Colonization Prevalence And Perinatal Outcomes Of Group B Streptococcus In Late Pregnancy In Nanjing

Part 1: Colonization prevalence,antibiotic sensitivity and resistance in late pregnancy in NanjingSection 1: Prevalence of Group B Streptococcus(GBS)colonization in late pregnancy in NanjingObjective: To study the colonization rate of GBS during late pregnancy,providing clinical basis for general screening.Methods: We recruited pregnant women who established test and care cards in outpatient clinics of Jinling Hospital and Jiangsu Maternal and Child Health Hospital from April 2016 to July 2017.Vaginal and rectal specimens were collected with informed consent.These women received regularly screening of GBS infection by GBS culture and analysis system after 35–37 weeks of gestation recommended by CDC guidelines of the United States.The subjects were further divided into GBS-positive and GBS-negative groups.Results: In total,7183 pregnant women were enrolled.No significant differences were found in age,place of origin,residence,history of pregnancy and childbirth and BMI between GBS-positive and GBS-negative group(P > 0.05).Significantly more pregnant women in GBS-positive group(95.26%)had high levels of education than in GBS-negative group(86.10%;P < 0.05).Glycosuria was more common in GBS-positive group(18.58% vs.14.08%,P < 0.05).The prevalence of GBS colonization was 3.52%.The positive rate of GBS was 2.39% in pregnant women who only provided vaginal specimens.Among recto-vaginal specimens,GBS was detected in 2.04% vaginal specimens,in 1.28% rectal specimens,and in 0.32% vaginal-rectal specimens.The detection rate of GBS was increased by 54.25% through the collection of rectal specimens.The monthly colonization rate of GBS fluctuated significantly(P < 0.05).The highest GBS colonization rate was 6.53% in October,5.25% in February and 5.97% in March,respectively,and the lowest was 5.08% in May.Conclusions: The colonization rate of GBS infection was 3.52% in late pregnancy in Nanjing with seasonal fluctuation,and the detection rate can be improved by 54.25% with supplementary rectal examination.Section 2: Antibiotic susceptibility and resistance of GBSObjective: The susceptibility and drug resistance of GBS were studied by drug sensitivity test,which may provide a reference for clinical prevention and treatment of GBS infection.Methods: The paper diffusion method was used to detect anti-GBS susceptibility of nine antibiotics,including ampicillin,penicillin,clindamycin,erythromycin,ceftriaxone,levofloxacin,vancomycin,linezolid and tetracycline,according to the 2012 CLSI standard.The sensitivity of antibiotics was classified as sensitivity,mediation and resistance.Results: The sensitivity rates of 253 GBS-positive samples to ceftriaxone,vancomycin and linezolid were 100%,and to ampicillin and penicillin were 98.02% and 93.28%,respectively.The resistance rates to clindamycin,erythromycin,levofloxacin and tetracycline were 47.83%,52.96%,30.43% and 88.54%,respectively.Conclusions: Penicillin and ampicillin may be effective in preventing GBS disease.The resistance of GBS to antibiotics,particularly erythromycin and tetracycline,was strongly present.PART 2: The influence of GBS infection and IAP(Intra-partum antibiotic prophylaxis)application on the outcome of maternal and infant deliverySection 1: The influence of GBS infection on parturient delivery outcomeObjective: To explore the difference of perinatal outcomes between GBS-positive and GBS-negative pregnant women.Methods: Pregnant women were recruited in outpatient clinics of Jinling Hospital and Jiangsu Maternal and Child Health Hospital from April 2016 to July 2017.Enrolled pregnant women were divided into GBS-positive and GBS-negative group according to the results of standard GBS culture of their vaginal or rectal swabs.The perinatal outcomes of premature rupture of membranes,intra-partum fever,mode of delivery,postpartum hemorrhage,postpartum fever and incision infection were compared between the two groups.Results: The incidences of premature rupture of membranes,intra-partum fever,postpartum hemorrhage,postpartum fever and incision infection in GBS-positive pregnant women were significantly higher than those in GBS-negative group(P < 0.05).Conclusions: GBS infection significantly increased the risk of complications during delivery.Section 2: Influences of GBS infection in pregnant women on neonatal outcomesObjective: To analyze the infection in newborns delivered by GBS-positive pregnant women.Methods: Enrolled pregnant women were divided into GBS-positive and GBS-negative group.The newborns were followed up in each group.The Apgar score and three months condition after birth were compared.Results: EOD(Early-onset of disease)in GBS positive group was 3.56%,which was much higher than that in GBS-negative group(0.68%(P < 0.05).No significant difference was observed in LOD(Late-onset of disease)incidence,Apgar score at birth and NICU transfer rate between the two groups(P > 0.05).Conclusions: GBS infection in mothers may increase the incidence of EOD in newborns.Section 3: The influence of IAP application on maternal and infant outcomes of GBS positive pregnant womenObjective: To explore whether IAP can improve perinatal outcomes of pregnant women with GBS infection.Methods: Pregnant women in GBS positive group were given antibiotics to prevent infection after parturition or premature rupture of membranes.The perinatal outcomes with or without full use of IAP were both recorded,including EOD,LOD,transfer to NICU,maternal postpartum fever and incision infection.Results: The incidence of EOD,LOD,transfer to NICU,maternal postpartum fever and incision infection in neonates were significantly lower after full use of IAP(P < 0.05).(P < 0.05).Conclusions: Adequate IAP application in pregnant women with positive GBS colonization can significantly reduce the incidence of maternal and infant infections.