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We report 4 cases of neonatal sepsis caused by Streptococcus gallolyticus. The clinical course was quite similar to early-and late-onset group B streptococcus disease. None of the mothers had group B streptococcus (GBS) colonization on prenatal screening nor received intrapartum antibiotics. We proposed the sporadic distribution of S. gallolyticus sepsis among neonates was partly due to relatively low colonization rate in adults compared with GBS. Species determination of S. gallolyticus may not be available using conventional microbiological methods and may contribute to underestimation or misclassification. In our series, we highlighted the importance of S. gallolyticus as an important pathogen in neonatal sepsis deserving further surveillance.

Background Self-sampling with proper instruction in 35-37 weeks’ gestation is supplementary to clinician sampling to prevent early-onset invasive group B streptococcal disease of infants. Despite of the accuracy proved in previous studies, disputes were raised on pregnant women’s low preference and adherence to the method of swab collection. We aimed to assess the accuracy of self-sampling and influencing factors for preference on collection method in Chinese women. Methods We compared screening results of self-sampling with clinician collection in a sample of 522 women in late pregnancy. These participants needed to complete a questionnaire on their preference and demographics after self-sampling. A multi-nominal logistic regression model was then used to measure the association between the influencing factors and preference for collection method. Results A good agreement between the two collection methods was found with a Cohen’s Kappa coefficient 0.83 (95%CI 0.71-0.95). The prevalence of GBS infection in the two methods is statistically different. Four factors (maternal age, parity, education attainment and pain difference) were included in the final multi-nominal regression model while gestational age and vaginal suppository use were excluded. Non-elderly parturient women were 2.84 (95% CI 1.19-6.74) times more likely to prefer self-sampling compared to clinician sampling, adjusting for parity, education and pain difference. If these participants experienced more or equal pain during self-sampling compared to clinician collection, they were more likely to prefer clinician sampling controlling the other three factors’ effect. Conclusions Our study suggests high agreement between the two collection methods. Self-sampling presented a higher detection rate than physician-collected samples. Pregnant women are able to collect rectovaginal samples prior to their antenatal visit. Self-sampling is preferable by 1/5 of the participants and it could be an option for those younger than 35 years old, especially for those with low pain threshold.

Background: The early-onset sepsis (EOS) calculator was developed and validated in a setting with routine-based group B Streptococcus (GBS) screening.Purpose: The study aimed to evaluate the extent of influence exerted by risk-based GBS screening on management recommendations by the EOS calculator.Methods: All newborns with a gestational age greater than 35 weeks were screened for EOS risk factors in a Dutch regional teaching hospital using a risk-based GBS screening strategy. We calculated the EOS risk at birth and stratified the infants into the following 3 risk levels with corresponding management recommendations: low, 1.54 per 1000 live newborns. Thereafter, we recalculated the EOS risk and recommendation for the newborn infants without available maternal GBS screening results at birth.Results: In one year, 1,877 eligible births occurred; of them, 206 infants were included. Maternal GBS status was available for 28 of 206 infants (14%) at birth, while a definitive GBS status was later available for 162 of 206 infants (79%). Median EOS risk was slightly lower after definitive GBS status was determined (0.41 vs. 0.46 per 1,000 live births, P=0.004). In 199 of 206 newborn infants (97%), the EOS calculator recommendation remained unchanged after the GBS results unavailable at birth were updated to definitive GBS status. Use of GBS status at birth versus definitive GBS status did not result in the withholding of antibiotic treatment of the newborn infants included in this study.Conclusion: Risk-based GBS screening is compatible with EOS calculator recommendations. Larger studies are needed to develop the best strategy for combining GBS screening and EOS calculator recommendations.

Maternal vaginal/rectal colonization of group B streptococcus (GBS) is a main risk for neonatal invasive infection. Efficient determination of GBS colonization in pregnant women is crucial. This study aimed to investigate the prevalence of GBS carriage and evaluate the diagnostic performance of six methodologies for GBS screening conducted in China, including blood agar plate, liquid chromogenic medium, and loop-mediated isothermal amplification (LAMP) without pre-enrichment, chromogenic agar plate with pre-enrichment, and GBS antigen detection without and with pre-enrichment in comparison with the standard reference method (Lim broth-enriched subculture with plating on 5% sheep blood agar). Vaginal/rectal swabs were collected from 1,281 pregnant women at 35–37 weeks of gestation. Of them, 309 were taken in triplicate, one for Lim broth-enriched subculture, one for blood agar plate, and the third for GBS antigen detection (Reagent W); 177 were acquired in duplicate, one for Lim broth-enriched subculture and the other for GBS antigen detection (Reagent H); 502 were obtained in duplicate, one for Lim broth-enriched subculture and the other for liquid chromogenic medium; 158 were collected in duplicate, one for Lim broth-enriched subculture and the other for LAMP; and 135 were inoculated in Lim broth-enriched for GBS antigen detection (Reagent W) and subculture with chromogenic agar plate and 5% blood agar plate. The overall prevalence of GBS carriage was 10.1% (130/1,281, 95% CI: 8.5–12.1%) according to the standard reference method. Compared with the standard reference method, the LAMP had excellent performance of sensitivity (100%, 95%CI: 83.4–100%), specificity (94%, 95%CI: 88.1–97.1%), and Yoden index (0.940); as well as the blood agar plate with sensitivity (81.5%, 95%CI: 61.3–93.0%), specificity (100%, 95%CI: 98.3–100.0%), and Yoden index (0.815). The other four methods were not sufficient to reach the threshold in terms of sensitivity or specificity compared to the standard reference method. Furthermore, for LAMP, results can be obtained within 0.5–1 h, while for blood agar plate, which needed 24–48 h, and further identification was required. Our data suggested that the performance of LAMP was highly comparable to the standard Lim broth-enriched subculture and LAMP is considered as an alternative for fast and accurate GBS screening.

Colonization with Group B Streptococcus in pregnancy is a major risk factor for neonatal infection. Universal screening for maternal streptococcal colonization and the use of intrapartum antibiotic prophylaxis has resulted in substantial reductions of neonatal early-onset Group B Streptococcus disease. To achieve the best neonatal outcomes, it is imperative for maternity healthcare providers to adhere to screening and management guidelines. This literature review uses a systematic approach and aims to provide a synthesis of what is known about compliance with Group B Streptococcus screening protocols in a variety of global settings, including maternity homes, private obstetric practice, and hospital clinical environments. The review was carried out using electronic databases as well as hand-searching of reference lists. Included papers reported primarily on compliance with Group B Streptococcus screening guidelines, potential factors which influence compliance rates, and implementations and outcomes of interventions. Six international studies have been retained which all focused on adherence to Group B Streptococcus screening guidelines and demonstrated that different factors might have an influence on adherence to GBS screening protocols such as financial aspects and high caesarean section rates. Findings of relatively low compliance rates led to recognizing the need of developing improved strategies for optimising antenatal GBS screening adherence. Adhering to Group B Streptococcus screening guidelines to prevent neonatal infection is crucial. Various factors influence compliance rates such as financial aspects and high proportions of caesarean sections. The implementation of strategies and different forms of education can result in improved compliance rates.

Background: Group B streptococcus is a leading infectious cause of morbidity in newborns and causes substantial disease in elderly individuals. Guidelines recommended antenatal culture-based screening as the optimal method for identifying chemoprophylaxis candidates. Objectives: To assess the primary care physicians’ knowledge about group B streptococcus screening in pregnant women and to identify the barriers that prevent primary care physicians from screening as recommended. Methods: A cross-sectional study conducted at the Al-Wazarat healthcare center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. A self-administrated questionnaire was distributed to 89 physicians asking about their knowledge and barriers regarding group B streptococcal infection High Vaginal Swab (HVS) screening. Results: The GBS screening average knowledge is 74.0% distributed on 11.2% scored poor, 31.5% good, and 57.3% excellent level of knowledge. Eight physicians’ attitude was positively agreeing with GBS screening statement with lowest agreement was in performing screening with primary care setting (76.4%). The barriers for GBS screening are system and protocol (52.8%), lack of training (46.1%), lack of tools (24.7%), fear of consequences (14.6%), and other barriers (16.9%). Regression analysis showed that in comparison to physicians younger than 30 years, physicians aged 30 – 39 years has higher average by 9.4% (p-value = 0.039), 40 – 49 years have higher knowledge with average 10.3% (p-value = 0.036), 50 years or older have higher knowledge on average 8.9% (p-value = 0.040) Conclusion: Education programs regarding GBS screening in pregnancy are needed to improve the primary care physicians’ knowledge in order to prevent inevitable complications of GBS infection in pregnancy.

Perinatal group B Streptococcus (GBS) disease prevention guidelines in 2010 allowed for processing of screening specimens by nucleic acid amplification tests (NAATs); however, the extent of NAAT use is unknown. A 2016 laboratory survey sent to 10 surveillance sites found that 18.7% of responding laboratories offered NAAT for GBS screening (antenatal only: 7.3%; intrapartum only: 4.1%; both: 3.4%).

Group B Streptococcus (GBS) is the leading cause of neonatal infections in industrialized countries. Intrapartum antibiotic prophylaxis (IAP) given to colonized parturients is a key step for the prevention of neonatal early-onset infection. We compared the performances of Xpert® GBS polymerase chain reaction (PCR) (Cepheid, Sunnyvale, CA, USA) as a point-of-care system in labor wards to standard culture for intrapartum GBS detection. Pregnant women with a GBS-positive antenatal screening were prospectively included. A vaginal double swab was collected at the time of delivery for point-of-care Xpert® GBS PCR and GBS culture. A total of 565 pregnant women were included. Valid Xpert® GBS results were obtained for 488 (86.4%) women on the first attempt. Repeat testing improved the PCR success to 516 (91.3%) women. Among the 305 women positive for GBS by culture at delivery, only 238 (78.0%) were positive by Xpert® GBS PCR, cycle thresholds being correlated to culture quantification. Among 260 women negative for GBS culture, 56 (21.5%) were positive by Xpert® GBS PCR, including 50 where IAP was initiated before vaginal sampling. Overall, among the 565 women with GBS antenatal positive culture, only 335 (59.3%) were still positive at delivery whatever the technique used, resulting in unnecessary IAP for 40% of them. This large cohort study comparing intrapartum to antepartum GBS detection provides evidence that (i) Xpert® GBS PCR might be a valuable solution for intrapartum GBS detection compared to culture-based strategies and (ii) laboratory training of non-specialized staff is mandatory to reach the performances required for point-of-care tests.

Objective To determine rates and results of maternal Group B streptococcus (GBS) screening during pregnancy and identify sociodemographic characteristics associated with GBS screening in Latin American countries. Background GBS is a primary cause of morbidity and mortality in neonates and is prevented by screening pregnant women for GBS before delivery and intrapartum antibiotic treatment. Yet, data regarding national GBS screening practices and the epidemiology of maternal GBS colonization in Latin America are limited. Methods We conducted a retrospective observational study using de-identified records of pregnant women in six Latin American countries from a regional database. 460,328 collected from January 1, 2009 through December 31, 2012 met study criteria and were included. Maternal screening rates for GBS were determined, association of demographic variables (ethnicity, age, education level, and civil status) with maternal GBS screening was determined using logistic regression, odds ratios were calculated comparing incidence of adverse neonatal outcomes (sepsis, pneumonia, and meningitis) between countries with high and low rates of GBS screening, maternal GBS colonization prevalence was determined by year and association of demographic variables with maternal GBS colonization was determined using logistic regression. Results Maternal GBS screening was less than 15% in each country, except Uruguay which screened greater than 65% of women. The final regression model examining maternal screening rates and demographic variables included the covariates ethnicity, maternal age group, education level and civil status. Countries with lower rates of maternal GBS screening had increased odds of neonatal sepsis [OR 23.3; 95% CI (15.2–35.9)] and pneumonia [OR 19.9; 95% CI (12.1–32.6)]. In Uruguay, GBS prevalence over the study period was 18.5%. Black women, older women and women without a primary education had higher rates of GBS colonization (21.3%, 20.4% and 21.9% respectively). Conclusions Our study highlights the need for national policy and investments to increase maternal GBS screening and better understand the prevalence of maternal GBS colonization in Latin America. Further research on the burden of neonatal GBS disease within Latin America is needed to inform the introduction of a maternal GBS vaccine, when available.

Pregnant women colonized by Streptococcus agalactiae, or group B streptococcus (GBS), are at an increased risk of premature delivery and stillbirth, and their neonates can be endangered by the development of an invasive GBS disease. In this study, the results of the GBS screening among pregnant women performed between 2012 and 2018 (n = 19267) are presented. For the GBS positive samples, the antibiotic susceptibility of the isolated strains was also tested (n = 3554). During the examined period, the colonization rate varied between 17.4% and 19.8%. The overall rate of erythromycin and clindamycin resistance in the GBS positive samples was 34.9% and 34.6%, respectively. The frequency of the erythromycin and clindamycin resistant strains showed an increasing tendency. An analysis of the MALDI-TOF MS spectra of 260 GBS isolates revealed that 46.5% of them belonged to either the ST-1 or the ST-17 sequence types, indicating a high prevalence of these potentially invasive GBS strains in our region. More than half of the strains identified as ST-1 (52.1%) proved to be resistant to erythromycin and clindamycin.

Throughout pregnancy, women are offered various screenings and diagnostic procedures. Group B Streptococcus (GBS) screening is currently a routine screening process in Australia, but not in the United Kingdom, which is offered to women at 35–37 weeks gestation. The results of GBS screening alter a woman’s course of care for labor and the postnatal period. This article is a review of evidence, policy, and clinical practice and aims to determine whether GBS screening is necessary and whether the screening has a positive or negative impact on women and their babies.

Objective There was no national data on group B streptococcus (GBS) infections in Taiwan. Until 2012, when prenatal GBS screening was introduced to obstetric practices as a national health policy aimed at reducing neonatal GBS infections. The purpose of this study was to examine the impact of this national health policy on the incidence of maternal GBS colonization and neonatal GBS infection rate. Relatedly, the clinical characteristics of neonatal GBS infection were investigated to determine the correlations between the incidence of maternal GBS colonization and the neonatal GBS infection rate. Materials and methods This population-based nationwide study used data for 2012–2013 from the National Health Insurance Research Database of Taiwan. A total of 789 newly diagnosed pregnant women with genital GBS infection were recruited. Results The maternal GBS screening rate was 93.2%. The maternal colonization rate of GBS was around 8.2%, and the incidence of neonatal GBS infection was 22.6%. The data indicate that no sepsis was developed in any of the cases, while fever was found in 3 cases (3/179, 1.7%) and UTI was found in 1 case (1/179, 0.6%). Conclusions We conclude that a policy calling for universal maternal rectovaginal cultures for GBS with intrapartum antibiotic prophylaxis is a good national policy for reducing morbidity due to GBS infections in neonates in Taiwan.

654 Virulence Volume 4 issue 7 Staphylococcus aureus infects millions worldwide. Methicillin-sensitive and methicillin-resistant S. aureus (MSSA and MRSA) isolates may closely share virulence determinants through related clonal complexes. The purpose of this pilot study was to assess the epidemiology of S. aureus colonization in pregnant women in a community-acquired MRSA endemic area at the time of group B streptococcus screening. Of 107 women, 23 were colonized with MSSA, none with MRSA. Virulence factors Panton–Valentine leukocidin and ACME arcA were found in 75% and 6% of isolates, respectively. Mothers of infants with longer lengths of stay were 1.5 times more likely to be S. aureus colonized (P = 0.07). Postpartum infections occurred in 13%. The impact of colonization on maternal health should continue to be studied. Staphylococcus aureus (S. aureus) is a common bacterial pathogen encountered by primary care providers and subspecialists alike. S. aureus frequently colonizes the anterior nares but also the skin, nails, pharynx, axilla, perineum, and vagina. Reported rates of S. aureus vaginal colonization during pregnancy range from 4% to 22%. The overall prevalence of community-acquired MRSA (CA-MRSA) infection in Chicago, Illinois has increased over A prospective cohort pilot study of the clinical and molecular epidemiology of Staphylococcus aureus in pregnant women at the time of group B streptococcal screening in a large urban medical center in Chicago, IL USA

Introduction: The incidence of early -onset group B streptococcus (GBS) disease has decreased substantially due to universal antenatal culture screening of pregnant women for GBS colonization at 35 -37 weeks of gestation and the widespread use of intrapartum antibiotic prophylaxis. However, the incidence of late-onset GBS disease has remained constant in the past decade and it is unaffected by maternal intrapartum chemoprophylaxis. Late-onset GBS infection affects infants who had an unremarkable maternal obstetric and early neonatal history. Other sources rather than vertical route, like horizontal transmission from hospital or community, albeit less frequently proved, can justifies late onset GBS disease.Case report: This case report illustrates a late-onset GBS disease, presenting as neonatal septic arthritis on a caucasian term infant, with unknown route of transmission and highlights the morbidity associated.Discussion: Additional research pertaining to the transmis- sion of late-onset GBS infections is required to develop effective preventive methods., Introdução: A incidência da infeção neonatal precoce por Estreptococo do grupo B (EGB) tem diminuído substancialmente devido ao rastreio da colonização por EGB nas grávidas entre as 35 e as 37 semanas de gestação e à instituição da quimio-profilaxia intraparto. No entanto, a incidência da infeção tardia tem-se mantido constante na última década, não sendo afetada pela quimioprofilaxia materna intraparto. A infeção tardia afeta lactentes sem intercorrências obstétricas e com uma evolução neonatal precoce favorável. Outras vias de transmissão além da via vertical, tais como a via horizontal através dos contatos hospitalares ou familiares, poderão justificar a infeção tardia.Caso clínico: Este caso clínico relata uma infeção tardia por EGB que se manifestou como um artrite séptica num lactente caucasiano de termo, com via de transmissão desconhecida. A morbilidade associada é descrita.Discussão: Investigações adicionais sobre o mecanismo de transmissão da infeção tardia por EGB são imperativas para o desenvolvimento de medidas preventivas adequadas.

Background Early-onset sepsis (EOS) is the major cause of neonatal morbidity and mortality. Maternal group B Streptococcus (GBS) screening and intrapartum antibiotic prophylaxis (IAP) were implemented in our hospital in 2004. Our aim was to evaluate the effectiveness of the program and changes in pathogens and antibiotic susceptibility. Methods The medical charts of mothers and infants with EOS between January 2001 and November 2008 were retrospectively reviewed. EOS was defined as sepsis occurring within 72 hours of birth. Data were pooled and compared for January 2001 through September 2004 (Period 1, without GBS screening) and October 2004 through November 2008 (Period 2, with GBS screening and IAP). Results The GBS screening rate increased from 10.11% in 2004 to 65% in 2008 and the IAP rate increased from 40% in 2004 to 90% in 2008. The most common EOS pathogen in Period 1 was GBS (45.4%), which decreased to 20% in Period 2 ( p =0.081; trend p =0.009). The percentage of EOS because of Escherichia coli in Period 1 was 40.9% but increased to 70% in Period 2 ( p =0.059). E coli EOS increased in extremely low birth weight premature babies weighing 500–1000g from Period 1 to Period 2 ( p =0.031). The incidence of ampicillin-resistant E coli EOS was relatively high, but no significant change (88.9% vs. 92.9%) after implementation of GBS screening and IAP was noted. Conclusion GBS screening plus IAP is effective in decreasing the incidence of GBS EOS; however, an increase in EOS caused by E coli was noted. Monitoring of pathogens causing EOS is important for effective treatment.

Rationale Group B streptococcus (GBS) neonatal infection can be prevented by screening pregnant women for GBS colonization from the 34th to the 38th week of gestation, as has been recommended in France since 2001. We assessed guideline adherence among midwives and obstetricians. Methods From 2006 to 2008, new and mandatory GBS data were added to the obstetric database. We merged the latter with a bacteriological database and a paediatric database and defined process indicators for pregnant women who delivered from the 37th week of gestation in the hospital of Poitiers and for neonates hospitalized for a GBS infection from 2006 to 2008. Results We abstracted 5997 pregnant women (1942 in 2006, 1975 in 2007 and 2080 in 2008) and 84 neonates (17 in 2006, 32 in 2007 and 35 in 2008). GBS pregnancy colonization prevalence was 15%, 13% and 18% respectively. Availability of GBS screening status was stable (96%, P = 0.15). The rate of GBS screening during pregnancy increased significantly (86% to 90%, P = 0.002). Percentage of correct-term screening increased significantly (89% to 96%, P

Objective: The standard antenatal screening method for Group B Streptococcus (GBS) has not been established yet. Therefore, many practitioners in South Korea offer GBS screening to all pregnant women without solid clinical evidence. The aim of this study was to compare the rates of early onset neonatal sepsis (EONS) according to two different antenatal GBS screening methods - risk-based versus universal screening. Methods: This is a retrospective cohort study from January 2014 to April 2017. The study period was divided into two 16-month periods: from January 2014 to April 2015 in which risk-based screening was performed (period 1), and from January 2016 to April 2017 in which universal screening was performed (period 2). We compared the rates of EONS caused by GBS and other bacterial species between the two periods. Results: 1,301 neonates from 1,293 deliveries and 924 neonates from 913 deliveries were enrolled in period 1 and period 2, respectively. Suspected or culture-proven EONS caused by any organisms were more frequently observed in period 2 (0.7% in period 1 vs. 1.8% in period 2, P=0.013). The causative organism was not confirmed by culture in most cases, except for GBS, Escherichia coli, and Enterococcus. Intrapartum administration of antibiotic prophylaxis (IAP) was more frequently performed in period 2 (10.9% in period 1 vs. 21.5% in period 2, P

PURPOSE The purpose of this study was to: 1) examine the occurrence of early-onset Group B Streptococcal (GBS) disease in newborns, and 2) describe the relationship between early-onset GBS disease in the newborn and the number of doses of antibiotics the mother received before delivery. SUBJECTS Women with a positive Group B Streptococcus screening culture were added to the study based on the inclusion criteria and further grouped based on the number of doses of intrapartum antibiotics received. The mothers and infants in Group 1 received only 1 dose of intrapartum antibiotics; Group 2 received > or =2 doses of intrapartum antibiotics. The sample consisted of a total of 128 women and their infants. DESIGN AND METHODS This pilot study used a descriptive correlational design. Data were obtained over a 6-month period by a retrospective chart review. Descriptive statistics were used to characterize the demographic data and chi(2) statistical analysis was done to compare the frequency of early-onset GBS disease in each group to determine if there were differences between groups. RESULTS The Pearson chi(2) value for comparing the 2 groups was 0 with 1 degree of freedom indicating no difference of probability outcome between the 2 groups. CONCLUSIONS There were no differences found in the incidence of early-onset GBS disease in newborns when a GBS positive pregnant woman received 1 or 2 doses of intrapartum antibiotics. These data provide further supporting evidence for the Centers for Disease Control and Prevention's recommendations that were based on the premise that vertical transmission of GBS will be greatly reduced by administration of 1 dose of intrapartum antibiotics at least 4 hours before delivery to expectant mothers.

Background: Early-onset group B streptococcal disease is a serious cause of neonatal morbidity and mortality. Although screening protocols for group B streptococcus are common, little is known of women's perceptions of this screening and the disease itself. The purpose of this study was to gain an understanding of women's experiences, knowledge, and perceptions about this bacteria and its screening. Methods: Nine focus group interviews with 35 women explored their experiences and understanding of group B streptococcus screening. Transcribed interview data were interpreted to identify and articulate the women's experiences. Results: Most women had little knowledge or understanding of group B streptococcus, obtaining their information largely from the stories or experiences of friends or family. Women struggled to understand the meaning and implications, both physical and ‘‘moral,’’ of the disease for their baby and for themselves, clearly indicating both the subjective and statistical importance of the concept of risk for pregnant women. Conclusions: Group B streptococcus continues to be poorly understood by pregnant women who try to understand and weigh up its risks and implications so as to make the best decisions about screening. The women participated in screening ultimately, however, since it was seen to be patently ‘‘best for baby,’’ relatively easy for them to undergo, and part of routine antenatal care. (BIRTH 30:2 June 2003)

Group B streptococcus (GBS), which commonly colonizes the female genital tract and rectum, can cause infections in newborns with varying severity, possibly leading to death. The aim of the present study was to evaluate Hitchens-Pike-Todd-Hewitt (HPTH) medium performance for GBS screening in pregnant women. A descriptive analytical cross-sectional study was performed with 556 pregnant women, of which 496 were at 35-37 weeks of gestation and 60 were at ≥ 38 weeks of gestation. The study was conducted from September 2011 to March 2014 in northern Parana, Brazil. Vaginal and anorectal clinical specimens from each pregnant woman were plated on sheep blood agar (SBA) and seeded on HPTH medium and Todd-Hewitt enrichment broth. Of the 496 pregnant women at 35-37 weeks of gestation, 141 (28.4%) were positive for GBS, based on the combination of the three culture media and clinical specimens. The GBS colonization rates that were detected by each medium were 22.2% for HPTH medium, 21.2% for SBA, and 13.1% for Todd-Hewitt enrichment broth. Of the 60 pregnant women at ≥ 38 weeks of gestation, seven (11.7%) were positive for GBS. These results demonstrate that HPTH medium and SBA were more sensitive than Todd-Hewitt enrichment broth for GBS screening in pregnant women and good GBS recovery in culture, indicating that the two media should be used together for vaginal and anorectal specimens.

A 2,496-g male infant was born at term to a 20-year-old primiparous African American woman whose pregnancy was complicated by a primary herpes simplex virus (HSV) outbreak 9 days prior to delivery. Prenatal laboratory findings were unremarkable, including negative results for human immunodeficiency virus, syphilis, hepatitis B, and group B Streptococcus screening tests and a normal glucose tolerance test result. The mother presented to the labor and delivery unit of a community hospital with concerns about decreased fetal movement. Fetal heart rate monitoring revealed late decelerations and lack of heart rate variability, so an emergent cesarean section was performed. At delivery, thick meconium was present, and the infant had abnormally increased tone, decorticate posturing, and minimal respiratory effort. Meconium was suctioned from below the vocal cords, after which the infant began crying spontaneously. Apgar scores at 1 and 5 minutes were 5 and 8, respectively. The infant was transferred to the nursery, where pulse oximetry revealed fluctuating oxygen saturations of 80% to 90%. He was placed under an oxygen hood with an FiO2 of 0.50 to maintain oxygen saturations greater than 90%. On physical examination, he exhibited increased work of breathing with retractions and abnormally increased tone. At 30 minutes after birth, the infant developed overt seizure activity manifested by lip smacking, eye deviation, and tonic-clonic movements of the extremities. A dextrose stick revealed a blood glucose concentration of less than 20 mg/dL (1.1 mmol/L), so a bolus of 10% dextrose solution was administered. Hypoglycemia persisted, requiring additional boluses of 10% dextrose and administration of dextrose-containing maintenance intravenous fluids. The infant ultimately required a glucose infusion rate of 8 mg/kg per minute to maintain …

To compare the incidence of group B Streptococcus colonization in diabetic (n = 98) and nondiabetic (n = 10) patients, 199 pregnant women were cultured at the vaginal introitus using a standardised technique. Eight diabetic patients had positive findings for group B Streptococcus cultures, and three nondiabetic patients had positive cultures. No significant difference (P = .109) was found in the group B Streptococcus colonization rates between these two groups of patients. In addition, no significant difference was found in the group B Streptococcal colonization rates between gestational and pregestational diabetics (P = .498). A within-group comparison of diabetic patients revealed that ethnicity (Hispanics versus nonhispanics) did generate a significant difference in the rate of colonization (P = .033). The results of the present study suggest that there is no substantial evidence to consider diabetes mellitus as a higher risk criterion for group B Streptococcus screening. However, population differences and ethnicity should be noted as important contributing factors when considering the implementation of group B Streptococcus screening protocols for pregnant women.

Introdução: A incidência da infeção neonatal precoce por Estreptococo do grupo B (EGB) tem diminuído substancialmente devido ao rastreio da colonização por EGB nas grávidas entre as 35 e as 37 semanas de gestação e a instituição da quimioprofilaxia intraparto. No entanto, a incidência da infeção tardia tem-se mantido constante na última década, não sendo afetada pela quimioprofilaxia materna intraparto. A infeção tardia afeta lactentes sem intercorrências obstétricas e com uma evolução neonatal precoce favorável. Outras vias de transmissão além da via vertical, tais como a via horizontal através dos contatos hospitalares ou familiares, poderão justificar a infeção tardia. Caso clínico: Este caso clínico relata uma infeção tardia por EGB que se manifestou como uma artrite séptica num lactente caucasiano de termo, com via de transmissão desconhecida. A morbilidade associada é descrita. Discussão: Investigações adicionais sobre o mecanismo de transmissão da infeção tardia por EGB são imperativas para o desenvolvimento de medidas preventivas adequadas. Introduction: The incidence of early-onset group B streptococcus (GBS) disease has decreased substantially due to universal antenatal culture screening of pregnant women for GBS colonization at 35-37 weeks of gestation and the widespread use of intrapartum antibiotic prophylaxis. However, the incidence of late-onset GBS disease has remained constant in the past decade and it is unaffected by maternal intrapartum chemoprophylaxis. Late-onset GBS infection affects infants who had an unremarkable maternal obstetric and early neonatal history. Other sources rather than vertical route, like horizontal transmission from hospital or community, albeit less frequently proved, can justifies late onset GBS disease. Case report: This case report illustrates a late-onset GBS disease, presenting as neonatal septic arthritis on a Caucasian term infant, with unknown route of transmission and highlights the morbidity associated. Discussion: Additional research pertaining to the transmission of late-onset GBS infections is required to develop effective preventive methods.

RESUMO Introdução: A incidência da infeção neonatal precoce por Estreptococo do grupo B (EGB) tem diminuído substancialmente devido ao rastreio da colonização por EGB nas grávidas entre as 35 e as 37 semanas de gestação e à instituição da quimioprofilaxia intraparto. No entanto, a incidência da infeção tardia tem-se mantido constante na última década, não sendo afetada pela quimioprofilaxia materna intraparto. A infeção tardia afeta lactentes sem intercorrências obstétricas e com uma evolução neonatal precoce favorável. Outras vias de transmissão além da via vertical, tais como a via horizontal através dos contatos hospitalares ou familiares, poderão justificar a infeção tardia. Caso clínico: Este caso clínico relata uma infeção tardia por EGB que se manifestou como um artrite séptica num lactente caucasiano de termo, com via de transmissão desconhecida. A morbilidade associada é descrita. Discussão: Investigações adicionais sobre o mecanismo de transmissão da infeção tardia por EGB são imperativas para o desenvolvimento de medidas preventivas adequadas. ABSTRACT Introduction: The incidence of early-onset group B streptococcus (GBS) disease has decreased substantially due to universal antenatal culture screening of pregnant women for GBS colonization at 35-37 weeks of gestation and the widespread use of intrapartum antibiotic prophylaxis. However, the incidence of late-onset GBS disease has remained constant in the past decade and it is unaffected by maternal intrapartum chemoprophylaxis. Late-onset GBS infection affects infants who had an unremarkable maternal obstetric and early neonatal history. Other sources rather than vertical route, like horizontal transmission from hospital or community, albeit less frequently proved, can justifies late onset GBS disease. Case report: This case report illustrates a late-onset GBS disease, presenting as neonatal septic arthritis on a caucasian term infant, with unknown route of transmission and highlights the morbidity associated. Discussion: Additional research pertaining to the transmission of late-onset GBS infections is required to develop effective preventive methods.

1. Laura Sass, MD* 1. *Division of Infectious Diseases, Children's Specialty Group, Children's Hospital of The King's Daughters, Norfolk, VA; Pediatrics, Eastern Virginia Medical School, Norfolk, VA. * Abbreviations: CDC: : Centers for Disease Control and Prevention CPS: : capsular polysaccharides CSF: : cerebrospinal fluid EOD: : early onset disease GBS: : group B Streptococcus IAP: : intrapartum antibiotic prophylaxis NAAT: : nucleic acid amplification test UTI: : urinary tract infection In 2010, revised guidelines were published with updated algorithms for group B Streptococcus screening, intrapartum prophylaxis, antibiotic doses, and revised management for newborns. After completing this article, readers should be able to: 1. Know the mode of transmission of group B Streptococcus (GBS) and the peripartum risk factors associated with a high risk of infection. 2. Know the major clinical manifestations of GBS and be able to differentiate the epidemiology and clinical presentation of early onset GBS disease from that of late-onset disease. 3. Know the laboratory testing for GBS: isolation, antigen detection, and susceptibility tests. 4. Know the treatment of GBS infections: drugs of choice, alternative drugs, and ineffective drugs. 5. Review the most recent guidelines for the prevention of perinatal GBS disease. 1. Understand the importance of maternal screening tests for GBS. 2. Know the criteria for the treatment of mothers known to be GBS carriers at the time of delivery. 3. Differentiate the prevention of early onset disease from that of late onset. Group B Streptococcus (GBS), or Streptococcus agalactiae , is an encapsulated gram-positive diplococcus that produces a narrow zone of β-hemolysis on blood agar and generally is resistant to bacitracin. GBS can be further differentiated by type-specific capsular polysaccharides (CPS) and protein antigens. Current circulating serotypes include Ia, Ib, Ia/c, II, III, IV, V, VI, VII, VIII, and IX. GBS initially was believed to be a bovine mastitis pathogen, but cases of puerperal sepsis in humans were described in the 1930s. The organism then became more prominent in the 1970s as a cause of maternal and neonatal disease. The most common maternal manifestations are asymptomatic bacteriuria, urinary tract infection (UTI), bacteremia, chorioamnionitis, and endometritis. In …

To perform a decision analysis to understand better the implications of 19 potential group B streptococcus screening and treatment strategies.We searched the literature to locate appropriate articles from which to derive probability estimates. Using decision analysis, we determined the likely outcomes of 19 group B streptococcus screening and treatment strategies and focused on three main outcomes: 1) number of expected cases of early-onset neonatal group B streptococcal sepsis, 2) percentage of gravidas treated with intrapartum antibiotics, and 3) total costs.The strategy recently recommended by two committees of the American Academy of Pediatrics (universal 28-week maternal rectovaginal group B streptococcal culture and treatment of culture-positive, high-risk patients in labor) is among the least effective at reducing neonatal sepsis and the most costly. Strategies based on the currently available rapid streptococcus identification tests are ineffective at reducing neonatal sepsis and are costly. Three strategies outperform the rest: 1) Universal intrapartum maternal antibiotic treatment is the most effective strategy in reducing early-onset neonatal group B streptococcal sepsis (6% of expected) and is also the least costly; 2) intrapartum treatment based solely on risk factors (recently endorsed by ACOG) lowers the rate of neonatal sepsis to 31% of expected with an 18% maternal treatment rate and low total costs; and 3) universal 36-week maternal culture, and treatment of all patients experiencing preterm birth and all culture-positive patients results in 14% of expected neonatal sepsis, with a 27% maternal treatment rate and low total costs.Given the present state of knowledge, three strategies emerge from this decision analysis as most optimal for the prevention of early-onset neonatal group B streptococcal sepsis: universal treatment, treatment based on risk factors, and treatment based on preterm delivery and 36-week culture status.

We used RambaQUICK StrepB in enrichment broth with samples taken from 31 pregnant women and compared its performance to that of standard enrichment media. RambaQUICK StrepB shortened the required incubation time and raised the sensitivity of streptococcal screening by 1.6 fold.

An aerobic chromogenic medium, CHROMagar™ StrepB agar, designed for isolation of group B Streptococci, was evaluated on 285 prepartum vaginal/rectal swabs from pregnant women. After overnight enrichment in Todd-Hewitt broth containing 15μg/ml nalidixic acid and 10μg/ml colistin, sensitivities were respectively 79% on day 1 and 92% on day 2, and significantly higher than those achieved by blood agar (40% and 58%) and colimycin-nalidixic-acid agar (82% on day 2).

The study aimed at determining the prevalence, risk factors, perinatal transmission, and serotypes of Group B Streptococcus (GBS) among pregnant women and their newborns in Beirut, Lebanon. This was a cross-sectional study of all pregnant women admitted from February to September 2006 to three major hospitals. Overall, 137 of 775 (17.7%) mothers and 50 of 682 newborns (7.3%) tested positive for GBS. Maternal colonization was not associated with maternal age, household income, gravidity, intrapartum fever, preterm labor, or premature rupture of membrane. Transmission rate was 40/120 (30%). Serotype 5 (24.1%) was the most common followed by serotype 1a (15.0%), 3 (14.4%), 2 (11.8%) and 1b (7.5%). Pregnant women in Lebanon appear to have a relatively high prevalence of GBS colonization with no identifiable risk factors for its acquisition. These results could provide basis for the institution of a national policy for universal maternal GBS screening to reduce neonatal morbidity and mortality.

Background: Group B streptococcus (GBS) is an important cause of neonatal sepsis. Guidelines advise to collect cultures at 35–37 weeks’ gestation and to administer intrapartum antibiotic prophylaxis in case of GBS-positive cultures, as well as in all preterm deliveries. Improved effectiveness of antenatal cultures might help to further decrease GBS early-onset disease. Objective: To determine the best timing of antenatal cultures, which may help establish optimal prevention of perinatal GBS infection in both term and preterm neonates. Methods: PubMed and EMBASE databases were searched for relevant articles published from 1966 to February 2009. Nine articles were included. Information about study features and predictive values of antenatal cultures were abstracted. Results: Positive predictive values for antenatal GBS cultures ranged from 43 to 100% (mean 69%) and negative predictive values from 80 to 100% (mean 94%). GBS cultures collected in late pregnancy had high positive predictive values for colonization during delivery. The negative predictive value was high and relatively constant regardless of GA. Conclusions: This systematic review confirms recommendations to screen pregnant women for colonization of GBS at 35–37 weeks’ gestation, but one should be aware of the limitations of screening, with 6% of GBS carriers remaining undetected in antenatal cultures.

Background. Intrapartum antibiotic prophylaxis is currently given to mothers who test positive for group B streptococcus (GBS) by antenatal culture-based screening, with a risk-based approach for cases with an unknown GBS status. A rapid real-time polymerase chain reaction (PCR) assay for the detection of GBS became available recently, making intrapartum screening possible. We aimed to assess its diagnostic accuracy and to compare it with antenatal screening. Methods. We conducted a prospective study in a French hospital. All pregnant women giving birth at the maternity ward were considered for inclusion, except those with planned cesarean delivery, with delivery at

Group B streptococcus (GBS) is the leading infectious cause of morbidity and mortality in Australian newborns. Although intrapartum chemoprophylaxis is recommended to reduce the risk of neonatal GBS transmission and disease, controversy exists as to the best method to select women 'at risk' for this treatment. Our study aimed to survey the opinions of obstetricians and neonatologists currently in practice in Australia on GBS screening and treatment. Of the 488 obstetricians and 68 neonatologists currently in practice who responded to the survey, 271 obstetricians (56%) and 40 neonatologists (61%) supported universal antenatal screening. Of those respondents who did not support a universal antenatal screening policy, 196 (93%) and 24 (92%) of the obstetricians and neonatologists respectively, supported antenatal screening based on risk factors. This diversity in practitioner opinion highlights the lack of certainty in the literature as to the best management strategy to prevent neonatal GBS sepsis.

This study compared the relative isolation rate of Group B Streptococcus (GBS) from 663 low vaginal swabs, collected from antenatal patients, on three media: horse blood agar plus neomycin (75 mg/l) (Neo), Islam agar (Islam) and Islam agar plus nalidixic acid (15 mg/l) and colistin sulphate (10 mg/l) (Islam Plus). One hundred and forty-seven (22%) GBS were isolated. At 24 hours the isolation rate was highest using Neo, but within 72 hours there was little difference. The isolation rates for Neo, Islam and Islam Plus at 24 hours were 124 (18.7%), 103 (15.6%), 109 (16.4%) (P0.05); at 48 hours 125 (18.9%), 116 (17.5%), 121 (18.1%) (P0.1); and at 72 hours 125 (18.9%), 121 (18.3%) and 127 (19.1%) (P0.1), respectively. Twenty-two isolates were missed on Neo, 26 on Islam and 20 on Islam Plus. Of those missed on Islam agars, 12 failed to produce pigment and were only detected on Neo. The disadvantage of Neo is the need to perform additional tests to confirm the identity as GBS. In the present study 100 suspicious colonies were identified as Group D.

This section focuses on issues in infectious diseases that are commonly encountered in pediatric office practice. Paul McCarthy discusses recent literature regarding the evaluation and management of acute fevers without apparent source on clinical examination in infants and children, and the evaluation of children with prolonged fevers of unknown origin. Jean Klig reviews recent literature about lower respiratory tract infection in children. Jeffrey Kahn and Eugene Shapiro discuss recent developments in pediatric infectious diseases concerning neonatal herpes infections, poliovirus immunization schedule, and group B streptococcus screening and treatment.

The online version of the original article can be found under doi:10.1007/s10995-010-0682-8.

Background The crude rate of early-onset Group B streptococcus disease (EOGBS) in Israel has been consistently under 0.5 for 1000 live births for the past 8 years. The Israeli Ministry of Health has adapted the risk factor based approach for preventing EOGBS and universal bacteriological screening for GBS is not recommended. In spite of this policy, there are indications that many pregnant women in Israel undergo bacteriological screening for GBS. The objective of this study is to assess the rate and characteristics of pregnant women who undergo screening for group B streptococcus (GBS) colonization in Israel. Methods Survey of expectant mothers who came to give birth in 29 delivery rooms throughout Israel during the month of July 2012 regarding GBS screening practice and demographics. Results A total of 2968 pregnant women participated in the assessment. Among them, 935 women (31.5 %) had been tested for GBS colonization. About 90 % of those women had no risk factors, only 542 women (60 %) underwent testing during the recommended gestational timing (35–37 weeks) and 23 % of the tested women reported being GBS carriers. GBS screening as part of the routine pregnancy follow- up was associated with: residence district, intermediate or high socioeconomic rank, being a member of certain health maintenance organization and being Jewish. Characteristics found to be significantly associated with being a GBS carrier were: low socioeconomic rank, and having a risk factor for GBS infection. Conclusions A substantial number of pregnant women in Israel undergo screening for GBS colonization despite the national policy against universal screening. While GBS colonization was more prevalent in women of lower socioeconomic status, screening is done more often in those of higher socioeconomic status, suggesting unnecessary monetary expenses.