Assessment of different methods for diagnosis of Group B streptococci during pregnancy

Objectives: To compare the different diagnostic techniques used to detect GBS colonization in pregnant women in late third trimester after thirty five weeks and to detect the frequency of GBS colonization among a sample of pregnant Egyptian women. Patients and methods: Vaginal swabs from the lower third of vagina were collected from 100 pregnant women in the late third trimester. Isolation of the organism by culture on selective media and confirmation by latex agglutination test and detection of CAMP factor by conventional PCR were compared. GBS isolates were tested by double disk diffusion method and D-zone test simultaneously for susceptibility to erythromycin and clindamycin and inducible clindamycin resistance for intrapartum antibiotic prophylaxis (IAP). Results: 25 participants (25%) were positive for GBS by culture in Lim broth with subculture onto TSA supplemented with 5% defibrinated sheep blood, while 75 participants (75%) were negative. Of the 25 GBS isolates, 19 (76%) were sensitive to erythromycin, 3 (12%) were intermediate and 3 (12%) were resistant. Of the 25 GBS isolates, 15 (60%) were sensitive to clindamycin, 2 (8%) were intermediate and 8 (32%) were resistant. Fourteen isolates (56%) were sensitive to both erythromycin and clindamycin whereas 3 (12%) were resistant to both (cMLSB). Latex agglutination test for GBS detection from the 24 hours incubated Lim broth was positive in 25 cases (25%). GBS was detected in 9 cases (9%) by the conventional PCR assay done directly from vaginal swabs specimens. Sensitivity, specificity, PPV and NPV for latex agglutination from the inoculated broth and PCR assay are 100%, 100%, 100%, 100% and 36%, 100%, 100%, 82.4% respectively. Latex agglutination test from the inoculated broth showed a statistically significant perfect agreement (100.0%) with culture with Kappa value 1.0 and 95% CI (1.0 – 1.0). PCR assay also showed a statistically significant but moderate agreement (84.0%) with culture with Kappa value 0.458 and 95% CI (0.253 – 0.662). Conclusion: Detection of GBS colonization by latex agglutination test from incubated selective broth directly is comparable to the gold standard (culture) as regards accuracy. PCR offers a rapid and highly specific method for detection of GBS colonization especially in intrapartum settings for administration of IAP in non-screened pregnant females; however, sensitivity is low resulting in a low NPV.