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A multi-country cross-sectional study of vaginal carriage of group B Streptococci (GBS) and Escherichia coli in resource-poor settings : prevalences and risk factors

(2016) PLOS ONE. 11(1).
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Abstract
Background : One million neonates die each year in low- and middle-income countries because of neonatal sepsis; group B Streptococcus (GBS) and Escherichia coli are the leading causes. In sub-Saharan Africa, epidemiological data on vaginal GBS and E. coli carriage, a prerequisite for GBS and E. coli neonatal sepsis, respectively, are scarce but necessary to design and implement prevention strategies. Therefore, we assessed vaginal GBS and E. coli carriage rates and risk factors and the GBS serotype distribution in three sub-Saharan countries. Methods : A total of 430 women from Kenya, Rwanda and South Africa were studied cross-sectionally. Vaginal carriage of GBS and E. coli, and GBS serotype were assessed using molecular techniques. Risk factors for carriage were identified using multivariable logistic regression analysis. Results : Vaginal carriage rates in reference groups from Kenya and South Africa were 20.2% (95% CI, 13.7-28.7%) and 23.1%(95% CI, 16.2-31.9%), respectively for GBS; and 25.0% (95% CI, 17.8-33.9%) and 27.1%(95% CI, 19.6-36.2%), respectively for E. coli. GBS serotypes Ia (36.8%), V (26.3%) and III (14.0%) were most prevalent. Factors independently associated with GBS and E. coli carriage were Candida albicans, an intermediate vaginal microbiome, bacterial vaginosis, recent vaginal intercourse, vaginal washing, cervical ectopy and working as a sex worker. GBS and E. coli carriage were positively associated. Conclusions : Reduced vaginal GBS carriage rates might be accomplished by advocating behavioral changes such as abstinence from sexual intercourse and by avoidance of vaginal washing during late pregnancy. It might be advisable to explore the inclusion of vaginal carriage of C. albicans, GBS, E. coli and of the presence of cervical ectopy in a risk- and/or screening-based administration of antibiotic prophylaxis. Current phase II GBS vaccines (a trivalent vaccine targeting serotypes Ia, Ib, and III, and a conjugate vaccine targeting serotype III) would not protect the majority of women against carriage in our study population.
Keywords
MULTIPLEX PCR ASSAY, ONSET NEONATAL SEPSIS, LOWER GENITAL-TRACT, PREGNANT-WOMEN, BACTERIAL VAGINOSIS, CERVICAL ECTOPY, AFRICAN WOMEN, ANTIMICROBIAL RESISTANCE, INTRAUTERINE-DEVICE, SAMPLING TECHNIQUES, Escherchia coli, Vaginal microbiology, group B streptococci

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Chicago
Cools, Piet, Vicky Jespers, Liselotte Hardy, Tania Crucitti, Sinead Delany-Moretlwe, Mary Mwaura Mwaura, Gilles F Ndayisaba, Janneke HHM van de Wijgert, and Mario Vaneechoutte. 2016. “A Multi-country Cross-sectional Study of Vaginal Carriage of Group B Streptococci (GBS) and Escherichia Coli in Resource-poor Settings : Prevalences and Risk Factors.” Plos One 11 (1).
APA
Cools, Piet, Jespers, V., Hardy, L., Crucitti, T., Delany-Moretlwe, S., Mwaura, M. M., Ndayisaba, G. F., et al. (2016). A multi-country cross-sectional study of vaginal carriage of group B Streptococci (GBS) and Escherichia coli in resource-poor settings : prevalences and risk factors. PLOS ONE, 11(1).
Vancouver
1.
Cools P, Jespers V, Hardy L, Crucitti T, Delany-Moretlwe S, Mwaura MM, et al. A multi-country cross-sectional study of vaginal carriage of group B Streptococci (GBS) and Escherichia coli in resource-poor settings : prevalences and risk factors. PLOS ONE. 2016;11(1).
MLA
Cools, Piet, Vicky Jespers, Liselotte Hardy, et al. “A Multi-country Cross-sectional Study of Vaginal Carriage of Group B Streptococci (GBS) and Escherichia Coli in Resource-poor Settings : Prevalences and Risk Factors.” PLOS ONE 11.1 (2016): n. pag. Print.
@article{7247741,
  abstract     = {Background : One million neonates die each year in low- and middle-income countries because of neonatal sepsis; group B Streptococcus (GBS) and Escherichia coli are the leading causes. In sub-Saharan Africa, epidemiological data on vaginal GBS and E. coli carriage, a prerequisite for GBS and E. coli neonatal sepsis, respectively, are scarce but necessary to design and implement prevention strategies. Therefore, we assessed vaginal GBS and E. coli carriage rates and risk factors and the GBS serotype distribution in three sub-Saharan countries. 
Methods : A total of 430 women from Kenya, Rwanda and South Africa were studied cross-sectionally. Vaginal carriage of GBS and E. coli, and GBS serotype were assessed using molecular techniques. Risk factors for carriage were identified using multivariable logistic regression analysis. 
Results : Vaginal carriage rates in reference groups from Kenya and South Africa were 20.2\% (95\% CI, 13.7-28.7\%) and 23.1\%(95\% CI, 16.2-31.9\%), respectively for GBS; and 25.0\% (95\% CI, 17.8-33.9\%) and 27.1\%(95\% CI, 19.6-36.2\%), respectively for E. coli. GBS serotypes Ia (36.8\%), V (26.3\%) and III (14.0\%) were most prevalent. Factors independently associated with GBS and E. coli carriage were Candida albicans, an intermediate vaginal microbiome, bacterial vaginosis, recent vaginal intercourse, vaginal washing, cervical ectopy and working as a sex worker. GBS and E. coli carriage were positively associated. 
Conclusions : Reduced vaginal GBS carriage rates might be accomplished by advocating behavioral changes such as abstinence from sexual intercourse and by avoidance of vaginal washing during late pregnancy. It might be advisable to explore the inclusion of vaginal carriage of C. albicans, GBS, E. coli and of the presence of cervical ectopy in a risk- and/or screening-based administration of antibiotic prophylaxis. Current phase II GBS vaccines (a trivalent vaccine targeting serotypes Ia, Ib, and III, and a conjugate vaccine targeting serotype III) would not protect the majority of women against carriage in our study population.},
  articleno    = {e0148052},
  author       = {Cools, Piet and Jespers, Vicky and Hardy, Liselotte and Crucitti, Tania and Delany-Moretlwe, Sinead and Mwaura, Mary Mwaura and Ndayisaba, Gilles F and van de Wijgert, Janneke HHM and Vaneechoutte, Mario},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keyword      = {MULTIPLEX PCR ASSAY,ONSET NEONATAL SEPSIS,LOWER GENITAL-TRACT,PREGNANT-WOMEN,BACTERIAL VAGINOSIS,CERVICAL ECTOPY,AFRICAN WOMEN,ANTIMICROBIAL RESISTANCE,INTRAUTERINE-DEVICE,SAMPLING TECHNIQUES,Escherchia coli,Vaginal microbiology,group B streptococci},
  language     = {eng},
  number       = {1},
  pages        = {30},
  title        = {A multi-country cross-sectional study of vaginal carriage of group B Streptococci (GBS) and Escherichia coli in resource-poor settings : prevalences and risk factors},
  url          = {http://dx.doi.org/10.1371/journal.pone.0148052},
  volume       = {11},
  year         = {2016},
}

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