Search

The rate of postoperative infections after cesarean section was studied in a prospective double-blind randomized study to compare cefuroxim with a placebo. Intravenous bolus injections were given at the beginning of, and 12h after the operation. Eighty patients received cefuroxim and 80 received placebo. Endometritis or wound infection, or both, was diagnosed in 2/80 (2.5%) patients receiving cefuroxim and in 23/80 (29%) patients receiving placebo. No side effects were demonstrated or reported by the patients. Thus, two bolus injections of 1.5 g of cefuroxim given peri-operatively significantly reduced postoperative infectious morbidity after emergency cesarean section.

The relationship between significant bacteriuria (SB), i.e. 2 subsequent voided urine specimens with ≥105 colony forming units (CFU)/ml, and the occurrence of bacteria in the urinary bladder detected by bladder punction, was investigated in asymptomatic pregnant women. From 30 (70%) of the 43 women with SB studied, bacteria were isolated from the urinary bladder. The same bacteria were found in the bladders of all 21 women with Escherichia coli, the one with Klebsiella pneumoniae, and the one with Staphylococcus saprophyticus in midstream urine. Six of 10 patients with group B streptococci (GBS), 1 of 4 patients with Streptococcus faecalis, and none of 5 patients with Staphylococcus epidermidis in voided specimens had bacteria in the aspirated urine. Serotype III was isolated from 8/10 patients with SB caused by GBS. One child born to a woman with GBS SB but no bacteria in the urinary bladder, got early onset septicaemia. The poor predictive value of SB with GBS, S. faecalis and S. epidermidis necessitates the increased use of bladder puncture for diagnosis of true asymptomatic bacteriuria (AB), i.e. AB with bacteria in the urinary bladder. SB with GBS even without bacteria in the urinary bladder, may constitute a threat to the baby's health.

AbstractA method has been developed for the detection in human sera of antibodies to surface antigens of group B streptococci (GBS), types Ia, Ib, or III. The sera were absorbed with GBS type II and then added to a suspension of GBS of the type against which antibodies were to be measured. After incubation and washing of the bacteria, the antibodies present on the surface of the cells were quantitated with radiolabelled protein A. Antibodies of IgG class were detected, probably specific for types Ia, Ib or III, with the exception that the Ib GBS suspension used could detect some antibodies to type Ia. With this method it was found that 67 mothers to infants with GBS septicemia had low levels of serum antibodies to the infant's type of GBS. Urogenital carriers of GBS, giving birth to neonatally healthy infants, had higher serum antibody levels against the colonizing type.

AbstractGroup B streptococci were isolated from the urogenital tract of 54 of 168 patients (32 ) examined at a gynecological outpatient department. 11 (7 ) of the patients were group B throat carriers. In contrast to the frequency of type III group B streptococci in the urogenital tract (41 of group B streptococcal carriers) only 1 of 11 strains isolated from the throat belonged to type III. Apart from 1 patient who carried type III streptococci in the urogenital tract, all patients who were both throat and urogenital tract carriers harboured the same type in both sites. Significantly more patients who were only throat carriers of group B streptococci or harboured another type in the throat than in the urogenital tract, harboured lactose-fermenting group B streptococci as compared to patients who were only carriers of group B streptococci in the urogenital tract. These results pointed out the possible existence of “throat-preferring” and “urogenital-preferring” group B streptococci.

AbstractSerum levels of type-specific antibodies against group B streptococci (GBS) were investigated in 53 pregnant urogenital carriers of GBS and in 20 pregnant non-carriers. The distribution of serotypes of GBS isolated from the urogenital tract of the 53 culture-positive patients was: type Ia, 20 patients (38), type II, 10 (19), and type III, 23 (43). Antibodies to GBS types Ia, Ib, II and III were quantitated by the use of radiolabelled protein A. It was found that the pregnant GBS carriers had in general higher levels of type-specific antibodies to GBS than non-carriers, irrespective of the type of GBS harboured in the urogenital tract. Furthermore, it was found that younger GBS carriers (20 to 29 yr of age) had higher serum levels of type-specific antibodies than older carriers (30 to 39 yr), a difference that did not occur among the non-carriers.

AbstractIn a kindergarten with 42 children and 17 female staff members, an epidemic of group B streptococcal carriage in the upper respiratory tract occurred. In the middle of February 1978, 6 children and 5 adults carried type I b streptococci in the throat while only 2 of these 11 were carriers 2 weeks later. Only one other streptococcus, belonging to type II, was found in the throat specimens. Five strains other than type I b were found in the urogenital tract of the staff. Three type I b throat carriers were also urogenital carriers of this type. The spread of type I b streptococci could have resulted from co-spreading with other upper respiratory tract pathogens found, including group A streptococci of type 12, Haemophilus influenzae, Branhamella catarrhalis and pneumococci. Estimation of antibodies with radiolabelled protein A indicated an immune response to type I b, but not to types I a, II or III group B streptococci in the staff compared with healthy blood donors.

AbstractObstetrical and neonatal complications were studied among 143 urogenital carriers of group B streptococci (GBS) and their 144 infants and compared with complications occurring in a control group of 157 pregnant non-carriers and their 158 infants. All parturients had experienced uncomplicated pregnancies until week 36. 26 infants, 13 from each group, were transferred to the neonatal intensive care unit for treatment and observation within the first 7 days of life. Among these infants, 1113 infants of GBS carriers contracted pneumonia and pulmonary adaptation syndrome, in contrast to 313 infants of non-carriers (p<0.05). The GBS carrier infants transferred to the neonatal intensive care unit had higher birth weights and higher gestational ages. Within the group of infants born to GBS carriers, those with pulmonary diseases evidenced abnormal fetal heart rate changes during labour in a higher rate than in the controls. Puerperal endometritis occurred with a significantly higher frequency among the GBS carriers (7143) than among the non-carriers (0157). Maternal carriage of GBS is a high risk factor for both the mother and her newborn, also after an otherwise uncomplicated pregnancy.

AbstractSera from 3 groups of individuals were investigated for antibodies to group B streptococci (GBS) types Ia, Ib and III using radiolabelled protein A: 45 girls, aged 1 to 12 years; 123 non-pregnant gynecological outpatients, aged 15 to 42 years; and 96 female venereological disease (VD) clinic patients, aged 15 to 54 years. The two groups of adults had higher antibody levels against type Ia than the girls, while no difference was found between the two adult groups in this respect. On the other hand, the VD patients had higher levels of antibodies against type Ib than the girls and the gynecological patients; the gynecological patients did not differ from the girls as regards anti-lb antibodies. The antibody levels against type III were higher among the VD clinic patients than among the gynecological patients, who in turn had higher levels than the girls. Thus, the adults showed higher levels of antibodies against 2 of the 3 GBS types than did the girls. Furthermore, the VD clinic patients had higher levels against 2 of the 3 GBS types than the gynecological patients.

AbstractThe occurrence of group B streptococci was investigated in urethral and cervical specimens from the following groups of individuals: 219 females visiting a gynaecological department for screening for cervical carcinoma for the first time; 104 pregnant women visiting a mother-care department; 94 patients with previous or existing cytological changes in cervical smears; 153 patients with gonorrhoea and their 67 sexual contacts; and 42 male medical undergraduates. The women with gonorrhoea harboured group B streptococci more often than the women visiting the cancer screening department for the first time (36.9 and 18.3, respectively). Both groups harboured B streptococci more often than the pregnant women (7.7) who were living in a more rural district. The men with gonorrhoea harboured B streptococci more often than the male medical undergraduates (21.7 and 2.7, respectively). B streptococci were equally common among the sexual contacts as among the patients infected with gonococci, whether the contacts were infected with gonococci or not. The 219 women visiting the cervical cancer screening department were questioned regarding the use of contraceptives. Neither IUD nor contraceptive pills were found to influence the frequency of group B streptococci. On background of these results, sexual transmission of group B streptococci is discussed.