Abstract
OBJECTIVES: To determine the in vitro resistance of group B streptococcus (GBS) to 12 antibiotics. To determine if there has been any decrease in sensitivity to the penicillins or other antibiotics currently used for GBS chemoprophylaxis in pregnant women. Find suitable alternative antibiotics to penicillin. Find an antibiotic that will have minimal selective pressure for resistance among the endogenous resident vaginal microflora. METHODS: The antibiotic susceptibility profiles of 52 clinical isolates of GBS were evaluated to 12 antibiotics: ampicillin, azithromycin, cefamandole, cefazolin, ceftriaxone, ciprofloxacin, clindamycin, erythromycin, nitrofurantoin, ofloxacin, penicillin and vancomycin. Antibiotic sensitivities were determined using disk diffusion and microdilution methods according to the guidelines of the National Committee for Clinical Laboratory Standards (NCCLS). RESULTS: All isolates were sensitive to vancomycin, ofloxacin, ampicillin, ciprofloxacin, nitrofurantoin and penicillin. However, the following number of clinical isolates exhibited intermediate or decreased sensitivity, nine (17%) to ampicillin, eight (15%) to penicillin, 14 (32%) to ciprofloxacin and one (2%) to nitrofurantoin. Thirty-one percent of the isolates were resistant to azithromycin and ceftriaxone, 19% to clindamycin, 15% to cefazolin and 13% to cefamandole. Eighteen (35%) of the clinical isolates tested were resistant to 6 of the 12 antibiotics tested. CONCLUSIONS: The relatively high rates of resistance for 6 of the 12 antibiotics tested suggest that for women allergic to penicillin and colonized with GBS, antibiotic sensitivities to their isolates should be determined. The antibiotic selected for intrapartum chemoprophylaxis should be guided by the organism's antibiotic sensitivity pattern. Patients with GBS bacteriuria should be treated with nitrofurantoin.
Full Text
The Full Text of this article is available as a PDF (81.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Amstey M. S., Gibbs R. S. Is penicillin G a better choice than ampicillin for prophylaxis of neonatal group B streptococcal infections? Obstet Gynecol. 1994 Dec;84(6):1058–1059. [PubMed] [Google Scholar]
- Betriu C., Gomez M., Sanchez A., Cruceyra A., Romero J., Picazo J. J. Antibiotic resistance and penicillin tolerance in clinical isolates of group B streptococci. Antimicrob Agents Chemother. 1994 Sep;38(9):2183–2186. doi: 10.1128/aac.38.9.2183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Blumberg H. M., Stephens D. S., Modansky M., Erwin M., Elliot J., Facklam R. R., Schuchat A., Baughman W., Farley M. M. Invasive group B streptococcal disease: the emergence of serotype V. J Infect Dis. 1996 Feb;173(2):365–373. doi: 10.1093/infdis/173.2.365. [DOI] [PubMed] [Google Scholar]
- Farley M. M., Harvey R. C., Stull T., Smith J. D., Schuchat A., Wenger J. D., Stephens D. S. A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med. 1993 Jun 24;328(25):1807–1811. doi: 10.1056/NEJM199306243282503. [DOI] [PubMed] [Google Scholar]
- Fernandez M., Hickman M. E., Baker C. J. Antimicrobial susceptibilities of group B streptococci isolated between 1992 and 1996 from patients with bacteremia or meningitis. Antimicrob Agents Chemother. 1998 Jun;42(6):1517–1519. doi: 10.1128/aac.42.6.1517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Harrison L. H., Ali A., Dwyer D. M., Libonati J. P., Reeves M. W., Elliott J. A., Billmann L., Lashkerwala T., Johnson J. A. Relapsing invasive group B streptococcal infection in adults. Ann Intern Med. 1995 Sep 15;123(6):421–427. doi: 10.7326/0003-4819-123-6-199509150-00004. [DOI] [PubMed] [Google Scholar]
- Levine E. M., Ghai V., Barton J. J., Strom C. M. Intrapartum antibiotic prophylaxis increases the incidence of gram-negative neonatal sepsis. Infect Dis Obstet Gynecol. 1999;7(4):210–213. doi: 10.1002/(SICI)1098-0997(1999)7:4<210::AID-IDOG10>3.0.CO;2-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lin L., Song J., Kimber N., Shott S., Tangora J., Aroutcheva A., Mazees M. B., Wells A., Cohen A., Faro S. The role of bacterial vaginosis in infection after major gynecologic surgery. Infect Dis Obstet Gynecol. 1999;7(3):169–174. doi: 10.1002/(SICI)1098-0997(1999)7:3<169::AID-IDOG10>3.0.CO;2-J. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Liu J. W., Wu J. J., Ko W. C., Chuang Y. C. Clinical characteristics and antimicrobial susceptibility of invasive group B streptococcal infections in nonpregnant adults in Taiwan. J Formos Med Assoc. 1997 Aug;96(8):628–633. [PubMed] [Google Scholar]
- Matushek M. G., Bonten M. J., Hayden M. K. Rapid preparation of bacterial DNA for pulsed-field gel electrophoresis. J Clin Microbiol. 1996 Oct;34(10):2598–2600. doi: 10.1128/jcm.34.10.2598-2600.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McDuffie R. S., Jr, McGregor J. A., Gibbs R. S. Adverse perinatal outcome and resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes and group B streptococcus carriage. Obstet Gynecol. 1993 Oct;82(4 Pt 1):487–489. [PubMed] [Google Scholar]
- Meyn L. A., Hillier S. L. Ampicillin susceptibilities of vaginal and placental isolates of group B streptococcus and Escherichia coli obtained between 1992 and 1994. Antimicrob Agents Chemother. 1997 May;41(5):1173–1174. doi: 10.1128/aac.41.5.1173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pearlman M. D., Pierson C. L., Faix R. G. Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin. Obstet Gynecol. 1998 Aug;92(2):258–261. doi: 10.1016/s0029-7844(98)00155-0. [DOI] [PubMed] [Google Scholar]
- Rouse D. J., Andrews W. W., Lin F. Y., Mott C. W., Ware J. C., Philips J. B., 3rd Antibiotic susceptibility profile of group B streptococcus acquired vertically. Obstet Gynecol. 1998 Dec;92(6):931–934. doi: 10.1016/s0029-7844(98)00263-4. [DOI] [PubMed] [Google Scholar]
- Schrag S. J., Zywicki S., Farley M. M., Reingold A. L., Harrison L. H., Lefkowitz L. B., Hadler J. L., Danila R., Cieslak P. R., Schuchat A. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med. 2000 Jan 6;342(1):15–20. doi: 10.1056/NEJM200001063420103. [DOI] [PubMed] [Google Scholar]
- Schuchat A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev. 1998 Jul;11(3):497–513. doi: 10.1128/cmr.11.3.497. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Schwartz B., Schuchat A., Oxtoby M. J., Cochi S. L., Hightower A., Broome C. V. Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta. JAMA. 1991 Aug 28;266(8):1112–1114. [PubMed] [Google Scholar]
- Tyrrell G. J., Senzilet L. D., Spika J. S., Kertesz D. A., Alagaratnam M., Lovgren M., Talbot J. A. Invasive disease due to group B streptococcal infection in adults: results from a Canadian, population-based, active laboratory surveillance study--1996. Sentinel Health Unit Surveillance System Site Coordinators. J Infect Dis. 2000 Jun 29;182(1):168–173. doi: 10.1086/315699. [DOI] [PubMed] [Google Scholar]
- Wessels M. R., Kasper D. L. The changing spectrum of group B streptococcal disease. N Engl J Med. 1993 Jun 24;328(25):1843–1844. doi: 10.1056/NEJM199306243282510. [DOI] [PubMed] [Google Scholar]
