الفهرس 
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Syndromes and sites of clinical infectionsOnly 14 pages are availabe for public view
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Abstract
group B Streptococcus infection represents a major
cause of neonatal mortality and morbidity. The public
health burden of these infections on newborns as well as on
women is important. That is mainly, neurological sequel for
the newborn and maternal sterility following postpartum
endometritis. Because of its frequency and complications,
GBS foeto-maternal infection remains a major concern for
perinatal care professionals.
Numerous studies report the prevalence of GBS
colonization in pregnant women living in high-income
regions. Approximately 10-30% of pregnant women are
colonized with GBS in industrialized countries.
GBS disease is caused mainly by serotypes I, II and
III. Serotype III is the most prevalent serotype in
asymptomatic carriers. The gastrointestinal tract is the
human reservoir of GBS. Women may carry GBS
temporary, intermittent or persistent. The lower
gastrointestinal tract and vagina are often colonized with
GBS.
GBS can cause significant morbidity in pregnant
women. Manifestations of symptomatic maternal infection
include chorioamnionitis, endometritis, cystitis,
pyelonephritis and febrile GBS bacteraemia. Caesarian
delivery appears to be a prominent risk factor for
postpartum endomyometritis.
The first approach involved universal screening for
GBS colonization of all pregnant women between 35 and 37 wk gestation using vaginal and rectal cultures to detect
GBS colonization. Properly obtained and processed
antenatal cultures correctly identified most women
colonized at the time of labour. Intrapartum antibiotics are
administered to all those with a positive GBS culture
regardless of risk factors. The risk-based approach involved
administration of antibiotics based solely on the presence of
antenatal or intrapartum risk factors.
group B Streptococcus remains exquisitely
sensitive to penicillin. Penicillin G is preferred because of
its narrow spectrum, and is expected to diminish induction
of resistant organisms and maternal yeast infections.
Clindamycin and erythromycin are acceptable alternatives
for women with an allergy to penicillin, although there is
increased resistance of GBS to these two antibiotics.
Detection of penicillin resistance in a GBS isolate
should be viewed as a sentinel event of importance
requiring laboratory confirmation. If confirmed by a local
laboratory, the CDC should be notified for confirmatory
testing.
Several clinical trials have demonstrated that use of
intravenous antibiotics during the intrapartum period is
highly effective at preventing early-onset neonatal GBS
infections. Use of intrapartum prophylaxis has also been
shown to be cost-effective in the United States.
This prospective cross sectional clinical trial study
was held in Obstetrics outpatient clinic, Ain Shams
University Maternity Hospital to Measure the prevalence of
GBS colonization and Compare between the efficacy ofAmpicillin and Clindamycin on the treatment in ladies with
viable pregnancy (after 35 weeks’ gestation).
The results of this study was:
Total number of two hundreds forty six pregnant
women were included in the study, out of which twenty
eight-about 11.4%- were found to be colonized by GBS.
Follow up swab show no resistance on the case of
Penicillin and only one case of resistance using
Clindamycin (around 7%).++++++
Outcome was monitored among studied cases
showing that 2.4% had preterm delivery, 13% had Prelabor
Preterm Rupture Of Membranes, 33% underwent CS
delivery and None of the newborn needed a Neonatal ICU
admission for Neonatal sepsis.
While comparing the outcome as regard first swab
findings show that Sepsis score was significantly higher
among GBS cases along with Preterm labor, PROM and CS
than GBS free cases with no statistically significant
difference on birth weight.
Comparing between antibiotic use (Ampicilin or
Clindamycin) with outcome as gestational age at delivery,
birth weight, PPROM, CS rates and sepsis score show no
significant statistical difference between them.
Previous GB and increasing the age were significant
risk factor for having GBS at first swab among the studied
cases.