Group B streptococcus anogenital colonization rate and antibiotic susceptibility among antenatal women at Moi teaching and referral hospital, Kenya.

Abstract

Abstract Background: Worldwide, Group B streptococcus (GBS) infection has been shown to be one of the leading causes of sepsis, meningitis and pneumonia in neonates. With approximately 5-35% of pregnant women being colonized, 1% to 2% of their newborns develop early onset sepsis within 7 days of life. Intrapartum prophylactic treatment with penicillin significantly reduces this risk by up to 80%. Despite penicillin being readily available at MTRH, no protocol for prevention of GBS sepsis currently exists at MTRH. Objective: To determine the anogenital colonization rate and antibiotic susceptibility patterns of Group B Streptococcus among women attending antenatal clinic. Methods: This was a prospective cohort study conducted between May and December of 2015 that involved recto-vaginal swabbing, and the swab culture and sensitivity, of gravid women ≥35 but < 41 weeks gestation by best estimate based on last menstrual period and/or obstetric ultrasound, attending antenatal clinic, at MTRH. Consecutive sampling was used. Structured questionnaires were administered to eligible participants.Data analysis was done using the software for statistical computing known as R (R Core Team, 2015). Results: Three hundred and eighty six women (386) met the inclusion criteria and consented to partake in the study. Median age of participants was 26.7 years, majority were married (86.8%), gravida 1 to 2 (67.9%) and had at least secondary education (79.2%). Median gestation duration of participants was 37 weeks.All participants followed up (385) delivered in a hospital. Only eight (2.1%, 95% CI: 0.9% - 4%) of those who accepted to participate in the study were culture positive for GBS. Of the eight, one participant was lost to follow up and of the remaining seven, five of the GBS culture positive participants (71.4%) were treated with antibiotics. No association was established between GBS carrier status and demographic, and clinical, characteristics of the participants.All the isolates of GBS were sensitive to penicillin, ampicillin, vancomycin, erythromycin, and clindamycin. Conclusion: The GBS colonization rate among women attending antenatal clinic at MTRH was low (2.1%) with the GBS isolates being susceptible topenicillin, ampicillin, vancomycin, erythromycin, and clindamycin. Recommendations: Based on the low prevalence, we do not recommend routine antenatal screening of GBS. As this was a facility based study the results may not be reflective of the whole population, thus we recommend a population based study.