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PubMed2000

Preventive procedures against GBS infection by means of antibody measurement.

OBJECTIVE: Screening group B Streptococcus (GBS) in the vagina of pregnant women and measuring serum level of its type-specific antibody would be useful for cost-benefit of the prevention against GBS infection. STUDY DESIGN: The subjects included a total of 1,150 pregnant women who consented to the study. Serotypes of GBS detected were classified with antiserum. Serum type-specific antibody titers were measured by a bacterial agglutination method. RESULTS: Of a total of 1,150 pregnant women, 250 cases (21.7%) had GBS in the vagina. The turn of GBS serotype occurrence was types VI (NT6) (27. 2%), VIII (JM9) (25.2%), III (11.2%), Ia (8.8%), and Ib (8.0%). None or low type-specific antibody titer was 41.0% of Ia, 20.0% of Ib, 22. 0% of II, 15.0% of III, 65.0% of VI, and 69.0% of VIII incarriers. Noneonatal GBS infection occurred under the empirically treatment. CONCLUSION: The measurement of serum type-specific antibody against GBS would be informative for the cost-benefit treatment of the vaginal GBS in pregnant women.

Antibodies, Bacterial↗
PubMed2003

Maximizing neonatal early onset group B streptococcal disease prevention with universal culture screening at 35 to 37 weeks gestation: a comparison of GBS detection rates between LIM broth and CNA culture media.

BACKGROUND AND OBJECTIVES: Group B streptococcal (GBS) disease is the most common cause of early onset neonatal sepsis. The Centers for Disease Control (CDC) recommends performing recto-vaginal cultures on pregnant woman to detect GBS, followed by treatment of women with positive cultures. Our facility adopted selective culture screening in 1997 using a colistin-naladixic acid (CNA) plate media instead of the more expensive LIM broth media. CNA plate cultures cost one third that of LIM broth and allow for final results in 24 hours, versus 48-72 hours with LIM broth. We hypothesized that CNA media saves time, money, and detects GBS as effectively as LIM broth. This study determined which media is superior at detecting recto-vaginal GBS. METHODS: This was a case-control study involving 152 consecutive pregnant patients at 35-37 weeks from August 1 to October 1, 2001, at Naval Hospital Bremerton, Wash. We obtained two recto-vaginal swabs from each patient. One was cultured in LIM broth and the other on CNA medium. We then compared differences in the rates of positive cultures with LIM broth versus CNA medium using chi-square statistics and calculation of odds ratios (OR). RESULTS: LIM broth detected GBS in 35 of 145 (24.19%) women versus 21 of 145 (14.5%) using CNA. CNA failed to detect GBS in 15 cases in which LIM broth succeeded (OR=1.88; 95% CI=1.03-3.4). CONCLUSIONS: LIM broth is superior at detecting maternal GBS colonization and is recommended over CNA plate to maximize prevention of early onset neonatal GBS disease.

Bacteriological Techniques↗
PubMed2004

The prevention of early-onset neonatal group B streptococcus infection: technical report from the New Zealand GBS Consensus Working Party.

AIMS: Early-onset neonatal group B streptococcus (GBS) is the leading infectious cause of disease in newborn babies. Since intrapartum antibiotics interrupt vertical GBS transmission, this is now a largely preventable public health problem. An important first step is to develop (then implement) nationally, agreed prevention policies. METHODS: Representatives from the New Zealand College of Midwives, the Paediatric Society of New Zealand, the New Zealand Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, the Royal New Zealand College of General Practitioners, and the Homebirth Association met to review evidence that will assist in the formulation of GBS prevention policies that are most suitable for New Zealand. RESULTS: The Technical Working Group noted that (i) no strategy will prevent all cases of early-onset GBS infection, (ii) intrapartum antibiotics are associated with rare, but serious, adverse effects, (iii) concerns remain over developing antibiotic resistance, (iv) an economic analysis is required to help inform policy, (iv) reliable bedside diagnostic tests for GBS in early labour are not yet available and (iv) the most important determinant of effectiveness will be compliance with a single national prevention policy. CONCLUSIONS: As an interim measure a GBS risk-based prevention strategy is recommended. This exposes the least numbers of women and their babies to antibiotics, while virtually preventing all deaths from GBS sepsis. Continuing education of health professionals and pregnant women, auditing protocol compliance, tracking adverse events amongst pregnant women, and national surveillance of neonatal sepsis and mortality rates and antibiotic resistance are necessary for the strategy's success.

Antibiotic Prophylaxis↗
PubMed1998

Strategies to decrease costs associated with GBS prophylaxis in preterm gestations.

Objective: 1) To evaluate the costs associated with a practice of routinely culturing women for Group B beta-Streptococcus (GBS) who are at risk for preterm delivery. 2) To evaluate the charges associated with a policy of empiric antibiotic therapy in women suspected of imminent delivery prior to 37 weeks gestation.Methods: In our hospital, women who present with preterm contractions (PTC), preterm labor (defined as uterine contractions resulting in cervical change, PTL), and preterm rupture of the membranes (PROM) were cultured for GBS. Women with PTL and PROM received parenteral antibiotic therapy pending availability of culture results (48 hours). We reviewed the records of women who participated in a study to determine the sensitivity and specificity of a rapid test for GBS (Am J Obstet Gynecol 1997;176:S35). Results of the Lim broth culture, our gold standard, were used for this analysis. The charges for performing cultures ($32/culture) and administering intravenous ampicillin ($54/dose) were calculated.Results: There were 118 women with PTC, 52 women with PTL, and 64 with PROM. Thirty-four (14.5%) of the cultures were positive. The results are presented below.In women with PTC, the incidence of GBS was 12.7%. The culture results were available and guided care in only the 6 women who delivered between 2 and 7 days. In women with PTL the incidence of positive cultures was 11.5%. All of the women received antibiotics pending results of cultures. The majority of the women had delivery delayed 48 hours until results were available. Care was modified in the 7 women who delivered between 2 and 7 days. In women with PROM the incidence of GBS was 20.3%. The culture results were available and guided therapy in 11 women.Conclusions: Our findings suggest that GBS cultures have limited clinical value in women with PTC. Only 6 women, 5.5%, had their care modified as a result of the cultures, at a cost of $3776. In women with PTL, we over-treated the majority of women with antibiotics, most of whom delivered after culture results were available. Cultures had minimal impact on management. Antibiotics should be reserved for women whose labor is progressing on tocolysis. In women with PROM, most delivered prior to availability of culture results. We would have saved $2048 had no cultures been obtained. These results are probably irrelevant, if routine antibiotic administration is utilized in PROM to prolong latency intervals regardless of GBS status.

Journal Article↗
PubMed2002

Vaccines to prevent neonatal GBS infection.

Group B Streptococcus (GBS) remains the leading bacterial cause of neonatal sepsis and meningitis in the United States. Although antibiotic prophylaxis has decreased the infection rate, the best long-term solution lies in the development of effective vaccines. The GBS capsular polysaccharide (CPS) is a major target of antibody-mediated immunity. While antibody to CPS is protective, uncoupled CPS is variably immunogenic in humans, a finding that led to the development of GBS CPS-protein conjugate vaccines. GBS CPS-protein conjugate vaccines of all clinically important serotypes have been produced and tested in animals. Mice and baboons immunized with CPS conjugates transplacentally transferred functionally active GBS-specific IgG to their offspring. Phase 1 and phase 2 clinical trials have shown that GBS conjugate vaccines are safe, well-tolerated and immunogenic in healthy adults. Moreover, human antibodies elicited by the conjugate vaccines are functionally active both in vitro and in animal models of invasive GBS disease.

Animals↗
PubMed2000

Epidemiological surveillance of Guillain-Barré syndrome in Sweden, 1996-1997. Network members of the Swedish GBS Epidemiology Study Group.

OBJECTIVES: To set up an epidemiological surveillance system of Guillain-Barré syndrome (GBS) in Sweden and to evaluate the pilot practice of the system for 2 years. MATERIAL AND METHODS: A network of neurologists reported incident patients with a GBS diagnosis among a general population of 4.5 million inhabitants in Sweden during 1996 1997. Historical GBS data from the national hospital in-patient registry were used for predicting incidences and controlling under-reporting. RESULTS: One hundred and seventeen cases were reported. No alarm signals were identified during the study period. A re-analysis of data in 1996 revealed: 1) a higher than expected incidence in the population aged below 40 years in January, and 2) 27% under-reporting mainly associated to one hospital and to GBS patients hospitalized outside neurological departments. Threshold values for GBS incidences among the general and selected populations were obtained from corrected data. CONCLUSION: - The Swedish Network for GBS Surveillance can provide immediate support for epidemiological evaluation of suspected outbreaks or increased GBS incidence.

Adult↗
PubMed1997

Can pregnant women obtain their own specimens for group B streptococcus? A comparison of maternal versus physician screening. The Mount Sinai GBS Screening Group.

OBJECTIVE: We aimed to compare the Group B Streptococcus (GBS) detection rate when pregnant women performed their own vaginal/anorectal swabs with that from the standard practice of physician-performed swabs. METHOD: The research involved a comparison of maternally obtained swabs for GBS with the current gold standard of physician-obtained swabs performed on the same patient. The women were surveyed about who they would prefer to do their swabs. This research was carried out in the offices of five family physicians and eight obstetricians at Mount Sinai Hospital, Toronto--a tertiary-care teaching hospital--between 1 November 1995 and 31 March 1996. The patients were consecutive pregnant women presenting for their 26-28 weeks antenatal visit. Patients were given a questionnaire and instructions describing how to perform a vaginal/anorectal swab. After each patient completed the survey and obtained her own GBS culture, the physician collected a GBS specimen in their usual manner. The main outcome measures were the results of self-performed and physician-obtained combined vaginal/anorectal culture specimens. RESULTS: Sixty-three matched pairs of GBS swab results and 161 patient surveys were collected. Using any positive result as the gold standard, the prevalence of GBS was 39 out of 163 (24%). Patients detected 38 cases for a sensitivity of 97% (lower 95% confidence limit 92), while physicians identified 32 cases for a sensitivity of 82% (95% confidence limit 70-94). Twenty-five per cent of the women preferred that the physician take the swab, while 75% were indifferent or preferred to self-swab. CONCLUSIONS: Patient-collected vaginal/anorectal swabs for GBS are at least as sensitive as the current practice of physician-performed swabs. The majority of participating patients were interested or willing to perform their own swab. Self-swabbing involves women more actively in their obstetrical care and may improve physician compliance with screening guidelines.

Adolescent↗
PubMed1989

The GBS scale in multi-infarct dementia and senile dementia of Alzheimer type.

The GBS profile was assessed for 39 patients with multi-infarct dementia (MID) and 34 patients with senile dementia of Alzheimer type (SDAT). The MID patients fulfilled the DSM-III criteria for multi-infarct dementia and had a score of 7 points or more on the Hachinski Ischemic Scale (HIS) and a score of 4 points or less on the Gustafson/Nilsson Alzheimer Scale (GNAS). The SDAT patients fulfilled DSM-III criteria for primary degenerative dementia and had a score of 5 points or more on the GNAS and a score of 6 points or less on the HIS. The total GBS score, the GBS subscale and relative subscale scores for intellectual functioning were significantly higher in patients with SDAT as compared with patients with MID. However, these subscale scores were considerably dispersed and nearly totally overlapping between patients with MID and SDAT, which implicates that the discriminative value is minimal. The validity between the GBS versus HIS and between the GBS versus GNAS was divergent, suggesting that the GBS scale has its own unique validity. In conclusion, the study does not support the hypothesis that the GBS profile may be of diagnostic value in clinical differentiation between multi-infarct dementia (MID) and senile dementia of Alzheimer type (SDAT).

Aged↗
PubMed2000

The changing spectrum of Group B streptococcal (GBS) infection in infants of Saudi Arabia.

This study describes the incidence, clinical presentation and outcome of neonatal Group B streptococcal (GBS) infection in a Saudi Arabian Hospital. Charts of all neonates with GBS infection admitted to our hospital during a 5-year period (1990-1994) were reviewed retrospectively. Of the 29,601 live births, 23 neonates had GBS infection, giving an overall incidence rate of 0.8 per 1000 live births. The incidence rate appeared to increase from 0.2 per 1000 live births in 1990 to 1.2 per 1000 live births in 1994 (not statistically significant (P=0.07)). Of the 23 neonates with GBS infection, 16 (70%) were full term infants (gestation > or = 37 weeks). In contrast, 7 (30%) were preterm infants (gestation < 37 weeks). Ten (44%) mothers had premature rupture of membrane. Intrapartum fever and/or urinary tract infection was observed in 9% of the mothers. Nineteen (82%) of the neonates had early onset GBS infection, whereas only 4 infants (18%) had late-onset infection. Blood and CSF cultures were positive in 21 (91%) and 5 (21%), respectively. Complications of GBS infection were as follows: sepsis without focus of infection 15 (65%); meningitis 5 (22%); pneumonia 3 (13%); urinary tract infection 2 (9%). None of these complications had any significant association with the onset of infection (P>0.1). The overall case-fatality rate was 9%. The incidence of GBS infection appears to be increasing in Saudi neonates and measures to prevent perinatal transmission need to emphasized and implemented.

Adult↗
PubMed2003

[Significance of group B streptococcus (GBS) infections in parturient women].

OBJECTIVES: Maternal infections of group B streptococcus (GBS) has recently been associated with preterm labor and early onset of neonatal infections. DESIGN: The aim of this study was to determine the incidence of GBS infections in parturient women, as well as, GBS infections influence on the pregnancy duration, cesarean section rate, birth weight and Apgar score. MATERIALS AND METHODS: A total of 701 cervical swabs were taken and cultured from pregnant women, who came to delivered to Department of Obstetrics and Gynaecology of Silesian Medical School from 1st of January to 30th of September 2002. Results of cervical swabs cultures were clinically analyzed. Mann Whitney test was used to perform statistical analysis. RESULTS: In 23 of 701 women (3.3%) who were admitted to our department GBS infections were detected. In women with GBS, preterm birth and low birth weight, as well as, low Apgar score were more frequently observed. CONCLUSIONS: Positive--GBS infection cervical swabs was found in 23 of 701 parturient women (3.3%) who were admitted to our department. In women with GBS, higher preterm birth rate, as well as, higher cesarean section rate performed because of intrauterine infection were observed, but the differences were not statistically significant.

Adult↗
PubMed1991

[Study of carrier rate and immunity to group B streptococcus (GBS) in unmarried women].

In order to study the carrier rate and immunity to Group B streptococcus (GBS) of unmarried women, an urinary culture was taken and blood serum was assayed by ELISA for type-specific antibody in female students. Heretofore there have been very few reports about GBS in unmarried women in Japan. The validity of urinary culture as a substitute for vaginal culture was initially studied. The carriage of GBS was evaluated by vaginal, anal and urinary cultures in 90 pregnant women. Carrier detection were 18 carriers (20.0%) by vaginal culture, 22 carriers (24.4%) by anal culture and 18 carriers (20.0%) by urinary culture. Fifteen of the 18 subjects (83.3%) detected as carriers by vaginal culture carried the same strain of GBS in urine. Therefore, an urinary culture appears to perform as well as the vaginal culture as a convenient test for GBS. Nineteen (16.2%) of 117 unmarried women had positive urinary cultures for GBS. Among the 19 with positive cultures for GBS, 3 (15.8%) were type Ia, 3 (15.8%) were type Ib, 8 (42.0%) were type III and 5 (26.4%) were other types. Type II was not detected. From the type-specific antibody assay, the histogram of ODI (optimal density index) frequency of types Ia, Ib and III showed a concentration in a relatively narrow range at low ODI, while that of type II was dispersed over a relatively wide range.

Adolescent↗
PubMed2006

Anti-ganglioside complex antibodies associated with severe disability in GBS.

Ganglioside complexes (GSCs) are known as target antigens in Guillain-Barré syndrome (GBS). To elucidate the clinical importance of the anti-GSC antibodies in GBS, we investigated serum antibodies to GSCs containing two of the gangliosides, GM1, GD1a, GD1b and GT1b, and analyzed clinical features of anti-GSC-positive GBS patients. Thirty-nine (17%) of 234 GBS patients had IgG anti-GSC antibodies. Anti-GSC-positive GBS had antecedent gastrointestinal infection and lower cranial nerve deficits more frequently than control GBS. The presence of antibody specificity to GD1a/GD1b and/or GD1b/GT1b was significantly associated with severe disability and a requirement for mechanical ventilation.

Adult↗
PubMed1997

Reactivity of serum IgG anti-GM1 ganglioside antibodies with the lipopolysaccharide fractions of Campylobacter jejuni isolates from patients with Guillain-Barre syndrome (GBS).

Campylobacter jejuni (Cj) enteritis is the most frequently recognised infection preceding Guillain-Barre syndrome (GBS) and this combination is commonly associated with anti-GM1 ganglioside (anti-GM1) antibodies. We have examined the hypothesis that the anti-GM1 antibodies represent an immune response against the Cj lipopolysaccharide (LPS). We prepared the LPS fraction from 8 isolates of Cj, 3 from GBS patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 3 from patients with Miller Fisher syndrome (MFS) and 2 from enteritis patients without neurological disease. We looked for IgG antibodies against LPS and GM1 in the serum of 10 GBS and 10 MFS patients, including the patients from whom the Cj had been isolated, and 11 normal control subjects. The highest levels of IgG binding to LPS fractions were found in the GBS patient sera and were with one of the LPS fractions extracted from the C. jejuni isolated from a GBS patient, one from a MFS patient and two Cj isolates from enteritis patients without neurological disease. The level of IgG binding to these LPS fractions was related to the level of IgG anti-GM1 antibody in the serum. Affinity-purified anti-GM1 antibodies showed the same pattern of differential binding to the LPS fractions as the serum from which they were derived. Cholera toxin bound to the same LPS fractions as GBS patients' IgG, the binding of which was blocked by the toxin indicating specific antibody reactivity with a GM1 hapten. The presence of serum anti-GM1 antibodies did not coincide with the presence of the GM1 hapten on the LPS of the infecting strain of Campylobacter indicating that anti-GM1 antibodies do not necessarily arise as part of a simple immune response against the LPS. The IgG antibodies binding to LPS were predominantly of the IgG2 isotype but patients with anti-GM1 IgG had mainly antibodies of IgG1 subclass against both LPS and GM1, implying their production by a T-cell dependent mechanism.

Adult↗
PubMedDate not supplied

Group B streptococcal (GBS) disease screening and treatment during pregnancy: nurse-midwives' consistency with 1996 CDC recommendations.

OBJECTIVE: In 1998, the screening and treatment practices of certified nurse-midwives (CNMs) for group B streptococcal (GBS) infection during pregnancy were studied and evaluated for their consistency with the 1996 perinatal GBS prevention guidelines of the Centers for Disease Control and Prevention (CDC). METHODOLOGY: Five hundred thirty-nine surveys were completed by CNMs attending the 1998 American College of Nurse-Midwives' Convention. Of these, 502 (94.7%) reported a practice policy for GBS prophylaxis. RESULTS: The Culture-Based Approach was used by 66.7% and the Obstetrical Risk Factor Approach by 28%. Most (69%) reported using multiple culture sites, most commonly the proximal vagina and anorectal area (33.2%), followed by the distal vagina and anorectal area (26.7%), and the anorectal area and proximal and distal vagina (7.1%). Most CNMs (92.5%) reported treating GBS intrapartally, with penicillin the most frequently reported antimicrobial (55.0%) used, and most (94.2%) reporting treatment through labor until birth. CONCLUSION: Overall, GBS prophylaxis practices among survey respondents comply with 1996 CDC recommendations; however, GBS screening practices show room for improvement and the need for continuing education that emphasizes the CDC guidelines, updates as they become available, and other new literature about the topic. In addition, heightened awareness among all perinatal providers is needed with respect to CDC guidelines, especially as they pertain to variations in culture sites, identification of risk categories, and the selection of appropriate antimicrobial treatment agents.

Centers for Disease Control and Prevention, U.S.↗
PubMedDate not supplied

Group B streptococcus (GBS) colonisation among expectant Irish mothers.

Group B streptococci (GBS) have been recognised for more than three decades as a serious cause of perinatal morbidity and neonatal mortality. The aim of this study was to accurately determine the prevalence of GBS carriage and the serotype distribution among pregnant Irish women. 504 women attending antenatal clinics had two swabs (one perianal and one low vaginal) taken in the last four weeks of their pregnancy. These were placed in Todd Hewitt broth and then subcultured onto solid media. Serotyping of the isolates was performed by the Central Public Health Laboratory, London. GBS colonised women were treated with prophylactic antibiotics in labour and their infants received prophylaxis for 48 hours. 129 women (25.6%) were found to be asymptomatically colonised with GBS. Dual site screening (low-vaginal and perianal) identified 5% more GBS carriers than one site would have done. Serotypes identified included types I (30%), II (17%), III (30%), IV (1%) and V (9%). GBS colonisation is very common in Irish pregnant women and therefore a strategy for management in pregnancy ought to be developed in order to reduce the recognised occurrence of neonatal morbidity and mortality caused by this organism.

Adolescent↗
PubMed1992

[Maternal carriage and vertical transmission of group B Streptococcus (GBS)].

The pneumonia, sepsis and meningitis are common diseases of GBS infection in infants. There are early-onset and late-onset types in this disease, the result of the infection is unknown. M. Sugiyama reported that M9 is a new type of GBS in Japan in 1989. Analysis of GBS typing and serum specific antibody concentrations of the type are simple with new technics. By studying the infants' contamination we discovered that GBS appeared to originate from mother-infant sources. The infants were followed for a year. 52% of the infants had GBS contamination in their throat or stool. The most common type was Ia, followed by III, JM9 and NT6. Those types without III type had been present for more than 9 months in the infant. The contamination term of Ia or III type in infants correlated with the blood specific antibody concentration of the type.

Carrier State↗
PubMed2003

Comparison between different types of surveillance samples for the detection of GBS colonization in both parturient mothers and their infants.

OBJECTIVE: To find the optimum screening method in detecting group B streptococcal (GBS) colonization in both mother and infant, and to identify the risk factors that influence GBS colonization in the infants. PATIENTS AND METHODS: 1,120 singleton pregnant women were evaluated for GBS colonization by combined lower vaginal-anorectal swabs (LVRS) and urine tests, while their infants were evaluated for colonization with skin, ear and gastric aspirate samples. RESULTS: LVRS swabs were positive in 14.2% of mothers while urine was positive in 7.6%. Among the infants skin, ear and gastric aspirate samples were positive in 7.0, 6.9 and 3.5%, respectively. Prolonged rupture of the membrane was the only significant factor associated with colonization in these infants (p < 0.001). CONCLUSIONS: Lower vaginal-anorectal swab is an effective method in detecting colonization in mothers especially when combined with urine culture. Skin or ear swabs are equally effective in detecting colonization in neonates. GBS colonization rate in our parturient and neonatal population is comparable to that was reported from other countries. A well-developed screening program and appropriate management strategies for both GBS colonized mothers and infants are recommended.

Anal Canal↗
PubMed2000

Basic studies on group B streptococcal (GBS) culture medium.

Yeast extract and Serum are said to be necessary for the pigmentation of Group B Streptococcus (hereafter, GBS). We're examined the necessity of these for the GBS pigmentation. Firstly, we examined the following four types of culture media. (1) The medium in which serum was excluded from the New Granada medium (hereafter, called Basic medium). (2) New Granada medium (hereafter, S medium). (3) The medium in which Yeast extract was added to (1) (hereafter, Y medium). (4) The medium in which added Serum and Yeast extract were added to (1) (hereafter, SY medium). As for GBS tested (7 serotypes, 27 strains), Basic medium showed the strongest pigmentation potency, but, S and SY medium showed the weakest. About the quickness of pigmentation initiation, similar to the potency above, Basic medium was the quickest, followed by Y medium, and then S medium and SY medium. Among the media examined, there were no differences in the relationships between the quantity of GBS applied and the positive ratio of each media.>From these results, among four types of the media, Basic medium is thought to be the best one for the GBS detection.

Bacteriological Techniques↗