Abstract
Group B Streptococcus (GBS) is the leading cause of neonatal infections in industrialized countries. Intrapartum antibiotic prophylaxis (IAP) given to colonized parturients is a key step for the prevention of neonatal early-onset infection. We compared the performances of Xpert® GBS polymerase chain reaction (PCR) (Cepheid, Sunnyvale, CA, USA) as a point-of-care system in labor wards to standard culture for intrapartum GBS detection. Pregnant women with a GBS-positive antenatal screening were prospectively included. A vaginal double swab was collected at the time of delivery for point-of-care Xpert® GBS PCR and GBS culture. A total of 565 pregnant women were included. Valid Xpert® GBS results were obtained for 488 (86.4%) women on the first attempt. Repeat testing improved the PCR success to 516 (91.3%) women. Among the 305 women positive for GBS by culture at delivery, only 238 (78.0%) were positive by Xpert® GBS PCR, cycle thresholds being correlated to culture quantification. Among 260 women negative for GBS culture, 56 (21.5%) were positive by Xpert® GBS PCR, including 50 where IAP was initiated before vaginal sampling. Overall, among the 565 women with GBS antenatal positive culture, only 335 (59.3%) were still positive at delivery whatever the technique used, resulting in unnecessary IAP for 40% of them. This large cohort study comparing intrapartum to antepartum GBS detection provides evidence that (i) Xpert® GBS PCR might be a valuable solution for intrapartum GBS detection compared to culture-based strategies and (ii) laboratory training of non-specialized staff is mandatory to reach the performances required for point-of-care tests.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Benitz WE, Gould JB, Druzin ML (1999) Risk factors for early-onset group B streptococcal sepsis: estimation of odds ratios by critical literature review. Pediatrics 103:e77
Jourdan-Da Silva N, Antona D, Six C, Georges S, Goulet V, Judlin P, Lévy-Bruhl D (2008) Neonatal group B streptococcus infections in France: incidence from 1997 to 2006 and current prevention practices in maternity wards. Bull Epidemiol Hebd 14:110–113
Edmond KM, Kortsalioudaki C, Scott S, Schrag SJ, Zaidi AKM, Cousens S et al (2012) Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis. Lancet 379:547–556. https://doi.org/10.1016/S0140-6736(11)61651-6
Edwards RK, Clark P, Duff P (2002) Intrapartum antibiotic prophylaxis 2: positive predictive value of antenatal group B streptococci cultures and antibiotic susceptibility of clinical isolates. Obstet Gynecol 100:540–544
Goodman JR, Berg RL, Gribble RK, Meier PR, Fee SC, Mitchell PD (1997) Longitudinal study of group B streptococcus carriage in pregnancy. Infect Dis Obstet Gynecol 5:237–243. https://doi.org/10.1155/S1064744997000409
Puopolo KM, Madoff LC, Eichenwald EC (2005) Early-onset group B streptococcal disease in the era of maternal screening. Pediatrics 115:1240–1246. https://doi.org/10.1542/peds.2004-2275
Block T, Munson E, Culver A, Vaughan K, Hryciuk JE (2008) Comparison of carrot broth- and selective Todd-Hewitt broth-enhanced PCR protocols for real-time detection of Streptococcus agalactiae in prenatal vaginal/anorectal specimens. J Clin Microbiol 46:3615–3620. https://doi.org/10.1128/JCM.01262-08
Ke D, Ménard C, Picard FJ, Boissinot M, Ouellette M, Roy PH et al (2000) Development of conventional and real-time PCR assays for the rapid detection of group B streptococci. Clin Chem 46:324–331
Montague NS, Cleary TJ, Martinez OV, Procop GW (2008) Detection of group B streptococci in Lim broth by use of group B streptococcus peptide nucleic acid fluorescent in situ hybridization and selective and nonselective agars. J Clin Microbiol 46:3470–3472. https://doi.org/10.1128/JCM.00858-08
Riedlinger J, Beqaj SH, Milish MA, Young S, Smith R, Dodd M et al (2010) Multicenter evaluation of the BD Max GBS assay for detection of group B streptococci in prenatal vaginal and rectal screening swab specimens from pregnant women. J Clin Microbiol 48:4239–4241. https://doi.org/10.1128/JCM.00947-10
Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP et al (2015) Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med 28:766–782. https://doi.org/10.3109/14767058.2014.934804
Hiller JE, McDonald HM, Darbyshire P, Crowther CA (2005) Antenatal screening for group B Streptococcus: a diagnostic cohort study. BMC Pregnancy Childbirth 5:12. https://doi.org/10.1186/1471-2393-5-12
Buchan BW, Faron ML, Fuller D, Davis TE, Mayne D, Ledeboer NA (2015) Multicenter clinical evaluation of the Xpert GBS LB assay for detection of group B Streptococcus in prenatal screening specimens. J Clin Microbiol 53:443–448. https://doi.org/10.1128/JCM.02598-14
El Helali N, Nguyen J-C, Ly A, Giovangrandi Y, Trinquart L (2009) Diagnostic accuracy of a rapid real-time polymerase chain reaction assay for universal intrapartum group B streptococcus screening. Clin Infect Dis 49:417–423. https://doi.org/10.1086/600303
Mueller M, Henle A, Droz S, Kind AB, Rohner S, Baumann M et al (2014) Intrapartum detection of Group B streptococci colonization by rapid PCR-test on labor ward. Eur J Obstet Gynecol Reprod Biol 176:137–141. https://doi.org/10.1016/j.ejogrb.2014.02.039
Park JS, Cho D-H, Yang JH, Kim MY, Shin SM, Kim E-C et al (2013) Usefulness of a rapid real-time PCR assay in prenatal screening for group B streptococcus colonization. Ann Lab Med 33:39–44. https://doi.org/10.3343/alm.2013.33.1.39
de Tejada BM, Pfister RE, Renzi G, François P, Irion O, Boulvain M et al (2011) Intrapartum Group B streptococcus detection by rapid polymerase chain reaction assay for the prevention of neonatal sepsis. Clin Microbiol Infect 17:1786–1791. https://doi.org/10.1111/j.1469-0691.2010.03378.x
Davies HD, Miller MA, Faro S, Gregson D, Kehl SC, Jordan JA (2004) Multicenter study of a rapid molecular-based assay for the diagnosis of group B Streptococcus colonization in pregnant women. Clin Infect Dis 39:1129–1135. https://doi.org/10.1086/424518
Valkenburg-van den Berg AW, Sprij AJ, Oostvogel PM, Mutsaers JAEM, Renes WB, Rosendaal FR et al (2006) Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands. Eur J Obstet Gynecol Reprod Biol 124:178–183. https://doi.org/10.1016/j.ejogrb.2005.06.007
Haberland CA, Benitz WE, Sanders GD, Pietzsch JB, Yamada S, Nguyen L et al (2002) Perinatal screening for group B streptococci: cost–benefit analysis of rapid polymerase chain reaction. Pediatrics 110:471–480
El Helali N, Giovangrandi Y, Guyot K, Chevet K, Gutmann L, Durand-Zaleski I (2012) Cost and effectiveness of intrapartum group B streptococcus polymerase chain reaction screening for term deliveries. Obstet Gynecol 119:822–829. https://doi.org/10.1097/AOG.0b013e31824b1461
Acknowledgements
The sponsor was Assistance Publique-Hôpitaux de Paris (APHP) (Department of Clinical Research). We thank Florence Artiguebieille, Valerie Fauroux, Farah Ketroussi, and Chahrazed Guettouche from URC-CIC Cochin-Necker, AP-HP, Paris, for the management of the clinical trial. We thank all the technical and medical staff of the maternity wards.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
CPo has received reimbursement for attending meetings from bioMérieux, Cepheid, and has received research funding from Institut Mérieux. CPl has received reimbursement from Cepheid for attending the European Congress of Clinical Microbiology and Infectious Diseases, which took place in Amsterdam from 9 to 12 April 2016.
This work was partially funded by a grant from APHP (P111008), Institut Mérieux, and the IRT Bioaster. Cepheid had no role in the data collection, data analysis, data interpretation, or writing of the report.
Research involving human participants
The study protocol was approved by the Ethical Research Committee (CPP12005).
Informed consent
All women included gave written informed consent.
Rights and permissions
About this article
Cite this article
Plainvert, C., El Alaoui, F., Tazi, A. et al. Intrapartum group B Streptococcus screening in the labor ward by Xpert® GBS real-time PCR. Eur J Clin Microbiol Infect Dis 37, 265–270 (2018). https://doi.org/10.1007/s10096-017-3125-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-017-3125-2