Group B Streptococcal Colonisation among Antenatal Women from a Tertiary Care Centre, Northern Kerala: A Cross-sectional Study

J. K. Mathew, Maya Sudhakaran, Mb Shabina, N. Menon
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Abstract

Introduction: Group B Streptococcus (GBS) is the leading cause of neonatal sepsis all over the world. Maternal colonisation of GBS in vaginal and anorectal area poses risk for subsequent invasive disease. The prevalence of maternal colonisation varies with geographical, biological and socio-economical factors. Current recommendations consider maternal screening and antibiotic therapy to prevent GBS neonatal disease with a potential of alteration of infant gut flora. Aim: To find out the prevalence, outcome and antimicrobial susceptibility pattern of the GBS colonisation in antenatal women. Materials and Methods: A hospital-based descriptive crosssectional study was conducted in Government Medical College, Kozhikode, Kerala, India, during December 2017 to May 2019 including 300 antenatal women of 35-37 weeks gestational age. Vaginal and rectal swabs were taken and were subjected to microbiological examination and culture. Data analysis was done by Statistical Package for the Social Sciences (SPSS) version 16.0. The Chi-square test and Fisher’s exact test were used wherever applicable and p-value <0.05 is considered significant. Results: Among the 300 antenatal women, 8 (2.7%) were colonised with GBS. Higher rate of colonisation was observed in women of 21-25 years, higher parity, rural dwelling and in women with poor glycaemic control. All the colonised women received antibiotic prophylaxis with intravenous ampicillin. None of the colonised women or the neonates born to them developed any invasive GBS infection. Antibiotic susceptibility testing showed that all the isolates were sensitive to penicillin, ampicillin and vancomycin but only 62.5% of the isolates were susceptible to clindamycin and 37.5% of the isolates were susceptible to erythromycin. Conclusion: The prevalence of GBS colonisation is low in Asian countries, compared to the data from western countries. Evidence based usage of narrow spectrum antibiotics should be considered. Further studies regarding prevalence, antibiotic susceptibility pattern, cost benefit analysis of the antibiotic usage and its effect on neonatal gut flora etc, including a wider population, is a need of the hour in the setting of emergence of resistance.
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喀拉拉邦北部三级保健中心产前妇女B组链球菌定菌:一项横断面研究
B群链球菌(GBS)是全世界新生儿败血症的主要原因。GBS在阴道和肛肠区的母体定植可能导致随后的侵袭性疾病。产妇殖民化的普遍程度因地理、生物和社会经济因素而异。目前的建议考虑产妇筛查和抗生素治疗,以预防GBS新生儿疾病与潜在的婴儿肠道菌群的改变。目的:了解产前妇女GBS定植的流行情况、转归及药敏模式。材料与方法:2017年12月至2019年5月,在印度喀拉拉邦Kozhikode政府医学院进行了一项以医院为基础的描述性横断面研究,包括300名35-37周孕龄的产前妇女。取阴道和直肠拭子,进行微生物检查和培养。数据分析采用社会科学统计软件包(SPSS) 16.0版本。采用卡方检验和Fisher精确检验,p值<0.05为显著性。结果:300例产前妇女中,8例(2.7%)感染GBS。在21-25岁、胎次较高、农村居住和血糖控制较差的妇女中观察到较高的殖民化率。所有定植的妇女都接受静脉注射氨苄西林的抗生素预防。被感染的妇女和她们所生的新生儿都没有出现任何侵袭性GBS感染。药敏试验结果显示,所有菌株对青霉素、氨苄西林和万古霉素均敏感,但对克林霉素和红霉素的敏感性分别为62.5%和37.5%。结论:与西方国家的数据相比,GBS定殖在亚洲国家的流行率较低。应考虑以证据为基础使用窄谱抗生素。在出现耐药性的背景下,需要进一步研究患病率、抗生素敏感性模式、抗生素使用的成本效益分析及其对新生儿肠道菌群的影响等,包括更广泛的人群。
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审稿时长
12 weeks
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