Streptococcus agalactiae from Ethiopian pregnant women; prevalence, associated factors and antimicrobial resistance: alarming for prophylaxis

Abstract

BackgroundMaternal Streptococcus agalactiae (Group B Streptococcus, GBS) colonization rates and its antibiotic resistance patterns provide important information useful in guiding prevention strategies. There is a paucity of evidence about GBS in the Amhara National Regional State, Ethiopia.ObjectiveTo determine colonization prevalence, associated risk factors, and antibiotics resistance including inducible clindamycin resistance patterns of GBS among Ethiopian pregnant women.MethodsA prospective cross-sectional study was conducted from 1st December 2016 to 30th November 2017 at the University of Gondar Referral hospital delivery ward. Combined recto-vaginal swabs were collected from 385 pregnant women and analyzed at the University of Gondar Bacteriology Laboratory by using LIM broth and 5% defibrinated sheep blood agar culture methods. Isolates were identified by using colony morphology, gram reaction, hemolysis, and CAMP test. Antibiotic susceptibility test was done using the disc diffusion method. Double disc diffusion method was used to identify inducible clindamycin resistance isolates. Data were analyzed by SPSS version 20 software. p ≤ 0.05 was considered as statistically significant.ResultsThe overall prevalence of maternal GBS colonization was 25.5% (95% CI 21–29.5%). Experiencing meconium stained amniotic fluid (AOR = 3.018, 95% CI 1.225, 7.437), and longer duration of premature rupture of membrane (AOR = 1.897, 95% CI 1.014, 3.417) were statistically significant to maternal colonization. Furthermore, GBS resistant to 0 (8.2%), 1 (25.5%) and 3 (39.8%) or more antibiotics were identified. A D-test showed 15.2% inducible clindamycin resistant GBS. Constitutive macrolide lincosamide–streptograminB, L-, and M-phenotypes were also detected.ConclusionsMaternal GBS colonization rate in this study was higher compared to the previous reports in Ethiopia. This much prevalence and antibiotics resistance results are the clue to which attention shall be given to this bacterium during management of pregnant women and the newborns.

Analysis of virulence factors and antibiotic resistance genes in Group B Streptococcus from clinical samples

“…However, our results agree with recent ndings in Ethiopia were a resistance of 77.3% to penicillin G was reported in pregnant women (17). Other studies have reported resistance to both penicillin G and ampicillin of 10.2% and 9.2% as well as 19.5% and 14.6% respectively (18,19). The high resistance reported may be due to the wide and non-prescription use of these two drugs in our study area (47,49).…”

“…This study also reports resistance to other penicillin surrogates (50) such as ceftriaxone 46.5% (20/43) and cefazolin 72.1% (31/43). A similar observation of approximately 31% for ceftriaxone was reported (18,51), whilst a lower range of 0%-15% for cefazolin has been reported (51)(52)(53). We recommend that antibiotic susceptibility testing should be performed if penicillin G or ampicillin therapy is needed in the prevention of neonatal GBS infection.…”

“…Generally, GBS is regarded to be 100% susceptible to penicillin and ampillicin (12,15,16). However, some studies in Ethiopia, USA and Japan have reported clinical isolates exhibiting intermediate and reduced resistance to both penicillin G and ampicillin (17)(18)(19)(20)(21). The prevalence of resistance to erythromycin, tetracycline and clindamycin has recently been increasing in S. agalactiae (12,13,22).…”

Streptococcus agalactiae maternal colonization, antibiotic resistance and serotype profiles in Africa: a meta-analysis

“…Primary studies conducted in the East African countries showed the colonization rates ranged from 3.0% to 28.8% [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26]; Central Africa,20.0% [27,28]; Western Africa, 2.5% to 34.2% [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]; Southern Africa, 1.77% to 48.23% [49][50][51][52][53][54][55][56][57]…”

Group B streptococci in pregnancy: New perspectives for old challenges

“…Previous studies identified various risk factors for GBS colonisation during pregnancy. These include obesity, age, being African‐American or Caucasian, older age at the first pregnancy, a history of GBS during a previous pregnancy, being multigravida, meconium‐stained amniotic fluid, a longer duration of the premature rupture of membranes, and smoking . The study by Chen et al builds on the existing literature and sets the stage for additional, much‐needed work to examine the factors associated with GBS colonisation during pregnancy, study causality and interrogate underlying mechanisms.…”