Intrapartum PCR-assay for detection of Group B Streptococci (GBS).

OBJECTIVE: We have recently introduced intrapartum PCR-testing for group B streptococcus (GBS) in women in labor with prolonged rupture of membranes or preterm delivery to offer intrapartum antibiotic prophylaxis only for GBS positive women.The goal of the present study is to report our experience and results from the first half year of GBS testing. STUDY DESIGN: This is a retrospective study. Rectovaginal swabs from 321 women presenting in the labor ward with pre-labor rupture of membranes for >14 h/rupture of membranes during delivery for >14 h, or labor between gestational weeks 35 0/7 and 36 6/7 from February 7, 2017 to August 6, 2017, were tested.We performed a molecular GBS test (Xpert GBS®, Cepheid Ltd., Sunnyvale, USA).Data from patient files including mode of delivery, use of antibiotics, infection of mother and child are presented in more detail.Data on the PCR results from the first year of testing were also collected. RESULTS: In the first half-year of testing a positive GBS test result was found in 58 (18.1%) and a negative test result in 263 women (81.9%). No invalid test result was achieved.The indication for performing PCR testing was PROM > 14 h or rupture of membranes during labor for >14 h in 266 women (82.9%) and labor in gestational weeks 35 0/7-36 6/7 in 44 women (13.7%). In the remaining 11 women, the PCR test was performed for other reasons.Of the 321 women tested 126 (39%) received antibiotics during labor.Ten women (3.4%) were treated after delivery on suspicion of infection. 25 newborns (7.8%) were treated with antibiotics. In 11 cases, the treatment was stopped after 2-4 days as there were no signs of infection. CONCLUSIONS: The introduction of the intrapartum GBS test in selected groups of women who gave birth in our department has been well accepted by the women, the midwifes and doctors. The result of the test is available within two hours, and as we only offer intrapartum antibiotic prophylaxis to GBS-positive women, we have reduced the use of antibiotics to approximately 40% in the groups tested, without an increase of infection in mother or child.

In Vivo Selection of a Unique Tandem Repeat Mediated Azole Resistance Mechanism (TR120) in Aspergillus fumigatus cyp51A, Denmark.

We report a fatal aspergillosis case in which STRAf typing and whole-genome sequencing substantiated in vivo emergence of an azole-resistant Aspergillus fumigatus with a 120-bp tandem repeat in the promoter region of cyp51A. This event, previously restricted to the environment, challenges current understanding of azole resistance development in A. fumigatus.

Diagnostic accuracy of polymerase chain reaction for intrapartum detection of group B streptococcus colonization.

INTRODUCTION: Many pregnant women are treated with antibiotics during labor to prevent transmission of group B streptococcus (GBS, Streptococcus agalactiae) to their baby during passage of the birth canal, and so reduce the risk of serious infection of the newborn. Methods for intrapartum testing for GBS have been introduced to select women to whom intrapartum antibiotic prophylaxis should be offered. For such an intrapartum test to be useful in clinical practice, it has to be specific as well as sensitive. The aim of the present study is to evaluate the accuracy of the polymerase chain reaction (PCR) assay compared with an optimized culture method for GBS. MATERIAL AND METHODS: In the period from 12 May 2015 to 18 December 2015 we collected rectovaginal swabs from 106 women in the labor ward presenting in labor between gestational week 35+0 and 36+6 or presenting with prelabor/preterm prelabor rupture of membranes (PROM/PPROM) for > 14 h after gestational week 34+0 . We performed GBS culture (reference standard) and a molecular GBS test (Xpert GBS, Cepheid Ltd., Sunnyvale, CA, USA). RESULTS: Based on intrapartum culture, 23.6% (25/106) were colonized with GBS. Intrapartum PCR showed a colonization rate of 25.7% (27/105). The sensitivity of the test was 100% (86.28-100%). The specificity of the test was 97.5% (91.26-99.70%). The positive predictive value was 92.6%. In one case, we had no result with PCR testing, giving an invalid test rate of < 1%. CONCLUSION: The PCR test has sufficient accuracy to direct intrapartum antibiotic prophylaxis for GBS transmission during delivery.