Prevalence of early neonatal sepsis and positive maternal culture for group B beta-hemolytic <i>Streptococcus</i>

Silva, Cecília Gomes Cunha; Leobas, Maria Júlia Arantes; Freitas, Andressa Paes Medeiros de; Mansano, Júlia Teoro; Rodrigues, Jaider Antonio Vidigal; Araujo Júnior, Edward; Peixoto, Alberto Borges

doi:10.1590/1806-9282.20230021

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Assoc. Med. Bras. 70 (1) • 2024 • https://doi.org/10.1590/1806-9282.20230021 copy

Prevalence of early neonatal sepsis and positive maternal culture for group B beta-hemolytic Streptococcus

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to evaluate the prevalence of early neonatal sepsis in pregnant women with a positive culture for group B beta-hemolytic Streptococcus in a middle-income city in Southeastern Brazil.

METHODS:

A retrospective cohort study was conducted, involving singleton low- and high-risk pregnancies in whom group B beta-hemolytic Streptococcus cultures were evaluated between 35 and 37 weeks of gestation using vaginal and anal swabs. A specific medium (Todd-Hewitt) was used for culturing. The pregnant women were divided into two groups based on positive (n==201) and negative (n==420) cultures for group B beta-hemolytic Streptococcus.

RESULTS:

The maternal colonization rate by group B beta-hemolytic Streptococcus was 32.3%. The prevalence of early neonatal sepsis was 1.0% (2/201) among patients with a positive group B beta-hemolytic Streptococcus culture and 1.9% (8/420) among patients with a negative culture. Among the patients who underwent adequate prophylaxis, crystalline penicillin G was used in 51.9% (54/104), followed by cefazolin in 43.3% (45/104), ampicillin in 3.8% (4/104), and clindamycin in 1.0% (1/104). A model that included prematurity (p==0.001) proved to be an independent risk predictor of early neonatal sepsis [χ² (1)==15.0, odds ratio: 16.9, 95% confidence interval: 4.7–61.6, p<0.001, Nagelkerke R²==0.157].

CONCLUSION:

The prevalence of a positive culture for group B beta-hemolytic Streptococcus was high. However, the prevalence of early neonatal sepsis was low in pregnant women with both positive and negative group B beta-hemolytic Streptococcus cultures and in pregnant women with a positive culture who underwent both adequate and inadequate antibiotic prophylaxis. Prematurity proved to be an independent predictor of early neonatal sepsis, considering the entire study population.

KEYWORDS:
Streptococcus ; Neonatal sepsis; Antibiotic prophylaxis; Pregnancy outcomes

		Positive culture (n=201)	Negative culture (n=420)	p-value
Age (years)		28.0 (23.0–34.5)	28.0 (24.0–34.0)	0.531^† † Mann-Whitney test: median (interquartile range);
Weight (kg)		78.0 (71.2–84.0)	77.5 (68.2–86.0)	0.532^† † Mann-Whitney test: median (interquartile range);
Height (m)		1.65 (1.62–1.68)	1.65 (1.60–1.69)	0.163^† † Mann-Whitney test: median (interquartile range);
BMI (kg/m²2 Joachim A, Matee MI, Massawe FA, Lyamuya EF. Maternal and neonatal colonisation of group B Streptococcus at Muhimbili National Hospital in Dares Salaam, Tanzania: prevalence, risk factors and antimicrobial resistance. BMC Public Health. 2009;9:437. https://doi.org/10.1186/1471-2458-9-437 https://doi.org/10.1186/1471-2458-9-437... )		28.0 (26.3–31.2)	28.4 (25.9–31.3)	0.678^† † Mann-Whitney test: median (interquartile range);
Ethnicity				0.523^§ § chi-square: percentage (N/n); p<0.05.
	White	46.2% (92/199)	49.3% (203/412)
	Black	11.1% (22/199)	8.3% (34/412)
	Mixed	41.2% (82/199)	41.7% (172/412)
	Asian	1.5% (3/199)	0.7% (3/412)
Smoking		6.5% (13/200)	7.7% (32/417)	0.600^§ § chi-square: percentage (N/n); p<0.05.
Number of pregnancies		2.0 (1.0–3.0)	2.0 (1.0–3.0)	0.281^† † Mann-Whitney test: median (interquartile range);
Number of deliveries				0.030^§ § chi-square: percentage (N/n); p<0.05.
	None	3.0% (6/201)	7.6% (32/420)
	≥1	97.0% (195/201)	92.4% (388/420)
Gestational age at vaginal collection (weeks)		36.1 (35.8–36.4)	36.0 (35.6–37.0)	<0.001^† † Mann-Whitney test: median (interquartile range);
High-risk pregnancy		32.3% (65/201)	39.5% (166/420)	0.083^§ § chi-square: percentage (N/n); p<0.05.
Premature rupture of ovular membranes		13.9% (28/201)	20.0% (84/420)	0.066^§ § chi-square: percentage (N/n); p<0.05.
Preterm birth		4.5% (9/201)	7.1% (30/420)	0.200^§ § chi-square: percentage (N/n); p<0.05.
Gestational age at delivery (weeks)		39.4 (38.6–40.0)	39.3 (38.4–40.0)	0.332^† † Mann-Whitney test: median (interquartile range);
Antibiotic use prophylaxis		65.7% (132/201)	20.7% (87/420)	<0.001^§ § chi-square: percentage (N/n); p<0.05.
Types of delivery				0.006^§ § chi-square: percentage (N/n); p<0.05.
	Vaginal	39.9% (79/198)	51.0% (212/416)
	Cesarean section	59.1% (117/198)	49.0% (204/416)
	Forceps	1.0% (2/198)	0.0% (0–416)
Birth weight (g)		3270.0 (2933.0–3573.0)	3240.0 (2915.0–3520.0)	0.402^† † Mann-Whitney test: median (interquartile range);
Apgar score 1st minute		8.0 (8.0–9.0)	9.0 (8.0–9.0)	0.007^† † Mann-Whitney test: median (interquartile range);
Apgar score 5th minute		8.0 (8.0–9.0)	9.0 (9.0–10.0)	<0.001^† † Mann-Whitney test: median (interquartile range);

		Adequate prophylaxis (n=104)	Inadequate prophylaxis (n=97)	p-value
High-risk pregnancy		35.6% (37/104)	28.9% (28/97)	0.309^§ § chi-square test: percentage (N/n); p<0.05.
Number of antibiotic doses		4.0 (4.0–4.0)	0.0 (0.0–1.0)	<0.0001^† † Mann-Whitney test: median (interquartile range);
Antibiotic use				<0.001^§ § chi-square test: percentage (N/n); p<0.05.
Crystalline penicillin G		51.9% (54/104)	20.6% (20/97)
Ampicillin		3.8% (4/104)	3.1% (3/97)
Clindamycin		1.0% (1/104)	2.1% (2/97)
Cefazoline		43.3% (45/104)	4.1% (4/97)
None		0.0% (0/104)	70.1% (68/97)
Gestational age at delivery (weeks)		39.4 (38.9–40.1)	39.3 (38.3–40.0)	0.130^† † Mann-Whitney test: median (interquartile range);
Preterm birth		1.92% (2/104)	7.22% (7/97)	0.091^§ § chi-square test: percentage (N/n); p<0.05.
Types of delivery				0.701^§ § chi-square test: percentage (N/n); p<0.05.
	Vaginal	42.7% (44/103)	36.8% (35/95)
	Cesarean section	56.3% (58/103)	62.1% (59/95)
	Forceps	1.0% (1/103)	1.1% (1/95)
Birth weight (g)		3282 (489.7)	3197 (553.0)	0.253^£ £ Student’s t-test: mean (standard deviation);
Apgar score at 1st minute		8.0 (8.0–9.0)	8.0 (8.0–9.0)	0.779^† † Mann-Whitney test: median (interquartile range);
Apgar score at 5th minute		9.0 (9.0–9.75)	9.0 (9.0–9.0)	0.728^† † Mann-Whitney test: median (interquartile range);

	OR	CI 95%	p-value
GBS-positive	0.16	0.10–2.50	0.408
Inadequate prophylaxis	3.78	0.47–30.2	0.209
Prematurity	16.9	4.7–61.4	<0.001

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: araujojred@terra.com.br