Antimicrobial resistance in colonizing group B Streptococci before the implementation of a Swedish intrapartum antibiotic prophylaxis program.

The prevalence of antibiotic resistance and their genetic determinants in colonizing group B streptococci (GBS) sampled in a Swedish nationwide survey was examined. In five GBS isolates (1.3%), kanamycin/amikacin resistance and the presence of the aphA-3 gene was identified. Three of these isolates carried the aad-6 gene and were streptomycin-resistant. Screening with kanamycin and streptomycin 1,000-µg disks enabled a rapid and easy detection of these isolates. In all, 312/396 (79%) GBS were tetracycline-resistant and 95% of the examined isolates harbored the tetM gene. Among the 22 (5.5%) GBS resistant to erythromycin and/or clindamycin, the ermB gene was detected in nine isolates (41%) and erm(A/TR) in ten isolates (45%). A high level of erythromycin and clindamycin resistance with minimum inhibitory concentrations (MICs) >256 mg/L was found in four serotype V isolates that harbored ermB. The erythromycin/clindamycin resistance was distributed among all of the common serotypes Ia, Ib, II, III, IV, and V, but was not present in any of the 44 serotype III isolates associated to clonal complex 17. Screening for penicillin resistance with 1-µg oxacillin disks showed a homogenous population with a mean inhibition zone of 20 mm. A change in the present oxacillin breakpoints for GBS is suggested.

Metabolic control and pregnancy outcome among women with insulin-dependent diabetes mellitus. A twelve-year follow-up in the country of Jämtland, Sweden.

OBJECTIVE: To assess metabolic control and pregnancy outcome in women with insulin-dependent diabetes mellitus (IDDM) in a defined rural area of Sweden and to compare results for three four-year periods (1982-85, 1986-89, 1990-93). MATERIAL AND METHOD: All pregnancies in women with IDDM during the 12-year period, 1982-93, received their antenatal care from a 'diabetic team' at the County Hospital, Ostersund. There were 50 women in the series, accounting for a total of 91 pregnancies. Spontaneous or induced abortions occurred in 19 cases. Case notes from maternity, neonatal and pediatric care were retrospectively scrutinized. RESULTS: In period one 31% of the pregnancies occurred in gravidae with diabetes classified as White D, F or R, as compared with 46% and 71% during periods two and three (p=0.001). Maternal hypertension was also more frequent in period three (12%, 26% and 54%, respectively; p=0.001). Fewer antenatal admissions (p=0.02) but more frequent ultrasound scannings (p=0.014) were recorded for period three. HbA1c levels decreased continuously from prepregnancy through first and third trimesters (9.7%, 8.4%, and 7.4%, respectively; p<0.0001). Perinatal mortality and frequencies of congenital malformations were both 4.2% (95% CI 0.5-8.8%), whereas the miscarriage rate was 14.3% (95% CI 6.8-21.8%). CONCLUSIONS: As compared with the first 4-year period, 1982-85, the third period, 1990-93, was characterized by a greater proportion of gravidae with more serious diabetes and a higher rate of pregnancy complications, though the outcome was nonetheless good, suggesting the diabetic pregnancy care program to have been efficacious.