GBS Medical Articles and Abstracts

ALTERNATIVE TREATMENTS | ANTIBIOTIC TREATMENTS |BACTERIAL PERSISTENCE |BREASTFEEDING | GBS TESTING | GBS IN URINE |INCIDENCE RATES | INTRAPARTUM INFECTION |INVASIVE PROCEDURES |PLACENTAL TRIAGE & PATHOLOGYPRETERM INFO | RECURRENT GBS | SEROTYPES |SEX AND GBS | STILLBIRTH |  SUBSEQUENT PREGNANCIES | UNIVERSAL SCREENING | VAGINITIS

ALTERNATIVE TREATMENTS

Downloadable Guide as to Why Alternative Treatments for GBS are NOT effective

Alternative GBS Treatment Guide (English PDF) Downloadable guide as to why alternative treatments for GBS are not effective
Authored by Josh Jones, GBS dad.

ANTIBIOTIC TREATMENTS

Third Trimester Intramuscular Penicillin

Efficacy of intramuscular penicillin in the eradication of group B streptococcal colonization at delivery. (abstract)
Pinette MG, Thayer K, Wax JR, Blackstone J, Cartin A.
J Matern Fetal Neonatal Med. 2005 May; 17(5):333-5.

Late third-trimester treatment of rectovaginal group B streptococci with benzathine penicillin G. (abstract)
Bland ML, Vermillion ST, Soper DE.
Am J Obstet Gynecol. 2000 Aug;183(2):372-6.

Persistence of penicillin G benzathine in pregnant group B streptococcus carriers. (abstract)
Weeks JW, Myers SR, Lasher L, Goldsmith J, Watkins C, Gall SA.
Obstet Gynecol. 1997 Aug;90(2):240-3.

Treatment for GBS in Urine

Antibiotic Elimination of Group-B Streptococci in Urine in Prevention of Preterm Labour (abstract)
AC Thomsen, L Morup, KB Hansen
The Lancet, 1(8533):591-593, 1987.

Intrapartum Treatment for Penicillin Allergic Patients

Intrapartum group B streptococci prophylaxis in patients reporting a penicillin allergy. (abstract)
Matteson KA, Lievense SP, Catanzaro B, Phipps MG. Department of Obstetrics and Gynecology, Women and Infants Hospital, the Warren Alpert Medical School at Brown University, Providence, Rhode Island 02905, USA.
1: Obstet Gynecol. 2008 Feb;111(2 Pt 1):356-64.

BACTERIAL PERSISTENCE

Newly Posted How long do nosocomial pathogens persist on inanimate surfaces? A systematic review Note: Not specific to group B strep (streptococcus agalactiae)
Axel Kramer, Ingeborg Schwebke, and Günter Kampf
BMC Infectious Diseases 2006, 6:130 doi:10.1186/1471-2334-6-130

Newly Posted Survival of enterococci and staphylococci on hospital fabrics and plastic. (abstract)
Neely AN, Maley MP
J Clin Microbiol.  2000 Feb;38(2):724-6.

BREASTFEEDING

Benefits

Newly Posted  Breastfeeding and the Use of Human Milk
American Academy of Pediatrics Policy Statement
Pediatrics Vol. 129 No. 3 March 1, 2012, pp e827-e841 (doi: 10.1542/peds.2011-3552)

Newly Posted  Mother’s Milk Still Best-and We Must Do Better. (abstract)
Sarasa, NL
MEDICC Rev. 2013 Jan;15(1):48.

Isotype composition of antibodies to streptococcus group B type III polysaccharide and to tetanus toxoid in maternal, cord blood sera and in breast milk (abstract)
Lagergard T, Thiringer K, Wassen L, Schneerson R, Trollfors B., Department of Medical Microbiology, University of Goteborg, Sweden.
Eur J Pediatr. 1992 Feb;151(2):98-102.

Immunoglobulin concentrations and bacterial antibody titres in breast milk from mothers of ‘preterm’ and ‘term’ infants (abstract)
Suzuki S, Lucas A, Lucas PJ, Coombs RR.
Acta Paediatr Scand. 1983 Sep;72(5):671-7.

Newly Posted ~ GBS in Breastmilk

Neonatal group B streptococcal infection related to breast milk. (abstract)
Byrne PA, Miller C, Justus K, Department of Pediatrics and Neonatology, Saint Charles Mercy Hospital, Oregon, Ohio 43616, USA. Paul_Byrne@mhsnr.org <Byrne@mhsnr.org>
Breastfed Med, 2006 Winter;1(4):263-70.

Mothers May be Key Source of LOD Strep in Neonates
Pullen LC
Medscape Medical News, January 7, 2013 www.

Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission. (abstract)
Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A,  Center for Biomedical Research, Department of Biological and Physical Sciences, Faculty of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia 4350. kotiw@usq.edu.au
Pediatr Dev Pathol. 2003 May-Jun;6(3):251-6. Epub 2003 Apr 14.

Breast milk transmission of group B streptococcal infection. (abstract)
Dinger J, Müller D, Pargac N, Schwarze R., Clinic of Pediatrics, Medical Faculty, Technical University of Dresden, Germany. DINGER@ukd80.med.tu-dresden.de
Pediatr Infect Dis J. 2002 Jun;21(6):567-8.SourceLate-onset group B streptococcal disease by infected mother’s milk detected by polymerase chain reaction. (abstract)
Lanari M, Serra L, Cavrini F, Liguori G, Sambri V.,Department of Paediatrics, Santa Maria della Scaletta Hospital, Imola, Italy.
New Microbiol. 2007 Jul;30(3):253-4.

GBS IN URINE

ACOG Patient Education Pamphlet of Urinary Tract Infections

Antibiotic Elimination of Group-B Streptococci in Urine in Prevention of Preterm Labour (abstract)
AC Thomsen, L Morup, KB Hansen.
The Lancet, 1(8533):591-593, 1987.

Prevention of Group B Streptococcal Disease in the Newborn
BS Apgar, MD, MS; G Greenberg, MD, MA; and G YEN, MD.
American Family Physician, March 1 2005
“Compared with infants born to lightly colonized women, those born to heavily colonized women have 2.5 times the risk of infection. Neonates born to mothers who have GBS bacteriuria at any time during pregnancy are known to be more frequently and more heavily colonized with GBS and are more likely to develop sepsis. Infections that occur in the first two days of life usually are caused by exposure to maternal organisms. Risk factors for neonatal transmission and infection are listed in Table 1. Compared with term newborns, preterm and low-birth-weight infants have increased rates of GBS sepsis.”

Urinary Tract Infections During Pregnancy (abstract)
John E. Delzell Jr, MD, and Michael L. Lefevre, MD, MSPH.
Am Fam Physician, 2000 Feb 1;61(3):713-21. Erratum in Am Fam Physician 2000 Jun 15;61(12):3567.

GBS TESTING

Rapid Tests

Nanologix
Rapid test solutions that detect active threat bacteria and other microorganisms 4x – 12x faster than traditional Petri culture technology

Your Guide to Group B Strep
A very informative set of articles on rapid testing solutions including parent interviews. Featured on USAToday.com for July 2012 International Group B Strep Awareness Month.

Molecular Testing

Understanding Group B Strep
This set of articles includes interviews by GBS moms who tested negative at 35-37 weeks gestation, but were positive when their membranes were stripped/babies were born resulting in devastating GBS infections.

INCIDENCE RATES

Evaluation of Universal Antenatal Screening for Group B Streptococcus
Van Dyke et al
The New England Journal of Medicine 2009; 360:2626-2636 June 18, 2009
This paper analyzes the implementation and impact of the universal screening recommendations on provider methods and the incidence of GBS disease. It highlights the positive impact of universal screening and also identifies areas that need continued improvement.

Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis (abstract)
Dr Karen M Edmond PhD, Christina Kortsalioudaki MBBS, Susana Scott PhD, Stephanie J Schrag DPhil, Prof Anita KM, Zaidi MBBS, Prof Simon Cousens DipMathStat, Prof Paul T Heath MBBS [Hons].
The Lancet, Volume 379, Issue 9815, Pages 547 -556, 11 February 2012, doi:10.1016/S0140-6736(11)61651-6.
“Despite widespread use of intrapartum antibiotic prophylaxis, group B streptococcus remains a leading cause of morbidity and mortality in infants in Europe, the Americas, and Australia. However, estimates of disease burden in many countries outside of these regions is not available. We aimed to examine the current global burden of invasive disease and the serotype distribution of group B streptococcus isolates.”

Perinatal Group B Streptococcal Disease After Universal Screening Recommendations; United States, 2003-2005
CDC MMWR Weekly, July 20, 2007.  “…Although incidence among white infants decreased steadily during 2003–2005, incidence increased 70% among black infants.”

INTRAPARTUM INFECTION

Newly Posted Intrapartum evidence of early-onset group B streptococcus. (Abstract)
Tudela et al. Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9032, USA.
Obstet Gynecol. 2012 Mar;119(3):626-9. doi: 10.1097/AOG.0b013e31824532f6.

INVASIVE PROCEDURES

Internal Monitoring

Previous intra-amniotic infection as a risk factor for subsequent peripartal uterine infections. (abstract)
Dinsmoor MJ, Gibbs RS.
Obstet Gynecol. 74(3 Pt 1):299-301. 1989.
“Those patients who did develop recurrent intra-amniotic infection had significantly longer labors, duration of ruptured membranes, and duration of internal monitoring, and an increased number of vaginal examinations.“

Risk factors for intraamniotic infection: a prospective epidemiologic study. (abstract)
Soper DE, Mayhall CG, Dalton HP.
Am J Obstet Gynecol. 161(3):562-6; discussion 566-8. 1989.
“The clinical diagnosis of intraamniotic infection was made in  (10.5%) patients. Patients with intraamniotic infection were younger, of lower gravidity and parity, more likely to require oxytocin augmentation, and more likely to be monitored internally than were patients who were not infected. They also had longer durations of labor, ruptured membranes, and hospitalization before delivery, had significantly more vaginal examinations, and were more likely to be delivered of infants by cesarean section, as compared with patients without infection. Logistic regression analysis identified four variables independently associated with intraamniotic infection: the number of vaginal examinations, duration of ruptured membranes, use of internal monitors, and duration of total labor.“

Logistic regression analysis of risk factors for intra-amniotic infection. (abstract)
Newton ER, Prihoda TJ, Gibbs RS.
Obstet Gynecol. 1989 Apr;73(4):571-5.
“…among patients meeting risk criteria, parity, duration of internal monitoring, and duration of membrane rupture were the significant risk factors for intra-amniotic infection.“

Is meconium passage a risk factor for maternal infection in term pregnancies? (abstract)
Jazayeri A, Jazayeri MK, Sahinler M, Sincich T.
Obstet Gynecol. 99(4):548-52. 2002.
“Meconium passage increases the risk of postpartum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.“

Induction with Prostaglandin E2 Gel

Maternal colonization with Group B Streptococcus and prelabor rupture of membranes at term: The role of induction in labor. (abstract)
Hannah, Mary E. MD,CM, et. al.
Am J Obstet Gynecol. 177:780-785. 1997.
“RESULTS: Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group. For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups. CONCLUSIONS: Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.”

Membrane Stripping

Stripping the Membranes
Website article at Childbirth.org.
“Stripping the membranes is where a health care provider will separate your bag of water from the cervix, it is not intended to break your water, however, it may. It may also cause infection, and may be painful for some.”

Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific Chemoprophylaxis (Eight Case Reports)
Kathryn DeMott
OB/GYN News, Oct 15, 2001.
“Obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping.”

Maternal colonization with Group B Streptococcus and prelabor rupture of membranes at term: The role of induction in labor. (abstract)
Hannah, Mary E. MD,CM, et. al.
Am J Obstet Gynecol. 177:780-785. 1997.
“RESULTS: Group B streptococci were predictive of neonatal infection for the induction with vaginal prostaglandin E2 gel and expectant groups but not for the induction with oxytocin group. For women positive for group B streptococci the rates of neonatal infection were 2.5% for the induction with oxytocin group and > 8% for all other groups. CONCLUSIONS: Induction of labor with intravenous oxytocin may be preferable for group B streptococci-positive women with prelabor rupture of membranes at term.”

Group B Strep: A Patient/Provider Approach for Optimizing Care
James McGregor, MDCM
“Research has been done showing that both labor contractions and manual or digital examinations by care providers can actually move infectious vaginal fluid through the mouth of the womb.”

Group B Streptococci (abstract)
Anne Schuchat MD
The Lancet; 353: 51-6. 1999
“Birth practices differ substantially around the world, and home births and less invasive procedures during hospital births might limit the risk of GBS sepsis in the newborn.”

Vaginal/Cervical Exams

Cervical Manipulations Linked to Perinatal Sepsis: Consider GBS-specific Chemoprophylaxis (Eight Case Reports)
Kathryn DeMott
OB/GYN News, Oct 15, 2001.
“Obstetricians may want to reconsider doing elective cervical manipulation, at least on patients who have cervical vaginal infection or colonization with potential perinatal pathogens. They may also want to consider providing GBS-specific chemoprophylaxis before membrane stripping.”

The Myth of the Vaginal Exam
Website article at About.com by Robin Elise Weiss, LCCE.
“Vaginal exams can increase the risks of infection, even when done carefully and with sterile gloves, etc. It pushes the normal bacteria found in the vagina upwards towards the cervix. There is also increased risk of rupturing the membranes.”

Vaginal Exams in Late Pregnancy
Website article at Childbirth.org.
“Having a vaginal exam can cause your membranes to rupture prematurely (making an induction necessary in the eyes of most care providers, which is also more likely to end in a cesarean), you run the risk of getting an infection which can harm both you and the baby…”

Preventing Chorioamnionitis
Samantha McCormick, CNM, Brooklyn, New York
Midwifery Today E-News 2(23) June 9, 2000
“Q: What are the detection-causes-treatment of chorioamnionitis, and simple ways to prevent it?
A: The primary way to prevent chorioamnionitis is to limit vaginal exams. So many inductions end up with maternal fever and more antibiotics, probably solely because of the many vaginal exams to ‘monitor progress.’ “

The microbiologic effect of digital cervical examination. (abstract)
Imseis HM, Trout WC, Gabbe SG. Am J Obstet Gynecol. 180(3 Pt 1):578-80. 1999.
“An immediate effect of digital examination is the introduction of vaginal organisms into the cervical canal.“

Characterization and control of intraamniotic infection in an urban teaching hospital. (abstract)
Soper DE, Mayhall CG, Froggatt JW.
Am J Obstet Gynecol. 175(2):304-9; discussion 309-10. 1996.
“Risk factors (duration of ruptured membranes, use of internal monitoring, number of vaginal examinations) were similar in both term and preterm women with intraamniotic infection.”

International Multicentre Term Prelabor Rupture of Membranes Study: evaluation of predictors of clinical chorioamnionitis and postpartum fever in patients with prelabor rupture of membranes at term. (abstract)
Seaward PG, Hannah ME, Myhr TL, Farine D, Ohlsson A, Wang EE, Haque K, Weston JA, Hewson SA, Ohel G, Hodnett ED.
Am J Obstet Gynecol. 177(5):1024-9. 1997.
“Increasing numbers of digital vaginal examinations, longer duration of active labor, and meconium staining of the amniotic fluid were the most important risk factors for the development of clinical chorioamnionitis in women with prelabor rupture of membranes at term.“

Is meconium passage a risk factor for maternal infection in term pregnancies? (abstract)
Jazayeri A, Jazayeri MK, Sahinler M, Sincich T.
Obstet Gynecol. 99(4):548-52. 2002.
“Meconium passage increases the risk of postpartum endometritis but not chorioamnionitis. Length of labor, internal monitoring, and number of vaginal exams are risk factors for chorioamnionitis.“

Pathophysiology, diagnosis, and management of intraamniotic infection. (abstract)
Riggs JW, Blanco JD.
Semin Perinatol. 22(4):251-9. 1998.
“There is no clearly established means for the prevention of IAI, but cervical examinations and cervical manipulation can increase the risk, so caution with their use is still warranted.“

Newly posted PLACENTAL TRIAGE & PATHOLOGY

Placental Triage 101 (website)
“Placental triage is the standardized, thorough gross examination of the placenta in the delivery room, to identify abnormal placentas to send to surgical pathology for complete gross and microscopic examination and to save the normal placentas for 7 days, refrigerated, until the condition of the infant and mother are stabilized, with documentation in the medical record of the examination findings. Despite the long description, once well practiced, placental triage only takes a couple of minutes.”

Abnormal Placentas May Signal Autism Risk
Deborah Brauser
Medscape News Infectious Diseaes, Apr 30, 2013

PRETERM INFO

Antibiotic Elimination of Group-B Streptococci in Urine in Prevention of Preterm Labour (abstract)
AC Thomsen, L Morup, KB Hansen
The Lancet, 1(8533):591-593, 1987.

Prevention of Group B Streptococcal Disease in the Newborn
BS Apgar, MD, MS; G Greenberg, MD, MA; and G YEN, MD
American Family Physician, March 1 2005
“Compared with infants born to lightly colonized women, those born to heavily colonized women have 2.5 times the risk of infection. Neonates born to mothers who have GBS bacteriuria at any time during pregnancy are known to be more frequently and more heavily colonized with GBS and are more likely to develop sepsis. Infections that occur in the first two days of life usually are caused by exposure to maternal organisms. Risk factors for neonatal transmission and infection are listed in Table 1. Compared with term newborns, preterm and low-birth-weight infants have increased rates of GBS sepsis.”

Premature labor with intact membranes: microbiology of the amniotic fluid and lower genital tract and its relation with maternal and neonatal outcome. (abstract)
Rev Med Chil. 2000 Sep;128(9):985-95.
Ovalle A, Martinez MA, Gomez R, Saez J, Menares I, Aspillaga C, Schwarze JE.
“In preterm labor with intact membranes, intraamniotic infection is the most frequent cause of prematurity and is associated with a higher prevalence of maternal and neonatal problems.“

RECURRENT GBS

Recurrent group B streptococcal infections in infants: clinical and microbiologic aspects. (abstract)
Green PA, Singh KV, Murray BE, Baker CJ.
J Pediatr. 1994 Dec;125(6 Pt 1):931-8.

Newly posted  Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission. (abstract)
Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A,  Center for Biomedical Research, Department of Biological and Physical Sciences, Faculty of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia 4350. kotiw@usq.edu.au
Pediatr Dev Pathol. 2003 May-Jun;6(3):251-6. Epub 2003 Apr 14.

SEROTYPES

Newly Posted  Serotype IV and Invasive Group B Streptococcus Disease in Neonates, Minnesota, USA, 2000–2010
Patricia Ferrieri, Ruth Lynfield, Roberta Creti, and Aurea E. Flores
CDC Emerging Infectious Diseases, Volume 19, Number 4–April 2013

SEX and GBS

Prevalence of group B streptococcus colonization and potential for transmission by casual contact in healthy young men and women. (abstract)
Manning SD, Neighbors K, Tallman PA, Gillespie B, Marrs CF, Borchardt SM, Baker CJ, Pearlman MD, Foxman B.
Clin Infect Dis. 2004 Aug 1;39(3):380-8. Epub 2004 Jul 16.

Newly Posted Major Bactericidal Activity of Human Seminal Plasma Is Zinc-Dependent and Derived from Fragmentation of the Semenogelins
Anneli M. L. Edström et al
J Immunol. 2008 September 1; 181(5): 3413–3421.

STILLBIRTH

Proceedings of the Stillbirth Summit 2011
GBSI attended this eye-opening conference on the many causes of stillbirth. Dr. James A. McGregor’s presentation on “Infection and Inflammation” is included as well as presentations by top stillbirth researchers around the world.

Prediction and prevention of recurrent stillbirth (abstract)
UM Reddy
Obstet Gynecol. 110(5):1151-64, November 2007.

SUBSEQUENT PREGNANCIES

Advice for Moms who have had a Previous GBS Infected Baby
By Lisa Porter, GBS mom

Newly Posted  Recurrence of Group B Strep High in Subsequent Pregnancies, Say Obstetricians
Science Daily, August 5, 2008.

UNIVERSAL SCREENING

A Population-Based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates
SJ Schrag et al.
New England Journal of Medicine, 2002.

VAGINITIS

Bacterial Vaginosis

What is the best approach for managing recurrent bacterial vaginosis?
Grace A. Alfonsi, MD; Judith C. Shlay, MD, MSPH
Denver Health and Hospital Authority, University of Colorado Health Sciences Ctr. Sandi Parker, MLS: Denison Memorial Library, University of Colorado Health Sciences Center, Denver.
Journal of Family Practice, Vol. 53, No. 8. August 2004.

Should we screen for bacterial vaginosis in those at risk for preterm labor?
Beth Potter, MD and Laura Jhorden, MD, Department of Family Medicine, University of Wisconsin–Madison;
Marlene Porter, MLS, Medical College of Ohio, Toledo.
Journal of Family Practice, Vol. 53(10)  October 2004.

GBS Vaginitis

Streptococcus agalactiae: a vaginal pathogen?  (abstract) Note: Streptococcus agalactiae is the scientific name for Group B Strep.
Maniatis AN, Palermos J, Kantzanou M, Maniatis NA, Christodoulou C, Legakis NJ. Department of Microbiology, Medical School, University of Athens, Greece.
J Med Microbiol.
;44(3):199-202, March 1996.

Can group B streptococci cause symptomatic vaginitis? (abstract)
Honig E, Mouton JW , van der Meijden WI.
Department of Dermatology and Venereology, Erasmus Medical Centre, Rotterdam, The Netherlands.
Infect Dis Obstet Gynecol. 1999;7(4):206-9.

Vaginal pH Testing

Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. (abstract)
Rönnqvist PD, Forsgren-Brusk UB, Grahn-Håkansson EE.
Department of Clinical Bacteriology, Umeå University, Sweden. daniel.ronnqvist@essum.se
Acta Obstet Gynecol Scand. 2006;85(6):726-35

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