Group B Streptococcus real-time PCR may potentially reduce intrapartum maternal antibiotic treatment

Nir Kugelman; Shiran Kleifeld; Pninit Shaked-Mishan; Wisam Assaf; Inbal Marom; Nadav Cohen; Maya Gruber; Ofer Lavie; Dan Waisman; Reuven Kedar; Mordehai Bardicef; Amit Damti

doi:10.1111/ppe.12841

Group B Streptococcus real-time PCR may potentially reduce intrapartum maternal antibiotic treatment

Paediatr Perinat Epidemiol. 2022 Jul;36(4):548-552. doi: 10.1111/ppe.12841. Epub 2021 Dec 9.

Authors

Nir Kugelman^{1

2}, Shiran Kleifeld^{1

2}, Pninit Shaked-Mishan³, Wisam Assaf^{1

2}, Inbal Marom^{1

2}, Nadav Cohen^{1

2}, Maya Gruber^{1

2}, Ofer Lavie^{1

2}, Dan Waisman^{2

4}, Reuven Kedar^{1

2}, Mordehai Bardicef^{1

2}, Amit Damti^{1

2}

Affiliations

¹ Department of Obstetrics & Gynecology, Carmel Medical Center, Haifa, Israel.
² Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
³ Clinical Serology and Virology Laboratory, Carmel Medical Center, Haifa, Israel.
⁴ Department of Neonatology, Carmel Medical Center, Haifa, Israel.

PMID: 34888893
DOI: 10.1111/ppe.12841

Abstract

Background: Protocols for preventing early-onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real-time polymerase chain reaction (PCR) can provide a result within 30-60 min and has been found to be specific and sensitive for defining intrapartum GBS status.

Objective: To evaluate whether implementation of GBS fast real-time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics.

Methods: This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35-37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real-time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration.

Results: Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real-time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1).

Conclusions: Compared with antepartum universal culture screening or intrapartum risk-factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real-time PCR, without compromising the sensitivity of GBS detection.

Keywords: PCR; antibiotics; culture; group B streptococcus; intrapartum; screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / therapeutic use
Female
Humans
Infant, Newborn
Male
Pregnancy
Pregnancy Complications, Infectious* / diagnosis
Pregnancy Complications, Infectious* / drug therapy
Pregnancy Complications, Infectious* / prevention & control
Prospective Studies
Real-Time Polymerase Chain Reaction
Streptococcal Infections* / diagnosis
Streptococcal Infections* / drug therapy
Streptococcal Infections* / prevention & control
Streptococcus agalactiae / genetics

Substances

Anti-Bacterial Agents