Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis

“… introducing the PCR test the sensitivity was 98.5% and the specificity was 99.6%, but the number of invalid tests was approximately 10%. In a later study from Sweden the GBS PCR test was used at the labor ward in two phases. In the first phase 44% of the test results were invalid.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of polymerase chain reaction for intrapartum detection of group B streptococcus colonization

Helmig

Gertsen

2017

Acta Obstet Gynecol Scand

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“…Further research is warranted to replicate these findings in other populations and determine the impact on infant health. It is also important to develop improved methods for optimising IAP, and to further explore how breastfeeding can minimise the adverse effects of IAP when it cannot be avoided.…”

Section: Resultsmentioning

confidence: 99%

Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study

Azad

Konya

Persaud

et al. 2015

BJOG

496

463

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Objective Dysbiosis of the infant gut microbiota may have long‐term health consequences. This study aimed to determine the impact of maternal intrapartum antibiotic prophylaxis (IAP) on infant gut microbiota, and to explore whether breastfeeding modifies these effects. Design Prospective pregnancy cohort of Canadian infants born in 2010–2012: the Canadian Healthy Infant Longitudinal Development (CHILD) Study. Setting General community. Sample Representative sub‐sample of 198 healthy term infants from the CHILD Study. Methods Maternal IAP exposures and birth method were documented from hospital records and breastfeeding was reported by mothers. Infant gut microbiota was characterised by Illumina 16S rRNA sequencing of faecal samples at 3 and 12 months. Main outcome measures Infant gut microbiota profiles. Results In this cohort, 21% of mothers received IAP for Group B Streptococcus prophylaxis or pre‐labour rupture of membranes; another 23% received IAP for elective or emergency caesarean section (CS). Infant gut microbiota community structures at 3 months differed significantly with all IAP exposures, and differences persisted to 12 months for infants delivered by emergency CS. Taxon‐specific composition also differed, with the genera Bacteroides and Parabacteroides under‐represented, and Enterococcus and Clostridium over‐represented at 3 months following maternal IAP. Microbiota differences were especially evident following IAP with emergency CS, with some changes (increased Clostridiales and decreased Bacteroidaceae) persisting to 12 months, particularly among non‐breastfed infants. Conclusions Intrapartum antibiotics in caesarean and vaginal delivery are associated with infant gut microbiota dysbiosis, and breastfeeding modifies some of these effects. Further research is warranted to explore the health consequences of these associations. Tweetable abstract Maternal #antibiotics during childbirth alter the infant gut #microbiome.

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“…Other publications have noted that the rates of invalid results decrease over time as sites gain experience with the assay (15).…”

Section: Comparison Of Xpert Gbs Lb Assay To Enriched Culturementioning

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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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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Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis

Abstract: The PCR assay, in the hands of labor ward personnel, can be useful for selection of women to which IAP should be offered.

Cited by 27 publications

References 20 publications

Diagnostic accuracy of polymerase chain reaction for intrapartum detection of group B streptococcus colonization

Diagnostic accuracy of polymerase chain reaction for intrapartum detection of group B streptococcus colonization

Impact of maternal intrapartum antibiotics, method of birth and breastfeeding on gut microbiota during the first year of life: a prospective cohort study

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

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