Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses

Bianchi-Jassir, Fiorella; Seale, Anna C.; Kohli-Lynch, Maya; Lawn, Joy E; Baker, Carol J.; Bartlett, Linda; Cutland, Clare; Gravett, Michael G.; Heath, Paul T; Ip, Margaret; Doare, Kirsty Le; Madhi, Shabir A.; Saha, Samir K.; Schrag, Stephanie J.; Meulen, Ajoke Sobanjo-ter; Vekemans, Johan; Rubens, Craig E.

doi:10.1093/cid/cix661

Cited by 158 publications

(137 citation statements)

References 63 publications

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“…As expected, the percentage of self-reported treatment for vaginal discharge was much higher than that in patient medical records. The prevalence of vaginal discharge in our study was much higher than those previously reported (16), and we could not assess the pathogen associated with infection. Another study conducted elsewhere reported that vulvovaginal candidiasis was the most prevalent cause of vaginal discharge (17).…”

Section: ' Discussioncontrasting

confidence: 89%

The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

Tedesco¹,

Galvão²,

Guida³

et al. 2020

Clinics

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OBJECTIVES: Evidence suggests that infection or inflammation is a major contributor to early spontaneous preterm birth (sPTB). Therefore, this study aimed to investigate the development and causes of maternal infection associated with maternal and neonatal outcomes in women with sPTB. METHODS: This was a secondary analysis of a multicenter cross-sectional study with a nested case-control component, the Brazilian Multicentre Study on Preterm Birth (EMIP), conducted from April 2011 to July 2012 in 20 Brazilian referral obstetric hospitals. Women with preterm birth (PTB) and their neonates were enrolled. In this analysis, 2,682 women undergoing spontaneous preterm labor and premature pre-labor rupture of membranes were included. Two groups were identified based on self-reports or prenatal or hospital records: women with at least one infection factor and women without any maternal infection (vulvovaginitis, urinary tract infection, or dental infection). A bivariate analysis was performed to identify potential individual risk factors for PTB. The odds ratios (ORs) with their respective 95% confidence intervals were calculated. RESULTS: The majority of women with sPTB fulfilled at least one criterion for the identification of maternal infection (65.9%), and more than half reported having urinary tract infection during pregnancy. Approximately 9.6% of women with PTB and maternal infection were classified as having periodontal infection only. Apart from the presence of a partner, which was more common among women with infectious diseases (p=0.026; OR, 1.28 [1.03-1.59]), other variables did not show any significant difference between groups. CONCLUSION: Maternal infection was highly prevalent in all cases of sPTBs, although it was not clearly associated with the type of PTB, gestational age, or any adverse neonatal outcomes. CLINICS 2020;75:e1508 Maternal infection in preterm birth Tedesco RP et al.

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Section: ' Discussioncontrasting

confidence: 89%

The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

Tedesco¹,

Galvão²,

Guida³

et al. 2020

Clinics

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“…9,52 Notably, these infants are at much higher risk of EOGBS disease as well as GBS-related mortality. 53 For this reason, the CDC has suggested that most preterm deliveries be accompanied by IAP. However, more research towards best IAP management for women delivering preterm is needed, as long-term exposure to antibiotics poses a risk for preterm infants.…”

Section: Discussionmentioning

confidence: 99%

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Hasperhoven

Al‐Nasiry

Bekker

et al. 2020

BJOG

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Background Early‐onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening‐based protocol), whereas others employ risk‐based protocols. Objectives To compare the effectiveness of screening‐based versus risk‐based protocols in preventing EOGBS disease. Search strategy Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture‐based, risk‐based. Selection criteria Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk‐based protocols with each other or with controls. Data collection and analysis Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel‐Haenszel analyses with random effects. Main results Seventeen eligible studies were included. In this meta‐analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk‐based protocols (ten studies, RR 0.43, 95% CI 0.32–0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11–0.84). Meta‐analysis could not demonstrate a significant effect of risk‐based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61–1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). Conclusions Screening‐based protocols were associated with lower incidences of EOGBS disease compared with risk‐based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. Tweetable abstract Meta‐analysis: general screening is associated with lower rates of early‐onset group B strep. neonatal sepsis compared with risk‐based protocols.

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“…[1][2][3] Infant invasive GBS disease is classified as early-onset disease (EOD) if it occurs during the first 6 days of life or late-onset disease (LOD) if it develops 7 or more days after birth. The worldwide burden of infant and maternal GBS disease is substantial, [4][5][6][7][8][9][10][11][12][13] and efforts are under-way to develop vaccines as a preventive measure to replace or supplement antenatal screening and intrapartum antibiotics effective against early but not late-onset disease. [14][15][16][17] EOD arises from vertical transmission from a GBS colonized mother to her baby during or just before birth, with clinical signs occurring within 48 h in more than 90% of cases.…”

Section: Introductionmentioning

confidence: 99%

Hospital clusters of invasive Group B Streptococcal disease: A systematic review

Collin

Lamb

Jauneikaite

et al. 2019

Journal of Infection

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Group B streptococcal disease Adult Neonatal Outbreak Cluster Healthcare-associated infection Systematic review s u m m a r y Objectives: To characterize outbreaks of invasive Group B Streptococcal (iGBS) disease in hospitals.Methods: Systematic review using electronic databases to identify studies describing iGBS outbreaks/clusters or cross-infection/acquisition in healthcare settings where 'cluster' was defined as ≥2 linked cases. PROSPERO CRD42018096297. Results: Twenty-five references were included describing 30 hospital clusters (26 neonatal, 4 adult) in 11 countries from 1966 to 2019. Cross-infection between unrelated neonates was reported in 19 clusters involving an early-onset ( < 7 days of life; n = 3), late-onset (7-90 days; n = 13) index case or colonized infant ( n = 3) followed by one or more late-onset cases (median serial interval 9 days (IQR 3-17, range 0-50 days, n = 45)); linkage was determined by phage typing in 3 clusters, PFGE/MLST/PCR in 8, WGS in 4, non-molecular methods in 4. Postulated routes of transmission in neonatal clusters were via clinical personnel and equipment, particularly during periods of crowding and high patient-to-nurse ratio. Of 4 adult clusters, one was attributed to droplet spread between respiratory cases, one to handling of haemodialysis catheters and two unspecified. Conclusions: Long intervals between cases were identified in most of the clusters, a characteristic which potentially hinders detection of GBS hospital outbreaks without enhanced surveillance supported by genomics.

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Preterm Birth Associated With Group B Streptococcus Maternal Colonization Worldwide: Systematic Review and Meta-analyses

Abstract: Complications of preterm birth are the leading cause of deaths in children aged <5 years. Group B Streptococcus may be a preventable and important contributor to this burden.

Cited by 158 publications

References 63 publications

The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

The role of maternal infection in preterm birth: evidence from the Brazilian Multicentre Study on Preterm Birth (EMIP)

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Hospital clusters of invasive Group B Streptococcal disease: A systematic review

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