Group B streptococcal infection in pregnant women
- Karen M Puopolo, MD, PhD
Karen M Puopolo, MD, PhD
- Associate Professor of Clinical Pediatrics
- University of Pennsylvania Perelman School of Medicine
- Lawrence C Madoff, MD
Lawrence C Madoff, MD
- Professor of Medicine
- University of Massachusetts Medical School
- Carol J Baker, MD
Carol J Baker, MD
- Professor of Pediatrics, Molecular Virology and Microbiology
- Baylor College of Medicine
Group B streptococcus (GBS; Streptococcus agalactiae) is a gram-positive coccus that frequently colonizes the human genital and gastrointestinal tracts, as well as the upper respiratory tract of young infants [1,2]. It is an important cause of illness in infants, pregnant women, and adults with underlying medical conditions .
In pregnant and postpartum women, GBS is a frequent cause of asymptomatic bacteriuria, urinary tract infection, upper genital tract infection (ie, intraamniotic infection or chorioamnionitis), postpartum endometritis (8 percent), pneumonia (2 percent), puerperal sepsis (2 percent), and bacteremia without a focus (31 percent). It also can cause focal infection such as meningitis and endocarditis, albeit rarely. The serotype distribution of invasive GBS infection in pregnant women is similar to that of early-onset neonatal disease .
GBS infection in pregnant women will be reviewed here. The microbiology of GBS; GBS infection in neonates, young infants, and nonpregnant adults; and prevention strategies through chemoprophylaxis and vaccination are discussed separately. (See "Group B streptococcus: Virulence factors and pathogenic mechanisms" and "Group B streptococcal infection in neonates and young infants" and "Group B streptococcal infections in nonpregnant adults" and "Neonatal group B streptococcal disease: Prevention" and "Management of the infant whose mother has received group B streptococcal chemoprophylaxis" and "Vaccines for the prevention of group B streptococcal disease".)
GBS infections in pregnant women include urinary tract infection, upper genital tract infection, intraamniotic infection, endometritis, and bacteremia [5,6]. Invasive maternal infection with GBS is associated with pregnancy loss and preterm delivery [4,7]. Prior to the widespread use of maternal intrapartum chemoprophylaxis, maternal colonization with GBS conferred an increased risk of chorioamnionitis, and early postpartum infection [8,9]. There does not appear to be an association between maternal GBS colonization during pregnancy and preterm delivery .
In the Centers for Disease Control and Prevention (CDC) surveillance study including data collected from 1999 to 2005, the rate of invasive infection (defined as isolation of GBS from a blood or other usually sterile body site, excluding urine) in pregnant women was 0.12 per 1000 live births (range 0.11 to 0.14 per 1000 births) . Upper genital tract infection accounted for approximately one-half of cases, isolated bacteremia occurred in one-third of cases, and GBS was isolated from maternal blood in approximately one-half of cases. Among women for whom pregnancy outcome data were available, approximately one-half of the maternal GBS infections led to fetal death, neonatal infections, neonatal death, or pregnancy loss.
- Edwards MS, Nizet V, Baker CJ. Group B Streptococcal Infections. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.419.
- Eichenwald EC. Perinatally transmitted neonatal bacterial infections. Infect Dis Clin North Am 1997; 11:223.
- Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59:1.
- Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008; 299:2056.
- Regan JA, Klebanoff MA, Nugent RP, et al. Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group. Am J Obstet Gynecol 1996; 174:1354.
- Krohn MA, Hillier SL, Baker CJ. Maternal peripartum complications associated with vaginal group B streptococci colonization. J Infect Dis 1999; 179:1410.
- Zaleznik DF, Rench MA, Hillier S, et al. Invasive disease due to group B Streptococcus in pregnant women and neonates from diverse population groups. Clin Infect Dis 2000; 30:276.
- Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000; 342:15.
- Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep 1996; 45:1.
- Valkenburg-van den Berg AW, Sprij AJ, Dekker FW, et al. Association between colonization with Group B Streptococcus and preterm delivery: a systematic review. Acta Obstet Gynecol Scand 2009; 88:958.
- Romero R, Oyarzun E, Mazor M, et al. Meta-analysis of the relationship between asymptomatic bacteriuria and preterm delivery/low birth weight. Obstet Gynecol 1989; 73:576.
- Mittendorf R, Williams MA, Kass EH. Prevention of preterm delivery and low birth weight associated with asymptomatic bacteriuria. Clin Infect Dis 1992; 14:927.
- Anderson BL, Simhan HN, Simons KM, Wiesenfeld HC. Untreated asymptomatic group B streptococcal bacteriuria early in pregnancy and chorioamnionitis at delivery. Am J Obstet Gynecol 2007; 196:524.e1.
- Wood EG, Dillon HC Jr. A prospective study of group B streptococcal bacteriuria in pregnancy. Am J Obstet Gynecol 1981; 140:515.
- Persson K, Bjerre B, Elfström L, et al. Group B streptococci at delivery: high count in urine increases risk for neonatal colonization. Scand J Infect Dis 1986; 18:525.
- Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005; 40:643.
- Aungst M, King J, Steele A, Gordon M. Low colony counts of asymptomatic group B streptococcus bacteriuria: a survey of practice patterns. Am J Perinatol 2004; 21:403.
- American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG Committee Opinion No. 485: Prevention of early-onset group B streptococcal disease in newborns. Obstet Gynecol 2011; 117:1019.
- Thomsen AC, Mørup L, Hansen KB. Antibiotic elimination of group-B streptococci in urine in prevention of preterm labour. Lancet 1987; 1:591.
- Hill JB, Sheffield JS, McIntire DD, Wendel GD Jr. Acute pyelonephritis in pregnancy. Obstet Gynecol 2005; 105:18.
- ACOG educational bulletin. Antimicrobial therapy for obstetric patients. Number 245, March 1998 (replaces no. 117, June 1988). American College of Obstetricians and Gynecologists. Int J Gynaecol Obstet 1998; 61:299.
- Hitti J, Tarczy-Hornoch P, Murphy J, et al. Amniotic fluid infection, cytokines, and adverse outcome among infants at 34 weeks' gestation or less. Obstet Gynecol 2001; 98:1080.
- Isada NB, Grossman JH. Perinatal Infections. In: Obstetrics: Normal and Problem Pregnancies, Gabbe SG, Niebyl JR, Simpson JL (Eds), Churchill Livingstone, New York 1991. p.1276.
- Blanco JD, Gibbs RS, Castaneda YS. Bacteremia in obstetrics: clinical course. Obstet Gynecol 1981; 58:621.
- Kankuri E, Kurki T, Carlson P, Hiilesmaa V. Incidence, treatment and outcome of peripartum sepsis. Acta Obstet Gynecol Scand 2003; 82:730.
- Cape A, Tuomala RE, Taylor C, Puopolo KM. Peripartum bacteremia in the era of group B streptococcus prophylaxis. Obstet Gynecol 2013; 121:812.
- Guerin JM, Leibinger F, Mofredj A, Ekherian JM. Streptococcus B meningitis in post-partum. J Infect 1997; 34:151.
- Braun TI, Pinover W, Sih P. Group B streptococcal meningitis in a pregnant woman before the onset of labor. Clin Infect Dis 1995; 21:1042.
- Deziel PJ, McGuire N, Brown PD. Group B streptococcal meningitis complicating elective abortion: report of 2 cases. Clin Infect Dis 2000; 31:E23.
- Palys EE, Li J, Gaut PL, Hardy WD. Tricuspid valve endocarditis with Group B Streptococcus after an elective abortion: the need for new data. Infect Dis Obstet Gynecol 2006; 2006:43253.