The International Infections in Pregnancy Study: group B streptococcal colonization in pregnant women

Cg, Whitney; Daly, Seán; Limpongsanurak, Sompop; Festin,; Thinn, KK; Chipato, Tsungai; Lumbiganon, P.; Sauvarin, Josephine; Andrews, William; Tolosa, JE

doi:10.1080/14767050410001668617

Cited by 37 publications

(33 citation statements)

References 15 publications

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“…GBS colonization of the urinary tract in women most likely occurs by an ascending route from the vagina, where GBS can persist asymptomatically. While the overall prevalence of GBS UTI in the adult population remains unclear, GBS bacteriuria during pregnancy occurs at rates of between 1 and 3.5% (4,23,41). Many of these episodes represent ABU (2, 18); however, GBS ABU is considered to be a surrogate for heavy maternal colonization (29,42) and is currently recommended for intrapartum antibiotic chemoprophylaxis (23,34).…”

Section: Serotypes Of Group B Streptococcus (Gbs) That Cause Urinary mentioning

confidence: 99%

Diversity of Group B Streptococcus Serotypes Causing Urinary Tract Infection in Adults

Ulett¹,

Benjamin

Zhuo

et al. 2009

J Clin Microbiol

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Serotypes of group B streptococcus (GBS) that cause urinary tract infection (UTI) are poorly characterized.We conducted a prospective study of GBS UTI in adults to define the clinical and microbiological characteristics of these infections, including which serotypes cause disease. Patients who had GBS cultured from urine over a 1-year period were grouped according to symptoms, bacteriuria, and urinalysis. Demographic data were obtained by reviewing medical records. Isolates were serotyped by latex agglutination and multiplex PCRreverse line blotting (mPCR/RLB). Antibiotic susceptibilities were determined by disc diffusion. GBS was cultured from 387/34,367 consecutive urine samples (1.1%): 62 patients had bacteriuria of >10 7 CFU/liter and at least one UTI symptom; of these patients, 31 had urinary leukocyte esterase and pyuria (others not tested), 50 (81%) had symptoms consistent with cystitis, and 12 (19%) had symptoms of pyelonephritis. Compared with controls (who had GBS isolated without symptoms), a prior history of UTI was an independent risk factor for disease. Increased age was also significantly associated with acute infection. Serotyping results were consistent between latex agglutination and mPCR/RLB for 331/387 (85.5%) isolates; 22 (5.7%) and 7 (1.8%) isolates were nontypeable with antisera and by mPCR/RLB, respectively; and 45/56 (80.4%) isolates with discrepant results were typed by mPCR/RLB as belonging to serotype V. Serotypes V, Ia, and III caused the most UTIs; serotypes II, Ib, and IV were less common. Nontypeable GBS was not associated with UTI. Erythromycin (39.5%) and clindamycin (26.4%) resistance was common. We conclude that a more diverse spectrum of GBS serotypes causes UTI than previously recognized, with the exception of nontypeable GBS.Group B streptococcus (GBS) is a leading cause of infection in newborns, pregnant women, and older persons with chronic medical illness (3,8). In addition to maternal cervicovaginal colonization and neonatal infection that results from the vertical transmission of bacteria from mothers to their infants, GBS can also cause urinary tract infection (UTI). The spectrum of GBS UTI includes asymptomatic bacteriuria (ABU), cystitis, pyelonephritis, urethritis, and urosepsis (6,8,10,20,23,26). GBS ABU is particularly common among pregnant women, although those most at risk for cystitis due to GBS appear to be the elderly and immunocompromised individuals (8,9,25). Despite the uropathogenic nature of GBS, the clinical and microbiological features of GBS UTI, including risk factors for disease and whether there is a tendency for particular GBS serotypes to cause UTI, are poorly understood.Clinically, UTI due to GBS may be indistinguishable from UTI caused by other uropathogens (25). However, a recent study of multiple uropathogens and host characteristics highlighted unique frequencies of host characteristics in UTI groups defined by the causal organism (37). This suggests that the clinical and microbiological features of UTI may differ depending on the infecting...

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Section: Serotypes Of Group B Streptococcus (Gbs) That Cause Urinary mentioning

confidence: 99%

Diversity of Group B Streptococcus Serotypes Causing Urinary Tract Infection in Adults

Ulett¹,

Benjamin

Zhuo

et al. 2009

J Clin Microbiol

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“…Implementation of rational GBS disease prevention protocols must be preceded by collection of data at the community level, due to variations in maternal GBS colonization and disease incidence rates in different populations [15]. The six published studies from Latin America provide evidence of geographical variation in maternal GBS colonization, but they give little information on disease incidence or risk factors that affect maternal colonization [16].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of maternal group B streptococcal colonization and related risk factors in a Brazilian population

Zusman¹,

Baltimore²,

Fonseca³

2006

Braz J Infect Dis

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The objective of this study was to determine the prevalence of maternal group B Streptococcal (GBS) colonization and compare risk factor data related to GBS colonization. A prospective surveillance study of 598 pregnant women was conducted in two socioeconomically diverse maternity hospitals in Ribeirão Preto, Brazil between June and October 1999. Swabs from the lower vagina were obtained between 35 and 37 weeks gestation and cultured on selective media. Risk factor data were obtained by patient interview and chart review. The overall maternal GBS colonization prevalence rate was 17.9%. There was no association of GBS colonization with maternity hospital and no association of GBS colonization with previously identified risk factors, such as age, race, martial status, maternal education, parity, smoking, or alcohol use. There is a relatively high prevalence of maternal GBS colonization in this Brazilian population, although previously-identified-risk factors were not found to be important. This study provides baseline data for the creation of community-based GBS disease prevention protocols.

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“…S. agalactiae bacteriuria of any count during pregnancy is routinely treated with antibiotics to minimize the risk of vertical transmission to the neonate (14)(15)(16)(17). S. agalactiae bacteriuria has an incidence of between 1.0 and 3.5% in individuals with suspected urinary tract infection (UTI) (4,(18)(19)(20)(21). S. agalactiae bacteriuria loads average between 50,000 and 70,000 CFU ml Ϫ1 in infected individuals (3), although these loads are dynamic and have been reported to change dramatically over just a few hours (2).…”

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confidence: 99%

Discovery and Characterization of Human-Urine Utilization by Asymptomatic-Bacteriuria-Causing Streptococcus agalactiae

et al. 2016

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f Streptococcus agalactiae causes both symptomatic cystitis and asymptomatic bacteriuria (ABU); however, growth characteristics of S. agalactiae in human urine have not previously been reported. Here, we describe a phenotype of robust growth in human urine observed in ABU-causing S. agalactiae (ABSA) that was not seen among uropathogenic S. agalactiae (UPSA) strains isolated from patients with acute cystitis. In direct competition assays using pooled human urine inoculated with equal numbers of a prototype ABSA strain, designated ABSA 1014, and any one of several UPSA strains, measurement of the percentage of each strain recovered over time showed a markedly superior fitness of ABSA 1014 for urine growth. Comparative phenotype profiling of ABSA 1014 and UPSA strain 807, isolated from a patient with acute cystitis, using metabolic arrays of >2,500 substrates and conditions revealed unique and specific L-malic acid catabolism in ABSA 1014 that was absent in UPSA 807. Whole-genome sequencing also revealed divergence in malic enzyme-encoding genes between the strains predicted to impact the activity of the malate metabolic pathway. Comparative growth assays in urine comparing wild-type ABSA and gene-deficient mutants that were functionally inactivated for the malic enzyme metabolic pathway by targeted disruption of the maeE or maeK gene in ABSA demonstrated attenuated growth of the mutants in normal human urine as well as synthetic human urine containing malic acid. We conclude that some S. agalactiae strains can grow in human urine, and this relates in part to malic acid metabolism, which may affect the persistence or progression of S. agalactiae ABU.

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The International Infections in Pregnancy Study: group B streptococcal colonization in pregnant women

Abstract: The prevalence of heavy colonization and GBS serotypes varied significantly among our study centers. Whether this variation could in part explain geographic differences in neonatal morbidity and mortality is a hypothesis that needs further study.

Cited by 37 publications

References 15 publications

Diversity of Group B Streptococcus Serotypes Causing Urinary Tract Infection in Adults

Diversity of Group B Streptococcus Serotypes Causing Urinary Tract Infection in Adults

Prevalence of maternal group B streptococcal colonization and related risk factors in a Brazilian population

Discovery and Characterization of Human-Urine Utilization by Asymptomatic-Bacteriuria-Causing Streptococcus agalactiae

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