A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates

Schrag, Stephanie J.; Zell, Elizabeth R.; Lynfield, Ruth; Roome, Aaron; Arnold, Kathryn E.; Craig, Allen S.; Harrison, Lee H.; Reingold, Arthur; Stefonek, Karen; Smith, Greg; Gamble, Melanie; Schuchat, Anne

doi:10.1056/nejmoa020205

Cited by 510 publications

(214 citation statements)

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“…The implementation of universal screening of pregnant women at 35 to 37 weeks' gestation has significantly reduced the risk of earlyonset GBS infection in neonates from 1.5 per 1,000 births in the 1980s to 0.34 per 1,000 births in recent years (4,5). Several studies have been performed to identify the cause of the remaining infections.…”

Section: Discussionmentioning

confidence: 99%

“…Transmission from an asymptomatically colonized mother to the neonate can result in early-onset invasive GBS disease, which is a leading cause of sepsis and meningitis in newborns in the United States (3). Early-onset GBS disease in newborns can result in death or longterm disabilities such as mental retardation and hearing or vision loss (4). Because these infections are acquired through direct contact of the neonate with GBS in the mother's urogenital tract during delivery, it has become a universal practice to screen pregnant women for vaginal/rectal colonization with GBS at 35 to 37 weeks' gestation (5).…”

Section: S Treptococcus Agalactiae (Group B Streptococcus [Gbs]) Is Amentioning

confidence: 99%

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Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

et al. 2015

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dNeonatal infection with Streptococcus agalactiae (group B Streptococcus [GBS]) is a leading cause of sepsis and meningitis in newborns. Recent guidelines have recommended universal screening of all pregnant women to identify those colonized with GBS and administration of peripartum prophylaxis to those identified as carriers to reduce the risk of early-onset GBS disease in neonates. Enriched culture methods are the current standard for prenatal GBS screening; however, the implementation of more sensitive molecular diagnostic tests may be able to further reduce the risk of early-onset GBS infection. We report a clinical evaluation of the Xpert GBS LB assay, a molecular diagnostic test for the identification of GBS from broth-enriched vaginal/rectal specimens obtained during routine prenatal screening. A total of 826 specimens were collected from women undergoing prenatal screening (35 to 37 weeks' gestation) and tested at one of three clinical centers. Each swab specimen was tested directly prior to enrichment using the Xpert GBS assay. Following 18 to 24 h of broth enrichment, each specimen was tested using the Xpert GBS LB assay and the FDA-cleared Smart GBS assay as a molecular diagnostic comparator. Results obtained using all three molecular tests were compared to those for broth-enriched culture as the gold standard. The sensitivity and specificity of the Xpert GBS LB assay were 99.0% and 92.4%, respectively, compared to those for the gold standard culture. The Smart GBS molecular test demonstrated sensitivity and specificity of 96.8% and 95.5%, respectively. The sensitivities of the two broth-enriched molecular methods were superior to those for direct testing of specimens using the Xpert GBS assay, which demonstrated sensitivity and specificity of 85.7% and 96.2%, respectively. S treptococcus agalactiae (group B Streptococcus [GBS]) is aGram-positive bacterium associated with transient colonization of mucosal membranes throughout the body, including the vagina, gastrointestinal tract, and urethra (1). GBS rarely causes disease in healthy individuals but can cause serious illness in immunocompromised patients, elderly individuals, and newborn infants (2). Of particular concern is neonatal infection caused by vertical transmission during labor and birthing. Transmission from an asymptomatically colonized mother to the neonate can result in early-onset invasive GBS disease, which is a leading cause of sepsis and meningitis in newborns in the United States (3). Early-onset GBS disease in newborns can result in death or longterm disabilities such as mental retardation and hearing or vision loss (4). Because these infections are acquired through direct contact of the neonate with GBS in the mother's urogenital tract during delivery, it has become a universal practice to screen pregnant women for vaginal/rectal colonization with GBS at 35 to 37 weeks' gestation (5). The identification of GBS during routine screening results in administration of intrapartum prophylaxis to mitigate transmission of bacteria and red...

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Section: Discussionmentioning

confidence: 99%

Section: S Treptococcus Agalactiae (Group B Streptococcus [Gbs]) Is Amentioning

confidence: 99%

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

et al. 2015

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“…Maternal GBS colonization rates range from approximately 10 to 40% in developed countries, with an estimated rate of 20% in near-term pregnant women in our health care region (2,4,5). Studies have shown that intrapartum administration of antibiotics reduces neonatal transmission of GBS, thereby preventing early-onset disease (1,6,7). Laboratory detection of GBS colonization status in near-term pregnant women is therefore important for the selective prescription of antibiotic prophylaxis at delivery.…”

mentioning

confidence: 99%

Evaluation of StrepB Select Chromogenic Medium and the Fast-Track Diagnostics Group B Streptococcus (GBS) Real-Time PCR Assay Compared to Routine Culture for Detection of GBS during Antepartum Screening

et al. 2017

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Life-threatening infection in neonates due to group B Streptococcus (GBS) is preventable by screening of near-term pregnant women and treatment at delivery. A total of 295 vaginal-rectal swabs were collected from women attending antepartum clinics in Calgary, Alberta, Canada. GBS colonization was detected by the standard culture method (Strep B Carrot Broth subcultured to blood agar with a neomycin disk) and compared to recovery with Strep Group B Broth (Dalynn Biologicals) subcultured to StrepBSelect chromogenic medium (CM; Bio-Rad Laboratories) and the Fast-Track Diagnostics GBS real-time PCR (quantitative PCR [qPCR]) assay (Phoenix Airmid Biomedical Corp.) performed with broth-enriched samples and the Abbott m2000sp/m2000rt system. A total of 62/295 (21%) women were colonized with GBS; 58 (19.7%) cases were detected by standard culture, while CM and qPCR each found 61 (20.7%) cases. The qPCR and CM were similar in performance, with sensitivities, specificities, and positive and negative predictive values of 98.4 and 98.4%, 99.6 and 99.6%, 98.4 and 98.4%, and 99.6 and 99.6%, respectively, compared to routine culture. Both qPCR and CM would allow more rapid reporting of routine GBS screening results than standard culture. Although the cost per test was similar for standard culture and CM, the routine use of qPCR would cost approximately four times as much as culture-based detection. Laboratories worldwide should consider implementing one of the newer methods for primary GBS testing, depending on the cost limitations of different health care jurisdictions.KEYWORDS chromogenic medium, detection, group B streptococcus, real-time PCR, screening G roup B streptococcus (GBS) is the most common cause of early-onset neonatal sepsis in developed countries (1, 2). Early-onset disease (0 to 6 days of life) is acquired intrapartum from mothers with vaginal-rectal colonization with GBS (1-3). Maternal GBS colonization rates range from approximately 10 to 40% in developed countries, with an estimated rate of 20% in near-term pregnant women in our health care region (2, 4, 5). Studies have shown that intrapartum administration of antibiotics reduces neonatal transmission of GBS, thereby preventing early-onset disease (1, 6, 7). Laboratory detection of GBS colonization status in near-term pregnant women is therefore important for the selective prescription of antibiotic prophylaxis at delivery.Guidelines for the prevention of early-onset neonatal GBS disease have previously been published that recommend universal prenatal culture-based screening of all

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“…Recommendations for diagnosing maternal GBS colonization and administering intrapartum antimicrobial prophylaxis have led to a significant decrease in these infections (1). The rate of invasive GBS disease in nonpregnant adults, however, continues to climb (2).…”

mentioning

confidence: 99%

Chromosomally and Extrachromosomally Mediated High-Level Gentamicin Resistance in Streptococcus agalactiae

Sendi

Furitsch

Mauerer

et al. 2016

Antimicrob Agents Chemother

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f Streptococcus agalactiae (group B Streptococcus [GBS]) is a leading cause of sepsis in neonates. The rate of invasive GBS disease in nonpregnant adults also continues to climb. Aminoglycosides alone have little or no effect on GBS, but synergistic killing with penicillin has been shown in vitro. High-level gentamicin resistance (HLGR) in GBS isolates, however, leads to the loss of a synergistic effect. We therefore performed a multicenter study to determine the frequency of HLGR GBS isolates and to elucidate the molecular mechanisms leading to gentamicin resistance. From eight centers in four countries, 1,128 invasive and colonizing GBS isolates were pooled and investigated for the presence of HLGR. We identified two strains that displayed HLGR (BSU1203 and BSU452), both of which carried the aacA-aphD gene, typically conferring HLGR. However, only one strain (BSU1203) also carried the previously described chromosomal gentamicin resistance transposon designated Tn3706. For the other strain (BSU452), plasmid purification and subsequent DNA sequencing resulted in the detection of plasmid pIP501 carrying a remnant of a Tn3 family transposon. Its ability to confer HLGR was proven by transfer into an Enterococcus faecalis isolate. Conversely, loss of HLGR was documented after curing both GBS BSU452 and the transformed E. faecalis strain from the plasmid. This is the first report showing plasmid-mediated HLGR in GBS. Thus, in our clinical GBS isolates, HLGR is mediated both chromosomally and extrachromosomally.

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A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates

Abstract: Routine screening for group B streptococcus during pregnancy prevents more cases of early-onset disease than the risk-based approach. Recommendations that endorse both strategies as equivalent warrant reconsideration.

Cited by 510 publications

References 20 publications

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

Evaluation of StrepB Select Chromogenic Medium and the Fast-Track Diagnostics Group B Streptococcus (GBS) Real-Time PCR Assay Compared to Routine Culture for Detection of GBS during Antepartum Screening

Chromosomally and Extrachromosomally Mediated High-Level Gentamicin Resistance in Streptococcus agalactiae

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