Failure of penicillin to eradicate the carrier state of group B streptococcus in infants

Paredes, Abel; Wong, Poo Sing; Yow, Martha D.

doi:10.1016/s0022-3476(76)80445-3

Cited by 59 publications

(26 citation statements)

References 6 publications

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“…Weeks et al 65 have recently reported a 72% reduction in GBS colonization rate and eradication of heavy GBS colonization at delivery after administration of benzathine penicillin G to women with GBS colonization at various times between 16 and 37 weeks gestation, but follow-up was unavailable for nearly a third of their subjects and no control group was studied. Now, it is generally accepted that it is extremely difficult or impossible to eradicate GBS from mucosal surfaces, 66 especially from the lower intestinal tract, 67 and that vaginal recolonization after a course of antibiotic therapy is exceedingly common, as initially reported by Hall et al 61 No studies have demonstrated an effect on neonatal infections.…”

Section: Antepartum Prophylaxismentioning

confidence: 99%

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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ABSTRACT. Objective. To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.Study Design. Literature review and reanalysis of published data.Results. The rate of early-onset GBS sepsis in highrisk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.Conclusions. Women with chorioamnionitis or preterm premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. Pediatrics 1999;103(6). URL: http://www.pediatrics.org/cgi/content/full/103/6/e78; group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.ABBREVIATIONS. EOGBS, early-onset neonatal group B streptococcus infection; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; GBS, group B streptococcus. P revention of early-onset neonatal group B streptococcal (EOGBS) sepsis requires the identification of infants who are at high risk and the use of effective preventive intervention. The American Academy of Pediatrics (AAP), 1,2 American College of Obstetricians and Gynecologists (ACOG), 3,4 and Centers for Disease Control and Prevention (CDC) 5 agree that this intervention should be intrapartum antibiotic treatment. The commentaries that accompany those recommendations and several recent cost-benefit or efficacy analyses implicitly 1-7 or explicitly 8 -11 assume that intrapartum antimicrobial prophylaxis is 100% effective, but reports of at least 50 cases of EOGBS disease in infants whose mothers received intrapartum prophylaxis [12][13][14][15] demonstrate that this cannot be correct. The decision analysis cited by the CDC recommendations 1...

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Section: Antepartum Prophylaxismentioning

confidence: 99%

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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“…Early onset disease, characterized by sepsis and meningitis, is the more common type and is acquired from the ano-genital tract of the mother at birth (3,4). Attempts at antibiotic prophylaxis in newborn infants (14,17) and pregnant women (19) have met with varied success and further study is needed. Development of a vaccine for antibody deficient mothers will be difficult and time-consuming (4).…”

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confidence: 99%

Prevention of Group B Streptococcal Colonization with Topically Applied Lipoteichoic Acid in a Maternal-Newborn Mouse Model

Cox

1982

Pediatr Res

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SummaryAn animal model of maternal-newborn transmission of group B streptococci (GBS) was developed. Pregnant Swiss-Webster mice were colonized by applying 10' GBS to the oral cavity, vagina, and nipples daily for 3 days before delivery. Lipoteichoic acid (LTA) from type 111 GBS or phosphate buffered saline was applied topically to the oral cavity, perineum or nape of newborn mice.Cultures of newborn mice at 3 days of age revealed 35 of 75 (47%) controls and 0 of 79 animals given 2 doses of LTA (2 mg/ ml) were positive for GBS at one or more sites. One to two% of control and LTA-treated mice remained culture positive at 7 days of age. None developed GBS disease and no obvious toxicity was noted. This is the first in vivo evidence that colonization with GBS can be prevented by interfering with their adherence to epithelial surfaces.LTA also prevented colonization by 60,000 GBS in the oral cavity of 1-day-old newborn mice. A minimum concentration of 0.5 mg LTA/ml was required and similar dose response curves were obtained in preventing maternal-newborn transmission or oral newborn colonization. LTA from type I11 GBS also protected against types Ia and 11. Only 6 of 15 (40%) vaginally colonized, nonpregnant mice became noncolonized 3 days after LTA treatment. SpeculationTopically applied lipoteichoic acid from group B streptococci may be a useful method of preventing GBS colonization and/or disease in human infants at birth if it is nontoxic. The method avoids the problems associated with antibiotic prophylaxis and vaccine development.Group B streptococci (GBS) are a significant cause of neonatal morbidity and mortality. Early onset disease, characterized by sepsis and meningitis, is the more common type and is acquired from the ano-genital tract of the mother at birth (3, 4). Attempts at antibiotic prophylaxis in newborn infants (14, 17) and pregnant women (19) have met with varied success and further study is needed. Development of a vaccine for antibody deficient mothers will be difficult and time-consuming (4). Development of alternate methods of prophylaxis are needed.In 1975, Beachey (6) showed that lipoteichoic acid (LTA) in the cell wall of group A streptococci was responsible for binding of these organisms to oral mucosal cells in vitro. Pretreatment of oral epithelial cells with purified LTA inhibited 78% of added streptococci from binding. In 1977, Ofek et al. (12) showed that LTA from group A streptococci inhibited group B streptococcal binding --to the same degree.Topical application of LTA to a mucosal surface at birth could potentially prevent or reduce colonization with GBS. This method would avoid the disadvantages of antibiotic prophylaxis and some of the difficulties in vaccine development. Because the method has not been tested in vivo, an animal model of maternal-newborn transmission of GBS was developed. MATERIALS AND METHODSOrganisms. Prototype strains type I a (SS-615) and type I1 (SS-619) and wild strain type 111 (DS-2434-80), beta-hemolytic group B streptococci were supplied by Richard Fa...

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“…From the findings described here, one might expect that group B streptococci colonizing such sites would be relatively resistant to the bactericidal effect of penicillin, and this phenomenon may contribute to the problems encountered during attempts to prophylactically eradicate colonizing group B streptococci (13,23) and also to treatment failures described in "early onset" neonatal infections (7,10,18,19,25,26). The relatively low pH of vaginal secretions has already been invoked as a possible factor contributing to the ineffectiveness of erythromycin treatment in vaginitis caused by Haemophilus vaginalis infection (11).…”

Section: Methodsmentioning

confidence: 83%

“…Penicillin has been the chemotherapeutic agent of choice in treating these infections (5), and prophylactic use of penicillin has been also suggested for the elimination of the bacteria from parturient women (13). Nevertheless, there have been numerous reports of treatment failures (7,10,18,19,25,26), and difficulties have been encountered in eradicating group B streptococci colonizing mucosal surfaces in both infants and adults (13,19,23). These failures have sometimes been attributed to the relatively high minimal inhibitory concentrations (MICs) of penicillin (1) and to the slow bactericidal effect of this antibiotic (21) in comparison with the highly penicillin-susceptible group A streptococci.…”

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confidence: 99%

pH-dependent penicillin tolerance of group B streptococci

Horne¹,

Tomasz²

1981

Antimicrob Agents Chemother

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Group B streptococci lose viability without apparent lysis during treatment with beta-lactam antibiotics and vancomycin. Rapid loss of viability was observed in early-exponential-phase cultures. Cultures in the mid-exponential growth phase exhibited various degrees of resistance to the bactericidal effect of the antibiotics, whereas their susceptibilities to the growth-inhibitory effect remained unchanged. This growth-phase-dependent tolerance was caused by the gradual increase in acidity of the cultures as the cell concentration increased. Retitration of the pH to neutrality made the formerly tolerant bacteria again fully susceptible to the killing effect of penicillin. Conversely, lowering the pH value of the medium resulted in antibiotic tolerance throughout culture growth. The penicillin-binding proteins of whole bacteria and their labeling pattern were found to be independent of culture pH. It is suggested that the mechanism of Ph-dependent tolerance is indirect and may be mediated by an autolysin. The tolerance of group B streptococci for penicillin could be clinically relevant in view of the relatively low pH values known to prevail in the natural host environments colonized by these bacteria.

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Failure of penicillin to eradicate the carrier state of group B streptococcus in infants

Cited by 59 publications

References 6 publications

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Prevention of Group B Streptococcal Colonization with Topically Applied Lipoteichoic Acid in a Maternal-Newborn Mouse Model

pH-dependent penicillin tolerance of group B streptococci

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