Bacteriuria in Pregnancy in a Danish Contemporary Cohort of Women.

Introduction: The purpose of this study is to describe bacteriuria with regard to the uropathogens found in relation to the frequency of urine culture tests in a contemporary cohort of pregnant Danish women. Methods: A historical cohort study of 24,817 pregnant women registered in the Danish Fetal Medicine Database at Aarhus University Hospital, from 2010 to 2014. Social security numbers were linked to the microbiological database with the registration of 17,233 urine cultures in 8,807 women. Bacteriuria was defined as 1 × 105 CFU/ml, with a maximum of two urinary pathogens. Streptococcus agalactiae (GBS) was included with 1 × 104 CFU/ml. Data are presented as numbers and proportions in percent. Logistic regression on predictors are presented as crude and adjusted odds ratios (ORc/ORa) with 95% confidence intervals (CIs). Results: 42% had a urine sample culture test at the hospital-the majority only once during pregnancy. 96% of all urine culture tests were negative. The bacteriuria incidence was 5.6%. The most frequent uropathogenic bacteria isolated were Escherichia coli (49%), GBS (29%), and Enterococci (10%). We identified subgroups of women with increased likelihood of bacteriuria during pregnancy: age < 25 years, ORa 1.60 (CI 1.26 to 2.02, p < 0.001); age > 34 years, ORa 1.28 (CI 1.01 to 1.61, p = 0.040); Afro-Caribbean origin, ORa 1.872 (CI 1.13 to 3.07, p = 0.014); Asian origin, ORa 2.07 (CI 1.29 to 3.32, p = 0.002); and mixed ethnicity ORa 2.34 (CI 1.23 to 4.46, p = 0.010). Women delivering preterm were more likely to have an episode of bacteriuria during pregnancy OR 2.05 (CI 1.36 to 3.09, p = 0.001). Conclusions: 96% of urine culture tests in pregnant women are negative. Optimized urine sampling may change this. Escherichia coli and GBS are predominant uropathogens. Younger and elder women, certain ethnical groups, and women delivering preterm seem more likely to have bacteriuria during pregnancy.

The draft genomes and investigation of serotype distribution, antimicrobial resistance of group B Streptococcus strains isolated from urine in Suzhou, China.

BACKGROUND: The group B Streptococcus (GBS) is a human commensal bacterium, which is capable of causing several infectious diseases in infants, and people with chronic diseases. GBS has been the most common cause of infections in urinary tract of the elders, but relatively few studies reported the urine-isolated GBS and their antimicrobial susceptibilities. Hence, we decided to investigate GBS specially isolated from urine in Suzhou, China. METHODS: 27 GBS samples were isolated from urine in Suzhou, China. The PCR and agarose gel electrophoresis were used to identify the serotype distribution. Susceptibility tests were based on MIC test and Kirby-Bauer test. Genome were sequenced via Illumina Hiseq platform and assembled by SPAdes. Genomes of five isolates were sequenced and submitted to NCBI genome database. The sequencing files in fastq format were submitted to NCBI SRA database. RESULTS: Five serotypes were identified. The resistant rates measured for tetracycline, erythromycin, clindamycin and fluoroquinolones were 74.1, 63.0, 44.4 and 48.1%, respectively. 18.5% of the isolates were nonsusceptible to nitrofurantoin. The resistance to tetracycline was mainly associated with the gene tetM. The erythromycin resistance was mainly associated with the genes ermB and mefE. The genes ermB and lnuB were the prevalent genes in cMLSB type. No known nitrofurantoin resistance gene was found in nitrofurantoin-nonsusceptible GBS. CONCLUSIONS: Five serotypes were identified in our study. High rates of GBS isolates were resistant to tetracycline, erythromycin, clindamycin and fluoroquinolones. The genes ermB and lnuB occupied high rates in cMLSB phenotype.

Prevalence and significance of vaginal group B streptococcus colonization in pregnant women from Osijek, Croatia.

The aim of the study was to determine the prevalence of vaginal group B streptococcus (GBS) colonization in pregnant women from Osijek area, the possible effect of GBS colonization on pregnancy outcome and neonatal complications and the role of intrapartum prophylaxis in this context. This retrospective case-control study took place at the Department of Gynecology and Obstetrics, Osijek University Hospital Center from December 2003 to June 2006. A total of 118 pregnant women was enrolled in study and divided into two groups: 59 women in 35th-37th week of gestation, free from risk factors for infection (control group); and 59 women in 25th-41st week of gestation with risk factors for infection. Low vaginal swab for GBS isolation and identification on selective and enriched medium was obtained from each woman. GBS colonization was recorded in 29 (24.6%) women: 12 (20.3%) control and 17 (28.8%) women at risk of infection, yielding a statistically non-significant difference (Chi2 = 1.480489; p < 0.48). Early neonatal infection was observed in six (20.7%) neonates born to 29 mothers with GBS colonization, pointing to a correlation between vaginal GBS colonization and early neonatal infection (r(s) = 0.99). Early perinatal infection was found in 22 (18.6%) neonates, including 17 (28.8%) pregnancies with risk factors, pointing to a significant correlation between vaginal GBS colonization, risk factors and early perinatal infection (Chi2 = 88.68; p < 0.001); however, gestational age and pregnancy outcome were not influenced by GBS colonization. In eight (36.4%) newborns, early neonatal infection developed in spite of intrapartum administration of antibiotics; three of these children were born to GBS positive mothers, and perinatal GBS infection was demonstrated in one (0.84%) child. Study results revealed a relatively high rate of GBS colonization in the population of pregnant women in Croatia, occasionally leading to early neonatal infection. Large studies are needed to develop national strategy for the prevention of GBS infection in Croatia.

Improvement of selection of pregnant women for intrapartum polymerase chain reaction screening for vaginal Group B Streptococci (GBS) colonization by adding GBS urine screening at 35-37 weeks of pregnancy.

OBJECTIVE: To evaluate whether systematic antepartum screening for Group B Streptococci (GBS) by urine culture improves the risk factor-based selection of pregnant women for intrapartum GBS screening with a rapid polymerase chain reaction (PCR) assay. METHODS: A prospective observational study was conducted between April 2013 and June 2014. GBS colonization judged by urine culture at 35-37 weeks of gestation was compared with the result of a vaginal GBS PCR test at labor as outcome. The results of urine culture were used as exposure variable. The PCR test was performed on intrapartum vaginal samples. RESULTS: Screening for urine GBS in 902 unselected pregnant Danish women at 35-37 weeks of gestation predicted intrapartum PCR GBS status with a sensitivity of 33.6%. A positive predictive value of 41.2% was seen among women with low GBS counts (<104 CFU/mL) and 83.3% among women with high GBS counts (≥104 CFU/mL). Systematic GBS screening of urine at 35-37 weeks of gestation added 30.9% extra women for intrapartum GBS PCR screening in the study group. CONCLUSION: Systematic antepartum GBS screening of urine should be implemented in order to improve risk stratification for early onset GBS by offering laboring women an intrapartum GBS PCR test.

Urine dipstick for predicting intrapartum recto-vaginal colonisation by group B streptococci.

INTRODUCTION: In pregnant women, bacteriuria with group B streptococci (GBS) may be associated with a high degree of recto-vaginal GBS colonisation and therefore an increased risk of early-onset GBS disease. The aim of this study was to assess the performance of routine use of dipstick urine analysis during pregnancy for prediction of recto-vaginal GBS colonisation at the time of labour. METHODS: Among 902 unselected Danish pregnant women, we obtained results from 1) dipstick urine analysis, 2) urine culture carried out during pregnancy, if indicated, and 3) recto-vaginal culture at labour. The inclusion criteria were age > 18 years and gestational age ≥ 37 weeks. RESULTS: Intrapartum recto-vaginal GBS colonisation was predicted by a positive urine dipstick with 5% sensitivity only. CONCLUSION: Dipstick urine analysis had a low sensitivity for predicting intrapartum recto-vaginal colonisation with GBS. FUNDING: none. TRIAL REGISTRATION: not relevant.

Parecoxib does not suppress thromboxane synthesis in newborn piglets with group B streptococcal sepsis.

Group B streptococci (GBS) cause fatal sepsis in newborns. Strong activation of thromboxane synthesis is assumed to correlate with severe pulmonary hypertension. In this study we compared the impact of indomethacin versus parecoxib on hemodynamics and outcome and investigated the pharmacological effects on thromboxane synthesis and EP-3 receptor gene expression. Whereas both parecoxib and indometacin reduced expression of thromboxane synthase and EP-3 receptor in infected lung tissue, parecoxib did not suppress urine levels of thromboxane like indometacin. We presume that COX-2 inhibition in GBS sepsis is associated with enhanced thrombogenicity.

Group B streptococci cultured in urine during pregnancy associated with preterm delivery: a selection problem?

Objective: To investigate an association between Group B streptococci (GBS) in urine culture during pregnancy and preterm delivery. Methods: A population-based cohort consisted of all the pregnant women (n = 36,097) from the catchment area of Lillebaelt Hospital, Denmark, during the period January 2002 -December 2012. The cohort of 34,285 singleton pregnancies used in this study was divided into three groups. Group I (N = 249) included women whose urine culture was positive for GBS; group II (N = 5765) included women whose urine culture was negative for GBS; and group III (N = 28 271) included women whose urine had not been cultured during pregnancy. Primary outcome was preterm delivery before 37 weeks' gestation (PTD). Results: We did not find an association between PTD and GBS bacteriuria in the cultured groups (odds ratios (OR) = 0.89; 95% CI: 0.5-1.4) ( Table 1 ). After controlling for potential confounders, the PTD remained not associated with GBS bacteriuria (adjusted OR = 0.99; 95% CI: 0.6-1.6). Combined, the cultured groups (I and II) were associated with a statistically significant higher risk for PTD, when compared with the group with no urine specimens taken for culture (OR = 1.96; 95% CI: 1.8-2.2 and adjusted or 1.80; 95% CI 1.6-2.0). The cultured group of women differed considerably from the group of women with no urine specimens taken for culture on the vast majority of variables examined. Conclusions: No association between asymptomatic GBS bacteriuria and preterm delivery among women with singleton pregnancy and urine specimens cultured during pregnancy was found. Previous suggestions of such association may have been compromised by a selection problem for testing due to a high-risk profile of pregnancy complications in pregnant women selected for urine culture.

Elevated urinary plasmin activity resistant to alpha2-antiplasmin in acute poststreptococcal glomerulonephritis.

BACKGROUND: A pathogenic role of intraglomerular plasmin bound to nephritogenic antigen (nephritis-associated plasmin receptor, NAPlr) and resistant to physiologic inhibitors such as alpha(2)-antiplasmin (alpha(2)-AP) has recently been proposed in acute poststreptococcal glomerulonephritis (APSGN). To confirm this concept, we analysed the urinary profile of plasmin cascade in APSGN patients. METHODS: Urine samples from 10 patients with APSGN, 12 patients with IgA nephropathy (IgAN), 10 patients with streptococcal infection without nephritis (SI) and 10 healthy control subjects were analysed. The alpha(2)-AP-resistant plasmin activity was assessed by a chromogenic assay after alpha(2)-AP was added to each urine sample. Urinary plasminogen activator (PA) and plasmin were further analysed by polyacrylamide gel zymography. Urinary NAPlr was assessed by western blot analysis in selected samples. RESULTS: Urinary alpha(2)-AP-resistant plasmin activity corrected for creatinine concentration (units/g x creatinine) was significantly higher in patients with APSGN (2.99 +/- 0.63) than in patients with IgAN (1.02 +/- 0.20, P < 0.01), SI (0.79 +/- 0.17, P < 0.01), or in healthy control subjects (0.73 +/- 0.18, P < 0.01). This tendency was confirmed by casein gel zymography. However urinary PA activity assessed by plasminogen-casein gel zymography did not differ between groups. NAPlr was detected in the urine of APSGN patients. CONCLUSIONS: We found elevated urinary plasmin activity resistant to alpha(2)-AP, which may be due to urinary excretion of NAPlr in patients with APSGN. This result supports the pathogenic role of the NAPlr-plasmin complex in the development of APSGN. Furthermore, alpha(2)-AP-resistant urinary plasmin activity may be useful as a diagnostic marker for APSGN.

[Colonization rates by Streptococcus agalactiae in Spanish and foreign pregnant women in the Fuenlabrada University Hospital]. / Tasas de colonización por Streptococcus agalactiae en gestantes españolas y extranjeras en el Hospital Universitario de Fuenlabrada.

OBJECTIVE: In pregnant women, the rectovaginal colonization by Streptococcus agalactiae (GBS) is related with geographic area of origin (6.5% to 36%). It was analysed GBS carriage in pregnant women in 2012-2014 in our hospital. METHODS: Observational retrospective study about GBS isolates from rectovaginal samples (RVS) and urine cultures of Spanish and immigrant pregnant women in 2012-2014. It was considered only a single isolation for patient. There were excluded women with GBS in urine samples of RVS study. RESULTS: A total of 4,648 Spanish and 1,405 immigrant women were analysed. GBS was detected in urine samples in 231 Spanish (5%) and 106 immigrant (7.6%). A total of 5,716 RVS were analysed, GBS was detected in 10.5% of Spanish women and in 18.9% of immigrant women. CONCLUSIONS: The overall colonization in immigrant women is higher than in Spanish with the exception of Asian women. Cases of GBS detected in urine samples might serve as a possible explanation for the high rate of GBS carriage.

[Progress on influencing factors regarding the neonatal group B streptococcal infectious diseases].

Group B streptococcus (GBS) is one of the severe pathogenic bacteria during the perinatal period, both on pregnant women and newborns. GBS infection may lead to pneumonia, septicemia, meningitis or other severe disease, even death in neonates. Although only 1%-2% infections will develop into GBS disease among the neonates, the etiological mechanism of which is worth researching. This review summarizes the possible factors related to GBS infection or occurrence of the disease, including the risk in gestation period (for example, colonization of GBS on vagina of pregnant women, preterm birth or premature rupture of fetal membranes and so on), related pathogens (bacteria strains, loads or virulence), immune level (inflammatory factor or neutralizing anticytokine auto-Abs), gene defect or primary immunodeficiencies of the hosts.

Influence of water diuresis on antimicrobial treatment of enterococcal pyelonephritis.

In the present studies, the effect of ampicillin (40 mg intramuscularly twice a day) in combination with water diuresis, produced by the ingestion of 5% dextrose in water, was determined on renal titers of enterococci after intravenous inoculation of 4 x 10(8)-2 x 10(9) enterococci into rats. Ampicillin injections with or without diuresis were started 4 or 21 days after initiation of infection and continued for 7 or 14 days. In comparison to controls (saline injections in rats drinking tap water), diuresis plus saline injections did not lower renal titers of enterococci. Injection of ampicillin in nondiuresing rats had little effect on renal titers of enterococci after 7 days of treatment started 4 or 21 days after initiation of infection. However, 2 wk of ampicillin therapy resulted in a significant decrease in renal titers. The addition of water diuresis to ampicillin treatment markedly potentiated the effect of ampicillin alone in decreasing renal titers of enterococci after 1 or 2 wk of therapy.These studies demonstrate that diuresis resulting from administration of dextrose in water plus ampicillin starting 4 or 21 days after intravenous injection of enterococci reduces renal titers more than ampicillin or diuresis alone.

Purple urine bag syndrome: case report for Streptoccocus agalactiae and literature review.

We report a case of purple urine bag syndrome, associated to Streptococcus agalactiae urinary tract infection, progressing to septic shock and death. We present a review of the literature on the subject and take the opportunity to attend readers about increasing incidence with population aging and its potential bad outcome.

Clinical interest of Streptococcus bovis isolates in urine.

OBJECTIVE: Streptococcus bovis includes variants related to colorectal cancer and non-urinary infections. Its role as urinary pathogen is unknown. Our objective was to assess the presence of urinary infection by S. bovis, analysing the patients and subsequent clinical course. METHODS: Observational study, with longitudinal data collection, performed at our centre between all the cultures requested between February and April 2015. Clinical course of the patients and response to treatment were analysed. RESULTS: Two thousand five hundred and twenty urine cultures were analysed, of which 831 (33%) had a significant microbial count. S. bovis was isolated in 8 patients (0.96%). In 75% of these cases the urine culture was requested because of urinary tract infection symptoms; the remaining 25% because of fever of uncertain source; during the follow-up period no evidence of cancer or endocarditis was detected. S. gallolyticus subspecie pasteurianus was the only variant observed (100%). The clinical response to initial treatment was favourable in all cases. CONCLUSIONS: S. bovis bacteriuria may have clinical significance, especially when S. gallolyticus subspecies pasteurianus is isolated in cases with underlying urinary tract disease.

Poststreptococcal acute glomerulonephritis superimposed on bilateral renal hypoplasia.

An 8-year-old girl with preexisting chronic renal failure (CRF) due to bilateral renal hypoplasia presented with edema, gross hematuria and acute deterioration of renal function. The diagnosis of poststreptococcal acute glomerulonephritis (PSAGN) was made based on clinical presentation, red blood cell casts, low level of C3 and elevated antistreptolysin 0 titer. Her course was prolonged with serum creatinine increased from the baseline level of 1.1 mg/dl to 2.2 mg/dl, returning toward the baseline level (1.2 mg/dl) after one month. Serum creatinine then started to increase again. The slope of creatinine clearance over time became steeper after the episode of PSAGN. A severe course of PSAGN and subsequent deterioration of renal function have previously been reported in patients with diabetic nephropathy or focal glomerulosclerosis. The present case along with a literature review suggests that individuals with fewer nephrons are at higher risk of severe course and outcome of PSAGN. Conversely, patients with severe PSAGN may be born with fewer nephrons due to low birth weight, unrecognized renal hypoplasia or other unknown causes.

Bacterial changes in the urine samples of patients with long-term indwelling catheters.

The bacterial flora in the urine samples of 15 nursing home patients with long-term, indwelling catheters were examined monthly for one year. There was a rapidly changing polymicrobial flora averaging 2.0 changes per month in species with colony counts greater than 100,000/mL, and 3.2 changes per month when changes in species, biogram, and quantity of bacteria were considered. The flora changed significantly more frequently, and cultures of Pseudomonas aeruginosa, Providencia stuartii, and Citrobacter diversus were significantly more frequent in those receiving sulfamethoxazole and trimethoprim prophylaxis than in those who did not. There was no difference in incidence of urinary tract infection (UTI) between those patients who received sulfamethoxazole and trimethoprim prophylaxis and those who did not. Ampicillin or gentamicin was effective against 99% of species cultured that are of established UTI pathogenicity. Owing to the rapidity of bacterial flora changes, routine monthly cultures are of little predictive value in patients with indwelling catheters. This study does not support the efficacy of sulfamethoxazole and trimethoprim prophylaxis in such patients.

Effect of urine latex agglutination tests on the treatment of children at risk for invasive bacterial infection.

BACKGROUND: Identifying febrile children with invasive bacterial infection is difficult in the absence of telltale physical findings. Urine latex agglutination (ULA) tests have been used for rapid, on-site identification of such children. OBJECTIVES: To study the performance of ULA tests in identifying children with Haemophilus influenzae, Streptococcus pneumoniae, and group B streptococcus infection and to examine how the results of ULA tests affect patient treatment. DESIGN: Retrospective review. SETTING: Urban children's hospital. PATIENTS: All emergency department and hospital patients tested by ULA in 1990, excluding patients in the neonatal units. RESULTS: Of 1629 patients, 36 had positive tests (20 H influenzae, 5 S pneumoniae, and 11 group B streptococcus). Thirteen of these were false positive based on culture results. Although ULA tests demonstrated excellent specificity, their sensitivity was poor. Positive predictive values for bacteremia ranged from 0.346 to 0.600, and negative predictive values ranged from 0.972 to 0.997. The decision to treat with antibiotics was made before ULA test results were available in 19 (53%) of the 36 patients with positive test results. Of 1593 patients with negative test results, 1211 (76%) were admitted to the hospital, and approximately 81% were empirically treated with parenteral antibiotics. CONCLUSIONS: In clinical practice, treatment and disposition decisions are frequently made without regard to ULA test results.

Urinary excretion of pneumococcal cell wall polysaccharide in children.

The urinary excretion of the cell wall polysaccharide of Streptococcus pneumoniae was studied in 92 children with the NOW test. Cell wall polysaccharide was detected in 65% of pneumococcal carriers and in 10% of noncarriers. Excretion rates were similar in healthy children and in children with acute otitis media. The high rate of antigen excretion among nonill carriers suggests that colonization is a major source of urinary antigen in children.

Urinary organic acid analysis in non-ketotic hyperglycinemia: non-specific occurrence of free benzoic acid, due to a beta-streptococcus infection.

The presence of free benzoic acid in the urine of a patient with non-ketotic hyperglycinemia was demonstrated to be due to a urinary tract infection with beta-streptococci (group B), and was eliminated by treatment with Penicillin G. In addition, the continuous excretion of p-hydroxyphenylacetic acid was observed. The patient was also found to excrete small and variable amounts of tiglic acid during the period of observation. Except for benzoic acid, large excesses of any specific organic acid were not observed.

False-negative urine latex particle agglutination testing in neonates with group B streptococcal bacteremia. A function of improper test implementation?

Although blood cultures remain the most specific indicator of Group B streptococcus (GBS) sepsis, a potentially life-threatening infection in neonates, test results may not be available for 24 to 48 hours. Detection of GBS antigen in the urine by latex particle agglutination (LPA) may speed diagnosis. This study analyzed the sensitivity of the GBS urine LPA assay under clinical conditions. The urine of neonates with early-onset GBS bacteremia was analyzed for GBS antigen over a three-year period at six military medical centers. Overall, 53.5% (38/71) of infants with positive blood cultures had a positive urine LPA test. Only one medical center routinely followed manufacturer's recommendations to concentrate urine specimens before testing. These data suggest that the sensitivity for the urine LPA assay, when performed on unconcentrated urine, is lower than previously reported. Clinicians should insist that the laboratory maximize sensitivity by concentrating urine prior to GBS LPA testing.