The effect of screening‐to‐labor interval on the sensitivity of late‐pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study

Virranniemi, Minna; Raudaskoski, Tytti; Haapsamo, Mervi; Kauppila, Jaana; Renko, Marjo; Peltola, J.; Risteli, L.; Laatio, Liisa

doi:10.1111/aogs.13522

Cited by 23 publications

(29 citation statements)

References 22 publications

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“…19 Our 1% rate of invalid PCR tests compares to 1-19% reported elsewhere. 19 GeneXpert can be used as a point-of-care test on the labour and delivery unit and would not necessarily require 24-hr laboratory staffing. 20 Widespread use of antibiotics may lead to antimicrobial resistance in the mother and child.…”

Section: Discussionmentioning

confidence: 41%

“…Moreover, only two of 180 women with negative PCR tests had a positive intrapartum culture (NPV of 98.9%), indicating that a PCR is unlikely to miss women who require antibiotics. Despite the above, the proportion of invalid PCR results affects the sensitivity and specificity of GBS detection in clinical practice 19 . Our 1% rate of invalid PCR tests compares to 1–19% reported elsewhere 19 .…”

Section: Discussionmentioning

confidence: 60%

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Group B Streptococcus real‐time PCR may potentially reduce intrapartum maternal antibiotic treatment

Kugelman

Kleifeld

Shaked‐Mishan

et al. 2021

Paediatric Perinatal Epid

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Background Protocols for preventing early‐onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real‐time polymerase chain reaction (PCR) can provide a result within 30–60 min and has been found to be specific and sensitive for defining intrapartum GBS status. Objective To evaluate whether implementation of GBS fast real‐time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics. Methods This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35–37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real‐time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration. Results Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real‐time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1). Conclusions Compared with antepartum universal culture screening or intrapartum risk‐factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real‐time PCR, without compromising the sensitivity of GBS detection.

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 60%

Group B Streptococcus real‐time PCR may potentially reduce intrapartum maternal antibiotic treatment

Kugelman

Kleifeld

Shaked‐Mishan

et al. 2021

Paediatric Perinatal Epid

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show abstract

“…Prenatal sampling may also influence the detection of GBS [ 30 ]. Studies have shown that the colonization rate of GBS culture in the third trimester (35–37 weeks) was 29.0%, slightly lower than that in the prenatal period (29.7%) [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Xpert GBS assay and Xpert GBS LB assay for detection of Streptococcus agalactiae

Han

Xie

Huang

et al. 2021

Ann Clin Microbiol Antimicrob

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Background Group B Streptococcal (GBS) infection is the primary agent of neonatal morbidity and mortality. Rapid and simple methods to detect GBS are Xpert GBS and GBS LB assays based on real-time polymerase chain reaction (PCR). However, since the diagnostic accuracy of the two techniques in diagnosing GBS remains unclear, we designed this study to appraise the diagnostic accuracy of the aforementioned. Methods A systematic search of all literature published before July 16, 2020 was conducted using Embase, PubMed, Web of Science, and Cochrane Library. The study quality was evaluated through Review Manager 5.3. Accordingly, data extracted in the included studies were analyzed using Meta-DiSc 1.4 and Stata 12.0 software. The diagnosis odds ratio (DOR) and bivariate boxplot were utilized to evaluate the heterogeneity. Publication bias was appraised by using Deeks’ funnel plot. Results A total of 13 studies were adopted and only 19 sets of data met the criteria. The sensitivity and specificity of Xpert GBS were 0.91 (95% CI 0.89–0.92) and 0.93 (95% CI 0.92–0.94). The area under the curve (AUC) was 0.9806. The sensitivity and specificity results of Xpert GBS LB were 0.96 (95% CI 0.95–0.98) and 0.94 (95% CI 0.92–0.95), respectively. The AUC was 0.9950. No publication bias was found. Conclusions The Xpert GBS and GBS LB assays are valuable alternative methods with high sensitivity and specificity. However, determining whether they can be used as clinical diagnostic standards for GBS is essential for the future.

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“…38 Research proved that GBS cultures have a high degree of accuracy in predicting GBS colonization status at delivery if cultures are collected within 5 weeks of birth, but this will decrease significantly when the culture-to-birth interval is longer than 5 weeks. 39 It is reasonable to repeat GBS screening if a pregnant woman whose original culture was negative does not give birth within this 5-week screening accuracy window.…”

Section: Timing and Methods Of Maternal Gbs Screeningmentioning

confidence: 99%

Updates in prevention policies of early-onset group B streptococcal infection in newborns

Zhu

Lin

2021

Pediatrics & Neonatology

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Invasive disease owing to group B Streptococcus (GBS) is a major cause of illness and death among newborns. Maternal GBS colonization of gastrointestinal tract and/or vagina is the primary risk factor for neonatal GBS early-onset disease (EOD). In Europe and America, there are marked declines in neonatal GBS-EOD through widespread implementation of guidelines for maternal GBS screening and subsequent intrapartum antibiotic prophylaxis (IAP). The key measures necessary for prevention of GBS-EOD include correct specimen collection and processing, nucleic acid amplification testing (NAAT) for GBS identification, regimens for mothers with premature rupture of membranes (PROM), preterm labor or penicillin allergy, and coordination between obstetrics and pediatrics. Antibiotic prophylaxis has some disadvantages, so researchers should develop other preventive measures. Maternal vaccines to prevent perinatal GBS infection are currently under development. However, as large, population-based sampling studies are rarely conducted, the colonization rate and the disease burden of GBS in perinatal period are poorly understood in developing countries. The harm of GBS to newborns has been recognized in recent years in mainland China, but authorized prevention measures are still lacking. In order to enhance the understanding of GBS-EOD prevention, the most recent guidelines updates by the American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP) in 2019e2020 are summarized in this article.

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The effect of screening‐to‐labor interval on the sensitivity of late‐pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study

Cited by 23 publications

References 22 publications

Group B Streptococcus real‐time PCR may potentially reduce intrapartum maternal antibiotic treatment

Group B Streptococcus real‐time PCR may potentially reduce intrapartum maternal antibiotic treatment

Evaluation of Xpert GBS assay and Xpert GBS LB assay for detection of Streptococcus agalactiae

Updates in prevention policies of early-onset group B streptococcal infection in newborns

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