantly since universal screening was adopted, while it has increased in the United Kingdom (UK), where universal screening was denied in favor of a risk-based approach [10]. In this risk-based approach adopted in the UK, the mother receives intrapartum antibiotics if there are a few risk factors involved, such as intrapartum fever or premature membranes rupture [8,10,11].…”

Section: Introductionmentioning

confidence: 99%

Streptococcus agalactiae in pregnant women in Brazil: prevalence, serotypes, and antibiotic resistance

et al. 2019

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Brazilian data for maternal GBS colonization shows different prevalence rates. This conflicting data may be related to the absence of an official recommendation from the Federal Brazilian Health Authorities describing guidelines and protocols to perform GBS screening in pregnant women, in both public and private clinics. In the present review, we evaluated published reports addressing the prevalence of GBS in different regions of the country, methods used, and, when available, information regarding antibiotic resistance and serological typing of clinical isolates. According to this review, GBS prevalence in pregnant women in Brazil ranged from 4.2 to 28.4%, in the last 10 years. Serotype Ia was the most prevalent. The highest antibiotic resistance rates were found for tetarcycline, although its use to treat GBS infections is not common. Our results also show high resistance rates to clindamycin and erythromycin, which are commonly used as an alternative to penicillin in GBS infecctions. The increased antibiotic resistance, variations in serotype distribution, and high GBS prevalences need to be further investigated. Based on the present situation, recommendations regarding GBS surveillance in the country were raised and may improve our strategies for preventing neonatal infections.

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Section: Introductionmentioning

confidence: 99%

Streptococcus agalactiae in pregnant women in Brazil: prevalence, serotypes, and antibiotic resistance

et al. 2019

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“…The primary route of transmission to neonates is from the mother during or preceding birth, with estimated transmission rates of up to 50% (2). Among neonates that are colonized, about 1% develop severe GBS disease, resulting in significant infant morbidity or mortality (2,4).…”

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confidence: 99%

Coassociation between Group B Streptococcus and Candida albicans Promotes Interactions with Vaginal Epithelium

et al. 2018

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Group B (GBS) is a leading cause of neonatal sepsis, pneumonia, and meningitis worldwide. In the majority of cases, GBS is transmitted vertically from mother to neonate, making maternal vaginal colonization a key risk factor for neonatal disease. The fungus is an opportunistic pathogen of the female genitourinary tract and the causative agent of vaginal thrush. Carriage of has been shown to be an independent risk factor for vaginal colonization by GBS. However, the nature of interactions between these two microbes is poorly understood. This study provides evidence of a reciprocal, synergistic interplay between GBS and that may serve to promote their cocolonization of the vaginal mucosa. GBS strains NEM316 (serotype III) and 515 (serotype Ia) are shown to physically interact with , with the bacteria exhibiting tropism for candidal hyphal filaments. This interaction enhances association levels of both microbes with the vaginal epithelial cell line VK2/E6E7. The ability of GBS to coassociate with is dependent upon expression of the hypha-specific adhesin Als3. In turn, expression of GBS antigen I/II family adhesins (Bsp polypeptides) facilitates this coassociation and confers upon surrogate the capacity to exhibit enhanced interactions with on vaginal epithelium. As genitourinary tract colonization is an essential first step in the pathogenesis of GBS and , the coassociation mechanism reported here may have important implications for the risk of disease involving both of these pathogens.

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“…It is clear that even strict and universal implementation of IAP guidelines does not eliminate EOD, 11,12 as disease can occur because of limitations to IAP administration (e.g. in precipitate labour), in infants of mothers who were negative on screening and where no risk factors are evident in labour.…”

Section: Fundingmentioning

confidence: 99%

Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study

Carreras-Abad

Cochet

Hall

et al. 2019

Health Technol Assess

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Background Group B streptococcus is the leading cause of infection in infants. Currently, intrapartum antibiotic prophylaxis is the major strategy to prevent invasive group B streptococcus disease. However, intrapartum antibiotic prophylaxis does not prevent maternal sepsis, premature births, stillbirths or late-onset disease. Maternal vaccination may offer an alternative strategy. Multivalent polysaccharide protein conjugate vaccine development is under way and a serocorrelate of protection is needed to expedite vaccine licensure. Objectives The ultimate aim of this work is to determine the correlate of protection against the major group B streptococcus disease-causing serotypes in infants in the UK. The aim of this feasibility study is to test key operational aspects of the study design. Design Prospective cohort study of pregnant women and their infants in a 6-month period (1 July to 31 December 2018). Setting Five secondary and tertiary hospitals from London and South England. National iGBS disease surveillance was conducted in all trusts in England and Wales. Participants Pregnant women aged ≥ 18 years who were delivering at one of the selected hospitals and who provided consent during the study period. There were no exclusion criteria. Interventions No interventions were performed. Main outcome measures (1) To test the feasibility of collecting serum at delivery from a large cohort of pregnant women. (2) To test the key operational aspects for a proposed large serocorrelates study. (3) To test the feasibility of collecting samples from those with invasive group B streptococcus. Results A total of 1823 women were recruited during the study period. Overall, 85% of serum samples were collected at three sites collecting only cord blood. At the two sites collecting maternal, cord and infant blood samples, the collection rate was 60%. A total of 614 women were screened for group B streptococcus with a colonisation rate of 22% (serotype distribution: 30% III, 25% Ia, 16% II, 14% Ib, 14% V and 1% IV). A blood sample was collected from 34 infants who were born to colonised women. Maternal and infant blood and the bacterial isolates for 15 newborns who developed invasive group B streptococcal disease during the study period were collected (serotype distribution: 29% III, 29% II, 21% Ia, 7% Ib, 7% IV and 7% V). Limitations Recruitment and sample collection were dependent on the presence of research midwives rather than the whole clinical team. In addition, individualised consent limited the number of women who could be approached each day, and site set-up for the national surveillance study and the limited time period of this feasibility study limited recruitment of all eligible participants. Conclusions We have verified the feasibility of collecting and processing rectovaginal swabs and blood samples in pregnant women, as well as samples from those with invasive group B streptococcal disease. We have made recommendations for the recruitment of cases within the proposed GBS3 study and for controls both within GBS3 and as an extension of this feasibility study. Future work A large case–control study comparing specific immunoglobulin G levels in mothers whose infants develop invasive group B streptococcal disease with those in colonised mothers whose infants do not develop invasive group B streptococcal disease is recommended. Trial registration Current Controlled Trials ISRCTN49326091; IRAS project identification number 246149/REC reference number 18/WM/0147. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 67. See the NIHR Journals Library website for further project information.

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Prevention of Early‐onset Neonatal Group B Streptococcal Disease

Cited by 130 publications

References 59 publications

Streptococcus agalactiae in pregnant women in Brazil: prevalence, serotypes, and antibiotic resistance

Streptococcus agalactiae in pregnant women in Brazil: prevalence, serotypes, and antibiotic resistance

Coassociation between Group B Streptococcus and Candida albicans Promotes Interactions with Vaginal Epithelium

Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study

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