Abstract
In our nursery, we identified neonates with positive urine latex particle agglutination (LPA) tests for group B streptococcus (GBS) antigen who did not have corroborating cultural evidence of infection. To investigate the mechanisms underlying these apparent false-positive reactions, we examined the urine LPA test in an unselected population of neonates suspected of sepsis. Urine specimens for LPA testing and culture and simultaneous perirectal cultures were obtained from 134 neonates with suspected sepsis. Six infants had positive blood cultures for GBS; four of the six were positive by LPA testing. An additional 20 infants had positive LPA tests but negative blood cultures; of these, 13 had mothers who received antibiotic treatment prior to delivery. Two infants with positive LPA results and negative blood cultures had bacteria isolated from urine cultures obtained in a nonsterile fashion (GBS, Escherichia coli). GBS was not isolated from perirectal swabs of infants with positive LPA tests and negative blood cultures. In conclusion, (i) a high proportion of neonates evaluated for sepsis gave positive LPA tests and negative blood cultures, (ii) local contamination of the perirectal skin or urinary tract with GBS was an unlikely source of false-positive LPA reactions, and (iii) maternal antibiotic pretreatment during labor may represent an important cause of apparent false-positive LPA reactions.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baker C. J., Clark D. J., Barrett F. F. Selective broth medium for isolation of group B streptococci. Appl Microbiol. 1973 Dec;26(6):884–885. doi: 10.1128/am.26.6.884-885.1973. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Baker C. J., Rench M. A. Commercial latex agglutination for detection of group B streptococcal antigen in body fluids. J Pediatr. 1983 Mar;102(3):393–395. doi: 10.1016/s0022-3476(83)80657-x. [DOI] [PubMed] [Google Scholar]
- Baker C. J., Webb B. J., Jackson C. V., Edwards M. S. Countercurrent immunoelectrophoresis in the evaluation of infants with group B streptococcal disease. Pediatrics. 1980 Jun;65(6):1110–1114. [PubMed] [Google Scholar]
- Boyer K. M., Gadzala C. A., Kelly P. D., Gotoff S. P. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. III. Interruption of mother-to-infant transmission. J Infect Dis. 1983 Nov;148(5):810–816. doi: 10.1093/infdis/148.5.810. [DOI] [PubMed] [Google Scholar]
- Boyer K. M., Gotoff S. P. Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. N Engl J Med. 1986 Jun 26;314(26):1665–1669. doi: 10.1056/NEJM198606263142603. [DOI] [PubMed] [Google Scholar]
- Bromberger P. I., Chandler B., Gezon H., Haddow J. E. Rapid detection of neonatal group B streptococcal infections by latex agglutination. J Pediatr. 1980 Jan;96(1):104–106. doi: 10.1016/s0022-3476(80)80340-4. [DOI] [PubMed] [Google Scholar]
- Freedman R. M., Ingram D. L., Gross I., Ehrenkranz R. A., Warshaw J. B., Baltimore R. S. A half century of neonatal sepsis at Yale: 1928 to 1978. Am J Dis Child. 1981 Feb;135(2):140–144. doi: 10.1001/archpedi.1981.02130260032010. [DOI] [PubMed] [Google Scholar]
- Friedman C. A., Wender D. F., Rawson J. E. Rapid diagnosis of group B streptococcal infection utilizing a commercially available latex agglutination assay. Pediatrics. 1984 Jan;73(1):27–30. [PubMed] [Google Scholar]
- Hamoudi A. C., Marcon M. J., Cannon H. J., McClead R. E. Comparison of three major antigen detection methods for the diagnosis of Group B streptococcal sepsis in neonates. Pediatr Infect Dis. 1983 Nov-Dec;2(6):432–435. doi: 10.1097/00006454-198311000-00004. [DOI] [PubMed] [Google Scholar]
- Harris M. C., Polin R. A. Neonatal septicemia. Pediatr Clin North Am. 1983 Apr;30(2):243–258. doi: 10.1016/s0031-3955(16)34355-3. [DOI] [PubMed] [Google Scholar]
- Ingram D. L., Pendergrass E. L., Bromberger P. I., Thullen J. D., Yoder C. D., Collier A. M. Group B streptococcal disease: its diagnosis with the use of antigen detection, Gram's stain, and the presence of apnea, hypotension. Am J Dis Child. 1980 Aug;134(8):754–758. doi: 10.1001/archpedi.1980.02130200024009. [DOI] [PubMed] [Google Scholar]
- Ingram D. L., Suggs D. M., Pearson A. W. Detection of group B streptococcal antigen in early-onset and late-onset group B streptococcal disease with the Wellcogen Strep B latex agglutination test. J Clin Microbiol. 1982 Oct;16(4):656–658. doi: 10.1128/jcm.16.4.656-658.1982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Morrow D. L., Kline J. B., Douglas S. D., Polin R. A. Rapid detection of group B streptococcal antigen by monoclonal antibody sandwich enzyme assay. J Clin Microbiol. 1984 Apr;19(4):457–459. doi: 10.1128/jcm.19.4.457-459.1984. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pass M. A., Gray B. M., Khare S., Dillon H. C., Jr Prospective studies of group B streptococcal infections in infants. J Pediatr. 1979 Sep;95(3):437–443. doi: 10.1016/s0022-3476(79)80531-4. [DOI] [PubMed] [Google Scholar]
- Rabalais G. P., Bronfin D. R., Daum R. S. Evaluation of a commercially available latex agglutination test for rapid diagnosis of group B streptococcal infection. Pediatr Infect Dis J. 1987 Feb;6(2):177–181. doi: 10.1097/00006454-198702000-00007. [DOI] [PubMed] [Google Scholar]
- Squire E., Favara B., Todd J. Diagnosis of neonatal bacterial infection: hematologic and pathologic findings in fatal and nonfatal cases. Pediatrics. 1979 Jul;64(1):60–64. [PubMed] [Google Scholar]
- Yow M. D., Mason E. O., Leeds L. J., Thompson P. K., Clark D. J., Gardner S. E. Ampicillin prevents intrapartum transmission of group B streptococcus. JAMA. 1979 Mar 23;241(12):1245–1247. [PubMed] [Google Scholar]