Magnitude of maternal vaginal colonization of Group B streptococcus and neonatal transmission in pregnant women during labor and delivery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
Background and aim: Streptococcus agalactiae or Group B Streptococci (GBS) frequently colonizes the human genital and gastrointestinal tract and a risk factor for subsequent infection in pregnant women and newborns. The study was conducted to determine the prevalence of maternal vaginal colonization of GBS during delivery, transmission rate to the newborns, to identify the possible risk factors and determine the antimicrobial susceptibility pattern of GBS isolates.
Subjects and Methods: A cross-sectional study design was used to enroll 250 pregnant women coming for delivery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Both maternal vaginal and neonatal oropharyngeal swabs were collected and inoculated onto CHROMagarTM StrepB and 5% sheep blood agar plates. Isolates were identified based on the mauve color on GBS CHROMagar, colony morphology, gram reaction and hemolysis on 5% sheep blood agar. Antimicrobial susceptibility testing was performed by using Kirbyâ€“Bauer disk diffusion method according to the Clinical Laboratory Standard Institute (CLSI) guidelines.
Results: The overall prevalence of GBS colonization among the participants was 23.6% with a transmission rate to the newborns of 47.4%. GBS colonization was significantly associated with occupation and parity (p< 0.05) GBS isolates had significantly high resistance level to cefepime (59.4%) and penicillin (57.7%). Highest susceptibility to vancomycin (93.3%), clindamycin (86.4%) and chloramphenicol (79.6%) were observed.
Conclusions: There was high rate of maternal colonization and maternal to child transmission of GBS with high resistance to commonly used antibiotics.
Keywords: Antibiotics susceptibility, Group B streptococcus, Intra-partum antibiotic
WHO. Global health observatory data on maternal and reproductive health; 2016
Sadaka, S.M., Aly, H.A., Meheissen, M.A., Orief, Y.I. and Arafa, B.M. Group B streptococcal carriage, antimicrobial susceptibility, and virulence related genes among pregnant women in Alexandria, Egypt. Alexandria Journal of Medicine, 2018; 54(1), 69-76
Nwachukwu N C, Utsalo S J, Kanu I, Anyanwu E C. Genital colonization of group B streptococcus at term pregnancy in Calabar, Nigeria. International Journal of Pediatrics and Neonatology, 2007; 7(9).
Shet A, Ferrieri P. Neonatal & maternal group B streptococcal infections: a comprehensive review. Indian Journal of Medical Research. 2004; 120:141-50.
Breed. Bergley, s Manual of Determinative Bacteriology. Baltimore: The Williams and Wilkins Co; 1957; 517- 518.
Baker J, Edwards M. Group B Streptococcal Infection. In: Remington J, Klein JO, editors. Infectious disease of the fetus and newborn infants. Philadelphia: WB Saunders; 1995; 980-1054.
Altoparlak U, Kadanali A, Kadanali S. Genital flora in pregnancy and its association with group B streptococcal colonization. International Journal of Gynecology and Obstetrics. 2004; 87(3):245-248.
Hathlahawatta H M, Samarage D K, Liyanage G S, Chandrasir S. A retrospective study on Group B beta haemolytic streptococcal sepsis in early infancy in Sri Lanka. Journal of Child Health, 2009; 38(4):124-126.
El Aila NA, Tency I, Claeys G, Saerens B, De Backer E, Temmerman M, Verhelst R, Vaneechoutte M. Genotyping of Streptococcus agalactiae (group B streptococci) isolated from vaginal and rectal swabs of women at 35-37 weeks of pregnancy. BMC infectious diseases, 2009; 9(1):153.
Farnaz F, Parviz P, Hojjat Z, Saeed T, Soheila A, Mohammad-Mehdi A, Leili C. Comparative Molecular and Microbiologic Diagnosis of Vaginal Colonization by Group B Streptococcus in Pregnant Women during Labor: Iranian Journal of Basic Medical Sciences, 2010; 13 (4): 183-188
Mengist A, Kannan H, Abdissa A. Prevalence and antimicrobial susceptibility pattern of anorectal and vaginal group B Streptococci isolates among pregnant women in Jimma, Ethiopia. BMC research notes. 2016; 9(1):351.
Tsega K., Tamrat A., Adane M., Mulugeta D. Prevalence and Antibiotic Susceptibility Pattern of Streptococcus agalactiae among pregnant women at Adigrat Zonal Hospital and Adigrat Health Center, Tigray, Ethiopia. Journal of Gynecology and Obstetrics, 2015; 3(2): 29-35
Woldu Z L, Teklehaimanot T G, Waji S T, Gebremariam M Y. The prevalence of Group B Streptococcus recto-vaginal colonization and antimicrobial susceptibility pattern in pregnant mothers at two hospitals of Addis Ababa, Ethiopia. Reproductive health, 2014; 11(1):80.
World Health Organization. WHO preferred product characteristics for group B streptococcus vaccines. World Health Organization; 2017.
American College of Obstetrics and Gynecologists Committee on Obstetric P. ACOG Committee Opinion No. 485: Prevention of early-onset group B streptococcal disease in newborns. Obstetrics and gynecology, 2011; 117(4):1019-27
Garcia L S, editor. Clinical microbiology procedures handbook. American Society for Microbiology Press; 2010 Aug 1.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; 28th ed Informational Supplement. CLSI Document M100-S28, vol.38. Wayne, Pennsylvania, USA: Clinical and Laboratory Standards Institute; 2018: 3.
Valkenburg-van den Berg A W, Sprij A J, Oostvogel P M, Mutsaers J A, Renes W B, Rosendaal F R, DÃ¶rr P J. Prevalence of colonization with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2006; 124(2):178-83.
Florindo C, Damiao V, Lima J, Nogueira I, Rocha I, Caetano P, Ribeiro L, Viegas S, Gomes JP, Borrego MJ. Accuracy of prenatal culture in predicting intrapartum group B streptococcus colonization status. The Journal of Maternal-Fetal & Neonatal Medicine, 2014; 27(6):640-2.
Hickman M E, Rench M A, Ferrieri P, Baker C J. Changing epidemiology of group B streptococcal colonization. Pediatrics, 1999; 104:203â€“10
Mavenyengwa, R. T., Afset, J. E., Schei, B., Berg, S., Caspersen, T., Bergseng, H. & Moyo, S. R. Group B Streptococcus colonization during pregnancy and maternal-fetal transmission in Zimbabwe. Acta Obstetricia et Gynecologica Scandinavica, 2010; 89, 250-5.
Monyama MC, Bolukaoto JY, Chukwu MO, Maloba MR, Moyo SR, Mavenyengwa RT, Nchabeleng M, Lebelo SL. Group B Streptococcus colonisation in pregnant women at Dr. George Mukhari Hospital, South Africa. Southern African Journal of Infectious Diseases, 2016; 31(3):74-8.
Gebremeskel T K, Zeleke T A, Mihret A, Tikue M D. Prevalence and antibiotic susceptibility pattern of Streptococcus agalactiae among pregnant women at Adigrat Zonal Hospital and Adigrat Health Center, Tigray, Ethiopia. Journal of Gynecology & Obstetrics. 2015; 3(2):29-35.
Assefa S, Desta K, Lema T. Group B streptococci vaginal colonization and drug susceptibility pattern among pregnant women attending in selected public antenatal care centers in Addis Ababa, Ethiopia. BMC pregnancy and childbirth. 2018; 18(1):135.
Carlos F, Vera D, Jorge L, Isabel N. Isilda R, Paula C, Lurdes R, Silvia V, Joao P, Maria J. Accuracy of prenatal culture in predicting intrapartum group B streptococcus colonization status. Journal of maternal fetal neonatal medicine, 2014;27(6):640-642
Stapleton R D, Kahn J M, Evans L E, Critchlow C W, Gardella C M. Risk factors for Group B streptococcal genitourinary tract colonization in pregnant women. Obstetrics & Gynecology, 2005; 106(6):1246-52.
Zusman A S, Baltimore R S, Fonseca S N. Prevalence of maternal group B streptococcal colonization and related risk factors in a Brazilian population. Brazilian Journal of Infectious Diseases, 2006; 10(4):242-6.
Kovavisarach E, Ying W S, Kanjanahareutai S. Risk factors related to Group B streptococcal colonization in pregnant women in labor. Journal-Medical Association of Thailand, 2007; 90(7):1287.
Kim E J, Oh K Y, Kim M Y, Seo Y S, Shin J H, Song Y R, Yang J H, Foxman B, Ki M. Risk factors for group B streptococcus colonization among pregnant women in Korea. Epidemiology and health, 2011; 33.
Sharmila V, Joseph N M, Babu T A, Chaturvedula L, Sistla S. Genital tract group B streptococcal colonization in pregnant women: a South Indian perspective. Journal of Infection in Developing Countries, 2011; 5(08):592-5.