The Accuracy of Group Beta Streptococcus Rectovaginal Cultures at 35 to 37 Weeks of Gestation in Predicting Colonization Intrapartum

Farrah N. Hussain; Zainab Al-Ibraheemi; Stephanie Pan; Antonia P. Francis; Dyese Taylor; Melissa Chu Lam; Dawnette Lewis

doi:10.1055/s-0039-1697655

American Journal of Perinatology Reports, Table of Contents

CC BY-NC-ND 4.0 · AJP Rep 2019; 09(03): e302-e309
DOI: 10.1055/s-0039-1697655

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Accuracy of Group Beta Streptococcus Rectovaginal Cultures at 35 to 37 Weeks of Gestation in Predicting Colonization Intrapartum

Authors

Farrah N. Hussain

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Zainab Al-Ibraheemi

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Stephanie Pan

²Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
Antonia P. Francis

³Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York
Dyese Taylor

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Melissa Chu Lam

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York
Dawnette Lewis

¹Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, New York

Abstract

Objective This study aims to investigate accuracy of group beta Streptococcus (GBS) rectovaginal cultures at 35 to 37 weeks in predicting intrapartum colonization.

Study Design Institutional review board (IRB) approved prospective cohort study of 302 women from October 2015 to May 2017. Patients had the following tests for GBS: first trimester urine culture, rectovaginal culture at 35 to 37 weeks, and intrapartum rectovaginal culture. Outcomes included accuracy of 35- to 37-week GBS rectovaginal culture in detecting results intrapartum, and accuracy of first trimester urine culture in comparison to intrapartum rectovaginal cultures.

Results There was sufficient evidence of agreement between results at 35 to 37 weeks with intrapartum cultures (p = 0.001). However, agreement was weak, 11 patients (3.7%) were GBS positive intrapartum but negative at 35 to 37 weeks; and 33 patients (11%) were initially GBS positive but were negative intrapartum. Sensitivity and specificity of the 35- to 37-week culture was 69% (95% confidence interval [CI]:54–84%) and 87% (95% CI: 83–91%), respectively. There was also weak agreement between first trimester urine culture and intrapartum rectovaginal culture. Specificity for this assessment was 98% (95% CI: 97–100%) and was significantly different compared with antepartum GBS culture (p < 0.001). Accuracy between antepartum GBS rectovaginal culture and urine culture was similar (85 vs. 87%, p = 0.47).

Conclusion The 35- to 37-week GBS rectovaginal culture might be a poor predictor for intrapartum colonization.

Keywords

bacterial colonization - bacteriuria - chemoprophylaxis - maternal infection - neonatal infection - obesity - pregnancy - group β Streptococcus - screening methods

Full Text

References

References
1 Centers for Disease Control and Prevention (CDC). Trends in perinatal group B streptococcal disease - United States, 2000-2006. MMWR Morb Mortal Wkly Rep 2009; 58 (05) 109-112
2 Schrag SJ, Zywicki S, Farley MM. , et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000; 342 (01) 15-20
3 Bromberger P, Lawrence JM, Braun D, Saunders B, Contreras R, Petitti DB. The influence of intrapartum antibiotics on the clinical spectrum of early-onset group B streptococcal infection in term infants. Pediatrics 2000; 106 (2, Pt. 1): 244-250
4 Escobar GJ, Li DK, Armstrong MA. , et al. Neonatal sepsis workups in infants >/=2000 grams at birth: A population-based study. Pediatrics 2000; 106 (2, Pt. 1): 256-263
5 Pinto NM, Soskolne EI, Pearlman MD, Faix RG. Neonatal early-onset group B streptococcal disease in the era of intrapartum chemoprophylaxis: residual problems. J Perinatol 2003; 23 (04) 265-271
6 Pulver LS, Hopfenbeck MM, Young PC. , et al. Continued early onset group B streptococcal infections in the era of intrapartum prophylaxis. J Perinatol 2009; 29 (01) 20-25
7 Puopolo KM, Madoff LC, Eichenwald EC. Early-onset group B streptococcal disease in the era of maternal screening. Pediatrics 2005; 115 (05) 1240-1246
8 Verani JR, McGee L, Schrag SJ. ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1-36
9 American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 485: Prevention of early-onset group B streptococcal disease in newborns. Obstet Gynecol 2011; 117 (04) 1019-1027
10 Boyer KM, Gadzala CA, Kelly PD, Burd LI, Gotoff SP. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. II. Predictive value of prenatal cultures. J Infect Dis 1983; 148 (05) 802-809
11 Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol 1996; 88 (05) 811-815
12 Valkenburg-van den Berg AW, Houtman-Roelofsen RL, Oostvogel PM, Dekker FW, Dörr PJ, Sprij AJ. Timing of group B streptococcus screening in pregnancy: a systematic review. Gynecol Obstet Invest 2010; 69 (03) 174-183
13 Rallu F, Barriga P, Scrivo C, Martel-Laferrière V, Laferrière C. Sensitivities of antigen detection and PCR assays greatly increased compared to that of the standard culture method for screening for group B streptococcus carriage in pregnant women. J Clin Microbiol 2006; 44 (03) 725-728
14 Regan JA, Klebanoff MA, Nugent RP. , et al; VIP Study Group. Colonization with group B streptococci in pregnancy and adverse outcome. Am J Obstet Gynecol 1996; 174 (04) 1354-1360
15 Anthony BF, Eisenstadt R, Carter J, Kim KS, Hobel CJ. Genital and intestinal carriage of group B streptococci during pregnancy. J Infect Dis 1981; 143 (06) 761-766
16 Dillon Jr HC, Gray E, Pass MA, Gray BM. Anorectal and vaginal carriage of group B streptococci during pregnancy. J Infect Dis 1982; 145 (06) 794-799
17 McKenna DS, Matson S, Northern I. Maternal group B streptococcal (GBS) genital tract colonization at term in women who have asymptomatic GBS bacteriuria. Infect Dis Obstet Gynecol 2003; 11 (04) 203-207
18 Edwards RK, Clark P, Duff P. Intrapartum antibiotic prophylaxis 2: positive predictive value of antenatal group B streptococci cultures and antibiotic susceptibility of clinical isolates. Obstet Gynecol 2002; 100 (03) 540-544
19 Kleweis SM, Cahill AG, Odibo AO, Tuuli MG. Maternal obesity and rectovaginal group B Streptococcus colonization at term. Infect Dis Obstet Gynecol 2015; 2015: 586767
20 Stapleton RD, Kahn JM, Evans LE, Critchlow CW, Gardella CM. Risk factors for group B streptococcal genitourinary tract colonization in pregnant women. Obstet Gynecol 2005; 106 (06) 1246-1252
21 Toyofuku M, Morozumi M, Hida M. , et al. Effects of intrapartum antibiotic prophylaxis on neonatal acquisition of group B Streptococci. J Pediatr 2017; 190: 169-173.e1
22 Van Dyke MK, Phares CR, Lynfield R. , et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360 (25) 2626-2636
23 Money D, Dobson S, Cole L. , et al. An evaluation of a rapid real time polymerase chain reaction assay for detection of group B streptococcus as part of a neonatal group B streptococcus prevention strategy. J Obstet Gynaecol Can 2008; 30 (09) 770-775
24 Feuerschuette OHM, Silveira SK, Cancelier ACL, da Silva RM, Trevisol DJ, Pereira JR. Diagnostic yield of real-time polymerase chain reaction in the diagnosis of intrapartum maternal rectovaginal colonization by group B Streptococcus: a systematic review with meta-analysis. Diagn Microbiol Infect Dis 2018; 91 (02) 99-104