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      Prevalence and antimicrobial susceptibility pattern of anorectal and vaginal group B Streptococci isolates among pregnant women in Jimma, Ethiopia

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          Abstract

          Background

          Streptococcus agalactiae (group B Streptococcus, GBS) is the most frequent pathogen isolated from neonates with invasive bacterial disease and responsible for serious infections in newborns such as pneumonia, septicemia and meningitis. Infection is primarily acquired vertically from mothers colonized with GBS. However, the prevalence and antimicrobial susceptibility pattern of GBS among pregnant women in Ethiopia are less studied.

          Methods

          This cross-sectional study involved 126 pregnant women at 35–37 weeks of gestation attending the antenatal clinic at Jimma University Hospital. Anorectal and vaginal swabs were cultured on to Todd-Hewitt broth medium supplemented with Gentamicin and Nalidixic acid and subsequently sub-cultured on 5 % sheep blood agar followed by identification of isolates based on colonial morphology, Gram stain, catalase reaction, hippurate hydrolysis and Christie, Atkins, Munch-Petersen (CAMP) test, and testing for their susceptibility to antimicrobial agents using the Kirby–Bauer method.

          Results

          The overall carriage rate of GBS was 19.0 % (24/126), and the rectal and vaginal carrier rates were 14.3 % (18/126) and 10.4 % (13/126), respectively. Concomitant vaginal and anorectal colonization was recorded in 29.2 % (7/24) of the women who were culture positive. All GBS isolates were susceptible to penicillin G, ampicillin, and vancomycin, but a considerable proportion was resistant to clindamycin (3.2 %), erythromycin (6.5 %), ciprofloxacin (9.7 %), ceftriaxone (9.7 %), norfloxacin (12.9 %), cotrimoxazole (29 %), and tetracycline (45.2 %).

          Conclusion

          This study reveals high carriage rate of GBS among pregnant women compared to some previous studies in Ethiopia. However, further epidemiological investigations should be done in different parts of the country in order to know the actual GBS colonization rate of pregnant women and to consider the possibility of implementing prophylactic treatment to prevent potential adverse maternal and neonatal outcomes. Future studies should be conducted to reveal serotype distributions of GBS in this community.

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          Most cited references30

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          Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC.

          Group B streptococcus (GBS) remains a leading cause of serious neonatal infection despite great progress in perinatal GBS disease prevention in the 1990s. In 1996, CDC, in collaboration with other agencies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45[RR-7]:1-24). Data collected after the issuance of the 1996 guidelines prompted reevaluation of prevention strategies at a meeting of clinical and public health representatives in November 2001. This report replaces CDC's 1996 guidelines. The recommendations are based on available evidence and expert opinion where sufficient evidence was lacking. Although many of the recommendations in the 2002 guidelines are the same as those in 1996, they include some key changes: * Recommendation of universal prenatal screening for vaginal and rectal GBS colonization of all pregnant women at 35-37 weeks' gestation, based on recent documentation in a large retrospective cohort study of a strong protective effect of this culture-based screening strategy relative to the risk-based strategy * Updated prophylaxis regimens for women with penicillin allergy * Detailed instruction on prenatal specimen collection and expanded methods of GBS culture processing, including instructions on antimicrobial susceptibility testing * Recommendation against routine intrapartum antibiotic prophylaxis for GBS-colonized women undergoing planned cesarean deliveries who have not begun labor or had rupture of membranes * A suggested algorithm for management of patients with threatened preterm delivery * An updated algorithm for management of newborns exposed to intrapartum antibiotic prophylaxis Although universal screening for GBS colonization is anticipated to result in further reductions in the burden of GBS disease, the need to monitor for potential adverse consequences of intrapartum antibiotic use, such as emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens, continues, and intrapartum antibiotics are still viewed as an interim strategy until GBS vaccines achieve licensure.
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            Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis.

            The most important risk factor for early-onset (babies younger than 7 days) invasive group B streptococcal disease is rectovaginal colonisation of the mother at delivery. We aimed to assess whether differences in colonisation drive regional differences in the incidence of early-onset invasive disease.
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              Diversity of group B streptococcus serotypes causing urinary tract infection in adults.

              Serotypes of group B streptococcus (GBS) that cause urinary tract infection (UTI) are poorly characterized. We conducted a prospective study of GBS UTI in adults to define the clinical and microbiological characteristics of these infections, including which serotypes cause disease. Patients who had GBS cultured from urine over a 1-year period were grouped according to symptoms, bacteriuria, and urinalysis. Demographic data were obtained by reviewing medical records. Isolates were serotyped by latex agglutination and multiplex PCR-reverse line blotting (mPCR/RLB). Antibiotic susceptibilities were determined by disc diffusion. GBS was cultured from 387/34,367 consecutive urine samples (1.1%): 62 patients had bacteriuria of >10(7) CFU/liter and at least one UTI symptom; of these patients, 31 had urinary leukocyte esterase and pyuria (others not tested), 50 (81%) had symptoms consistent with cystitis, and 12 (19%) had symptoms of pyelonephritis. Compared with controls (who had GBS isolated without symptoms), a prior history of UTI was an independent risk factor for disease. Increased age was also significantly associated with acute infection. Serotyping results were consistent between latex agglutination and mPCR/RLB for 331/387 (85.5%) isolates; 22 (5.7%) and 7 (1.8%) isolates were nontypeable with antisera and by mPCR/RLB, respectively; and 45/56 (80.4%) isolates with discrepant results were typed by mPCR/RLB as belonging to serotype V. Serotypes V, Ia, and III caused the most UTIs; serotypes II, Ib, and IV were less common. Nontypeable GBS was not associated with UTI. Erythromycin (39.5%) and clindamycin (26.4%) resistance was common. We conclude that a more diverse spectrum of GBS serotypes causes UTI than previously recognized, with the exception of nontypeable GBS.
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                Author and article information

                Contributors
                +251(0)934594712 , abymaa@gmail.com
                hema_paramesh@yahoo.com
                alemseged.abdissa@ju.edu.et
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                1756-0500
                19 July 2016
                19 July 2016
                2016
                : 9
                : 351
                Affiliations
                [ ]Department of Medical Laboratory Science, College of Health Science and Medical Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
                [ ]Department of Medical Laboratory Science and Pathology, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
                Article
                2158
                10.1186/s13104-016-2158-4
                4950240
                27435469
                025d2817-c90a-4aab-9257-a54d42f2819d
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 December 2015
                : 13 July 2016
                Funding
                Funded by: Jimma University College of public health and medical sciences.
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Medicine
                group b streptococcus (gbs),pregnant women,antimicrobial susceptibility,ethiopia
                Medicine
                group b streptococcus (gbs), pregnant women, antimicrobial susceptibility, ethiopia

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