Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis.

Abstract

OBJECTIVE:

Intrapartum antibiotic prophylaxis (IAP) reduces the incidence of neonatal early onset group B streptococcal infections. The present study investigated if an automated PCR-assay, used bedside by the labor ward personnel was manageable and could decrease the use of IAP in a setting with a risk-based IAP strategy.

METHODS:

The study comprises two phases. Phase 1 was a multicenter, randomized, controlled trial. Women with selected risk-factors were allocated either to PCR-IAP (prophylaxis given if positive or indeterminate) or IAP. A vaginal/rectal swab and superficial swabs from the neonate for conventional culture were also obtained. Phase 2 was non-randomized, assessing an improved version of the assay.

RESULTS:

Phase 1 included 112 women in the PCR-IAP group and 117 in the IAP group. Excluding indeterminate results, the assay showed a sensitivity of 89% and a specificity of 90%. In 44 % of the PCR assays the result was indeterminate. The use of IAP was lower in the PCR group (53 versus 92%). Phase 2 included 94 women. The proportion of indeterminate results was reduced (15%). The GBS colonization rate was 31%.

CONCLUSION:

The PCR assay, in the hands of labor ward personnel, can be useful for selection of women to which IAP should be offered.

• Authors: Stellan Håkansson, Karin Källén, Maria Bullarbo, Per-Åke Holmgren, Katarina Bremme, Asa Larsson, Margareta Norman, Håkan Norén, Catharina Ortmark-Wrede, Karin Pettersson, Sissel Saltvedt, Birgitta Sondell, Magdalena Tokarska, Anna von Vultee, Bo Jacobsson
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 27 Issue 4 Pg. 328-32 (Mar 2014) ISSN: 1476-4954 [Electronic] England
• PMID: 23795754 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• DNA, Bacterial

Topics

• Antibiotic Prophylaxis (methods)
• DNA, Bacterial (analysis)
• Female
• Humans
• Infant, Newborn
• Infectious Disease Transmission, Vertical (prevention & control)
• Perinatal Care (methods)
• Pregnancy
• Real-Time Polymerase Chain Reaction
• Risk Assessment
• Risk Factors
• Sensitivity and Specificity
• Streptococcal Infections (diagnosis, prevention & control, transmission)
• Streptococcus agalactiae (genetics, isolation & purification)