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See detailReal-Time PCR detection of group B streptococci from pregnant women's vaginal specimens at time of delivery: clinical evaluation
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Lorquet, Sophie et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 44th Intersciences Conference on Antimicrobial Agents and Chemotherapy (2004, November)

Guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP) for pregnant women with a positive prenatal culture-based screening for GBS. To improve this strategy, a rapid screening ... [more ▼]

Guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP) for pregnant women with a positive prenatal culture-based screening for GBS. To improve this strategy, a rapid screening performed at the onset of labor with the IDI-Strep BTM test (IDI), a real time PCR detection (Infectio Diagnostic), may be used. Objective: To evaluate the performance of the IDI to detect GBS from vaginal specimens collected at time of delivery. Methods: Intrapartum vaginal specimens from 923 pregnant women were tested to determine the status of GBS colonization, by CDC’s recommended culture method (including selective LIM broth) with a Granada agar (GR) added as well as by the IDI and the immunologic StrepB OIATM test (OIA), BioStar. The performance of the different methods was compared. Results: GBS were recovered from 16.8% and 23.6% specimens respectively on primary culture plates and overall. The colonization rate for GBS was 18.6 % by IDI and 15.7 % by OIA testing. The sensitivity of IDI for identifying vaginal colonization status at delivery was 92 % or 77.1 % when compared to GR primary cultures or to overall culture results, and for the OIA, it was respectively 65.1 or 52.1 %. The specificity was 99.1 % for IDI and 95.5 % for OIA. The turnaround time for obtaining results was less than one hour for both IDI and OIA. Conclusions: 1) Strep B-IDI test, performed on intrapartum vaginal specimens, yields relevant results rapidly enough to be used as an efficient diagnostic tool for the identification of GBS colonized women, in order to offer IAP really targeted to GBS carriers. 2) By comparison to the prenatal screening-based strategy, the high sensitivity and specificity of IDI would allow a reduction of useless IAP and of missed opportunities. 3) IDI testing might be implemented “in routine” in some hospitals for further clinical and practical evaluation. [less ▲]

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See detailHow many women can benefit from a full intrapartum antibiotic prphylaxis for prevention of perinatal group B streptococcal disease?
MELIN, Pierrette ULg; Lorquet, Sophie; Rodriguez Cuns, Grisel et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 44th Intersciences Conference on Antimicrobial Agents and Chemotherapy (2004, November)

Background: In Belgium as in many Western countries, GBS are still the leading cause of severe perinatal infections. Current guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP ... [more ▼]

Background: In Belgium as in many Western countries, GBS are still the leading cause of severe perinatal infections. Current guidelines for prevention recommend intrapartum antimicrobial prohylaxis (IAP) administered promptly before delivery to pregnant women colonized with GBS. The risk of vertical GBS transmission to the newborn decreases as the duration of prophylaxis increases. The considered threshold for prophylaxis adequacy is the first dose administered at least 4 hours before delivery. Objective: To evaluate the proportion of pregnant women who could benefit from an adequate IAP for the prevention of GBS perinatal infections. Methods: Between June and October 2003, we recorded in two hospitals the elapse time between admission for labor and delivery. We assumed 5 hours represent a useful threshold to allow admission, revision of chart and administration of adequate IAP. The status of vaginal colonization with GBS was determined by CDC’s recommended culture method with Granada agar added. Results: Among 532 women, 27.3 % delivered within 5 hours after admission for labor. The colonization rate for GBS was 25.6 %. The distribution of elapse time between admission and delivery for GBS colonized pregnant women was not significantly different from non colonized women (p <= 1). Conclusions: 1) With the current prevention strategy, 27.3 % of these pregnant women would not have benefit from adequate prophylaxis 2) These results highlight the importance of an efficient organization to warranty prompt administration of IAP as soon as possible when mandatory. 3) If a rapid intrapartum screening test is used, no delay can be afforded “from ward to bench to bed”. [less ▲]

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See detailEvaluation of the group B differential agar for the detection of group B streptococci from vaginal specimens
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Lorquet, Sophie et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 104th General Meeting of the American Society for Microbiology (2004, May)

Background Group B streptococci (GBS) are the leading cause of severe perinatal infections. Most current guidelines for the prevention of GBS perinatal disease are based on prenatal screening culture for ... [more ▼]

Background Group B streptococci (GBS) are the leading cause of severe perinatal infections. Most current guidelines for the prevention of GBS perinatal disease are based on prenatal screening culture for vaginal GBS colonisation. Use of selective and differential media could improve the sensitivity of these cultures. Objective To evaluate the GBS-Differential Agar (GBSDA) recently formulated by Becton Dickinson for the selective growth and production of orange colonies of b- hemolytic (b-H) GBS. Methods 283 vaginal swabs (VAG) collected from pregnant women were inoculated in selective Lim broth. After overnight incubation, Lim broth were subcultured on GBSDA, on Granada agar (Biomedics, Spain) and on Columbia blood agar (BA). To evaluate the stability, 99 isolates of GBS (REF) from adult or neonatal infections (Belgian GBS reference laboratory collection) were cultured on GBSDA and Granada at their limit of expiration, and on BA. GBSDA and Granada were incubated anaerobically and BA aerobically + 7% CO2, at 35°C, 24 to 48 h. Positive and negative control strains (GBS ; E. faecalis) were cultured with each run. Specific identification of colonies suggestive of GBS (pale to dark orange on GBSDA and Granada, b-H on BA) was performed. Results b-H GBS were recovered from 63 VAG (22.3 %): 62 were easily identified after overnight incubation on GBSDA and 63 on Granada without requiring any subculture. All GBS were also recovered from BA however it was after many subcultures. All orange colonies were confirmed as GBS. Among REF, 3 strains were non hemolytic ; they grew but were not differentiated as orange colonies on GBSDA or Granada. 96 REF were b-H, 94 (97.9%) produced orange to very dark orange colonies on GBSDA, 2 produced white colonies, and on Granada, 74 (77.1 %) produced pale to dark orange colonies and 22 white to white-orange colonies. Conclusion 1) GBSDA and Granada: a) very high sensitivity and specificity for the detection of b-H GBS, in a single step b) Results available within 48 h after inoculation in Lim broth, low workload 2) Excellent stability up to expiration date for GBSDA 3) Non hemolytic GBS: grown but not differentiated on GBSDA or Granada. [less ▲]

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See detailAntimicrobial Susceptibilities of recent clinical isolates of group B streptococci agalactiae from Belgium
MELIN, Pierrette ULg; Maquet, Julie; Rodriguez Cuns, Grisel et al

in American Society of Microbiology (Ed.) Program and Abstracts of the 43rd Intersciences Conference on Antimicrobial Agents and Chemotherapy (2003, September)

Background: : GBS cause severe infections in neonates, pregnant women and other adults. Empiric therapy is usually started before susceptibility results are available. Early neonatal diseases can be ... [more ▼]

Background: : GBS cause severe infections in neonates, pregnant women and other adults. Empiric therapy is usually started before susceptibility results are available. Early neonatal diseases can be prevented with intrapartum antibiotic prophylaxis based on accurate susceptibility surveillance data. A previous Belgian study showed an increase of 3 to 10 % R to erythromycin (EM) through the 1990s. Methods: 187 GBS isolates consecutively received at the reference laboratory between 2001 to March 2003 were from 73 neonates (52 early-onset and 21 late-onset diseases), 52 adults and 62 from pregnant women’s vagina. MICs of penicillin (PG), EM, clindamycin (CM) and gentamicin (GM) were determined with Etest. PG MBCs were also determined by inactivating the drug in MIC plates using betalactamase. EM resistant (R) isolates were tested by the CM + EM double disk to determine macrolide R phenotypes. Results: All strains were susceptible (S) to PG and no tolerance was observed with MBCs falling within 2 dilutions of MICs. 19.2% of isolates were R to EM, with significantly more R isolates from adults (30.8%; p <0.01) and serotype V (46.8%; p <0,001). 80% had the MLSB phenotype (R to EM and CM), 16 were constitutive and 12 inducible. The M phenotype (R to EM and S to CM) was seen in 7 (20%) of isolates. Less than 10% of isolates were inhibited by GM MIC of <=64 mg/L, 83.6% by 128-256 mg/L and 2.9% by >/=512 mg/L. Non typable strains were more R to GM (p <0.01). Conclusions: 1) PG remained active against all isolates and no tolerance was seen. 2) Prevalence of R to macrolides had increased since 1999, particularly in adult isolates and serotype V. 3) Intermediate to high level R to GM was seen and potential synergy of PG + GM should be investigated. 4) R surveillance is mandatory to guide prophylaxis and treatment of serious GBS infections. [less ▲]

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See detailPrevalence of ermB, ermTR and mefA/B gene classes among erythromycine resistant group B streptococcus isolates collected in Belgium
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Tsobo, Chantal et al

Poster (2001, October)

Background: Emergence of erythromycin (Er) and clindamycin (C) resistance (R) observed in GBS, is currently becoming recognized. Methods: Clinical isolates were obtained from a Belgian surveillance for ... [more ▼]

Background: Emergence of erythromycin (Er) and clindamycin (C) resistance (R) observed in GBS, is currently becoming recognized. Methods: Clinical isolates were obtained from a Belgian surveillance for invasive GBS disease in newborns and adults in 1996-1998 (N1=235) and from consecutive specimens submitted, during 1999-2000, to the University hospital of Liege (N2=165). MICs of Er were determined buy using Etest® strip (interpretive criteria of NCCLS). Furthermore, for the ErR isolates, the inducible (iMLS), constitutive (cMLS) and M phenotypes were assessed by disk diffusion and by a double-disk test; the distribution of genes encoding RNA methylases and efflux pumps was investigated by PCR. Results: Of the N1 and N2 isolates, 16 (6.8%) and 19 (11.5%) were respectively R to Er. Among these 35 ErR isolates, 21 (60%) exhibited the cMLS phenotype. They demonstrated a high level R to Er with MICs ranging from 16 to >256 mg/L. The ermB gene was harbored by 19/21 isolates, the ermTR gene by 1 isolate and both ermB and ermTR were present in another isolate. The iMLS phenotype was observed in 10 (29%) ErR isolates; the ermTR gene was present in all isolates except one harboring an ermTR gene. These strains demonstrated low level of R to Er, with MICs of 1-12 mg/L. All 4 isolates (11%) expressing an M phenotype, displayed low level R to Er alone (MICs, 2 mg/L) and were positive for the mefA/B gene. Conclusion: In Belgium, by year 2000, prevalence of R to macrolide in GBS exceeded 10%. R was mainly caused by target-site modification (ermB, ermTR) mechanisms; efflux (mefA/B) R mechanism was also prevalent among the isolates tested. These results indicate the possibility of inappropriate prophylaxis or therapy using C or E as the recommended alternatives in penicillin-allergic patients. [less ▲]

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See detailAntimicrobial Susceptibility of Streptococcus agalactiae Isolated from Patients in Belgium Through 1989-1991 and 1996-1999
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Vincento Fernandez, Walter et al

in Martin, Diana R.; Tagg, John R. (Eds.) Streptococci and Streptococcal Diseases Entering the New Millenium - Proceeding of the XIV LISSSD (2000, November)

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See detailAntimicrobial Susceptibility of Streptococcus agalactiae Isolated from Patients in Belgium through 1989-1991 and 1996-1999
Melin, Pierrette ULg; Rodriguez Cuns, Grisel; Vicentino Fernandez, Walter et al

in Martin, Diana R; Tagg, John R (Eds.) Streptococci and Streptococcal Diseases - Entering the New Millenium", Proceedings of the XIV Lancefield International Symposium on Streptococci and Streptococcal Diseases (2000)

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See detailAntimicrobial Susceptibility of Streptococcus agalactiae isolated from patients in Belgium through 1989-1991 and 1996-1999
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Vincento Fernandez, Walter et al

Poster (1999, October)

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See detailSurveillance of antimicrobial resistance in Streptococcus agalactiae isolated from patients in Belgium (1989-1991 versus 1996-1999)
MELIN, Pierrette ULg; Rodriguez Cuns, Grisel; Vincento Fernandez, Walter et al

Poster (1999, September)

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