Peripartum Transmission of Penicillin-Resistant Streptococcus pneumoniae

Abstract

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis. We present a recent case of S. pneumoniae bacteremia acquired on the first day of life in a neonate born at 30 weeks of gestation to a mother without prenatal care who had prolonged rupture of the membranes and received intravenous ampicillin prior to delivery. The isolate was resistant to penicillin, with a MIC of the drug of 4 g/ml. The child responded to a 7-day course of intravenous vancomycin. S. pneumoniae was recovered from the vagina of the mother on a swab culture collected prior to delivery, and isolates from mother and child were confirmed to be identical on the basis of pulsed-field gel electrophoresis. Although neonatal sepsis due to the peripartum transmission of S. pneumoniae is rare, this case highlights the concern that increasing efforts to prevent group B streptococcus neonatal disease may lead to an increase in neonatal infections due to resistant organisms. CASE REPORTThe mother was a 20-year-old employee of a fast-food restaurant who presented in premature labor with rupture of her membranes that occurred during sexual intercourse on the day of admission. This was her fourth pregnancy; she had undergone normal vaginal delivery of a healthy, full-term male infant 2 years earlier and had had two voluntary abortions. She presented at her 30th week of pregnancy after having had only one prenatal visit approximately 1 month prior to her presentation. Her only medications were prenatal vitamins and metronidazole that she had been taking for an episode of bacterial vaginosis diagnosed 1 to 2 weeks earlier. She denied history of fever, cough, headache, neck stiffness, dysuria, abdominal pain, or diarrhea.On examination, she was alert and awake, with painful uterine contractions every 3 to 4 min. Her vital signs were normal and she was afebrile. The results of heart and lung examinations were normal, and her abdomen was gravid and nontender. She had pooling of clear amniotic fluid in her vaginal vault, and her cervix was dilated between 8 and 9 cm. Fetal heart sounds were present at a rate of approximately 160 beats per min, with variable decelerations during contractions. Routine laboratory testing that was performed at the time of admission included a normal white blood cell count as well as a negative rapid plasma reagin test, hepatitis B surface antigen test, human immunodeficiency virus serology, cervical swabbing for Neisseria gonorrhoeae and Chlamydia trachomatis for a nucleic acid amplification test, urine toxicology screening, and vaginal culture testing for group B streptococcus. Except for the white blood cell count, none of these test results were available until at least 1 day following admission of the patient.The mother was admitted with anticipated vaginal delivery, and at 24 h after the rupture of her membranes, she was given 2 g of intravenous ampicillin with plans to continue this at a dose of 1 g every 4 h for the prevention of group B streptococcus early onset disease. Approximately 2 h after her initial d...

Serious community-acquired neonatal infections in rural Southeast Asia (Bohol Island, Philippines)

“…39 It has been suggested that maternal vaginal colonization with S. pneumoniae may be responsible for its peripartum transmission. 40,41 and may be an important mode of spread of S. pneumoniae in developing countries. In contrast to the WHO young infant study, which enrolled infants up to 90 days of age, our study included only infants below 60 days old.…”

Early Onset of Neonatal Streptococcus pneumoniae Bacteremia and Septic Arthritis

“…Recently, McDonald and colleagues reported a case of S. pneumoniae bacteremia acquired on the first day of life in a premature baby. 15 The isolate was resistant to penicillin with an MIC of 4 µg/mL and intermediately susceptible to cefotaxime and ceftriaxone, both MIC = 1.0 µg/mL. The baby responded well to vancomycin.…”

Meningitis neonatal por Streptococcus pneumoniae atípico: Reporte de un caso y revisión

“…En la patogenia de la infección invasora del RN por S. pneumoniae se ha atribuido un rol a la transmisión vertical asociada a portación vaginal materna y/o a endometritis 2,5,6 . Mediante estudios de biología molecular se ha comprobado la transmisión clonal de la bacteria desde la madre al niño 5 .…”

“…Mediante estudios de biología molecular se ha comprobado la transmisión clonal de la bacteria desde la madre al niño 5 . La frecuencia de colonización vaginal por S. pneumoniae es muy baja (< 0,03%), sugiriendo una alta incidencia de infección invasora en el RN expuesto a este agente durante el parto 2 .…”

“…Estudios publicados en la década pasada advertían de un posible aumento de la colonización vaginal por este agente, debido al cambio en las prácticas sexuales durante el embarazo (ej: sexo oro-genital) y al desarrollo de mejores técnicas diagnósticas. Mas aún, McDonald y cols plantearon que si la incidencia de sepsis neonatal por S. pneumoniae llegara a aumentar al punto de requerirse medidas de prevención específicas, podría considerarse la vacunación materna como una medida útil 5 . Una preocupación adicional es la posible colonización vaginal de las madres con cepas de S. pneumoniae resistentes a penicilina y a cefalosporinas de tercera generación o la selección de cepas resistentes mediante el uso de antimicrobianos para la prevención de infección neonatal por S. agalactiae.…”