Evaluation of the Cepheid Xpert GBS Assay for Rapid Detection of Group B Streptococci in Amniotic Fluids from Pregnant Women with Premature Rupture of Membranes

Bourgeois-Nicolaos, Nadège; Cordier, Anne-Gaël; Guillet-Caruba, Christelle; Casanova, François; Benachi, Alexandra; Doucet‐Populaire, Florence

doi:10.1128/jcm.03356-12

Cited by 19 publications

(13 citation statements)

References 10 publications

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“…Finally, in this study, Xpert Ò GBS was performed in the laboratory by specialized personnel and not as a point-of-care (POC) assay by midwives, once again favoring the success of this molecular method. Another advantage of this test is that in the context of rupture of the membranes, the Xpert Ò GBS was at least as sensitive as culture when both are performed on amniotic fluid [33]. A small study performed in the USA compared the Xpert Ò GBS with antenatal culture, using intrapartum culture as a gold standard.…”

Section: Polymerase Chain Reactionmentioning

confidence: 99%

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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Section: Polymerase Chain Reactionmentioning

confidence: 99%

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

2013

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“…In a prospective study on 139 women with premature rupture of membranes, it has been documented that results of antenatal GBS screening cultures do not always accurately predict intrapartum GBS status [114]. Thus, the intrapartum rapid GBS-PCR test was the only method available to identify GBS colonized women at risk, who delivered preterm and potentially avoid the delivery of a GBS colonized neonate by the administration of IAP.…”

Section: Non-culture Methods For Intrapartum Specimen Processingmentioning

confidence: 99%

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Renzo

Melin²,

Berardi

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

153

135

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Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecologyobstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

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“…Recently, two studies have shown its utility when it is performed on vaginal swabs during intrapartum instead of antenatal screening, at 35 to 37 weeks of gestation (9), and on amniotic fluids collected from pregnant women with premature rupture of membranes (10). Our study aimed to evaluate the test's performance when applied to gastric fluid specimens collected from newborns.…”

mentioning

confidence: 99%

Xpert GBS Assay for Rapid Detection of Group B Streptococcus in Gastric Fluid Samples from Newborns

et al. 2014

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eThe Xpert GBS real-time PCR assay was applied to gastric fluid samples from 143 newborns, and it detected group B streptococcus (GBS) within 1 h for 16 (11.2%) cases, while microscopic examination detected only 2 cases. The sensitivity and specificity of the Xpert GBS were 80% and 100%, respectively, with regard to 20 cases of GBS colonization or infection. Concordance of Xpert GBS results versus culture was 92.3%. This test detects in a timely manner newborns at risk for invasive GBS disease. Early-onset group B streptococcus (GBS) neonatal disease is a serious and frequent complication of birth in developed countries. GBS causes more than one-third of the materno-fetal infections (MFI) of term infants, followed by Escherichia coli and other Streptococcus spp., as well as species now classified in the Enterococcus genus (1). GBS colonizes the maternal genitourinary tract (at reported frequencies from 4 to 36%) during pregnancy in Europe and the United States (2) and may cause an ascending infection after the onset of labor or the preterm rupture of membranes. Neonates may become colonized (in 40 to 70% of the cases [3]) during passage through the birth canal at the time of delivery. Two strategies have significantly reduced the rate of early neonatal GBS colonization and infection (4): (i) late antenatal GBS screening of pregnant women and (ii) intrapartum chemoprophylaxis for colonized women to reduce vertical transmission of GBS. Despite international guidelines, the worldwide incidence rate of GBS neonatal diseases is still 0.23 to 1.22‰ of births (5, 6).Because early detection of infected newborns is clinically difficult and the newborn's health can worsen rapidly, GBS detection for newborns is one of the emergencies in clinical microbiology. Gastric fluid is the usual relevant specimen for GBS detection (7). Its microscopic examination is so far the only bacteriological finding rapidly available for clinicians who suspect an early MFI. GBS microbiological diagnosis is delayed, since it is based on an 18-h culture. Since microscopic examination has a low sensitivity (27.5%) (8), a rapid method of GBS detection that is reasonably sensitive and specific would be valuable in stratifying the risk of MFI among neonates.The Xpert GBS assay (Cepheid) is a marketed real-time PCR for screening maternal carriage by detecting GBS DNA in vaginal or rectal specimens. Recently, two studies have shown its utility when it is performed on vaginal swabs during intrapartum instead of antenatal screening, at 35 to 37 weeks of gestation (9), and on amniotic fluids collected from pregnant women with premature rupture of membranes (10). Our study aimed to evaluate the test's performance when applied to gastric fluid specimens collected from newborns. Our aim was to shorten the time to detect GBScolonized infants and thus help in the diagnosis of invasive GBS materno-fetal infections.We conducted a prospective study at Lariboisière University Hospital (Paris, France), where 2,500 deliveries are processed per year in an IIA matern...

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Evaluation of the Cepheid Xpert GBS Assay for Rapid Detection of Group B Streptococci in Amniotic Fluids from Pregnant Women with Premature Rupture of Membranes

Cited by 19 publications

References 10 publications

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

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

Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Xpert GBS Assay for Rapid Detection of Group B Streptococcus in Gastric Fluid Samples from Newborns

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