Abstract
Objective
To compare the detection rates of vaginal-perineal cultures for group B streptococci
(GBS) with the standard vaginal and rectal cultures and evaluate the diagnostic yield
of vaginal-perineal vs. rectal swabs for extended spectrum β-lactamase producing Enterobacterales
(ESBL-E) during the third trimester of pregnancy.
Study design
Vagino-perineal and rectal swabs were collected cross-sectionally from pregnant women
between 35–37 weeks gestation and tested for the presence of GBS and ESBL-E. Accuracy
of the vagino-perineal swab was compared to the combined vagino-perineal/rectal swab.
Risk factors for ESBL carriage were examined. Degrees of pain, discomfort and stress
related to the rectal swab were analyzed on visual analogue scales.
Results
48 out of 250 participants (19.2%) were GBS positive. The vagino-perineal swab was
positive in 44 of 48 women (91.7%) yielding a negative predictive value of 98.1%.
Agreement (kappa) between the two methods was 0.95. Six out of 190 women with additional
ESBL-E screening (3.2%) tested positive by rectal swab. Of these, only two had also
a positive vagino-perineal swab. The rectal swab caused overall little subjective
discomfort, pain or stress, as indicated by low scores indicated on the visual scales.
Conclusions
The GBS detection rate of the vagino-perineal swab was lower compared to the reference
standard. However, agreement between the two screening methods was high and there
were no cases of GBS neonatal sepsis in the recruited population, supporting this
less invasive screening strategy. In contrast, the vaginal-perineal swab was inferior
to the rectal swab for detecting ESBL-E, indicating that this less invasive method
for detecting antibiotic resistant bacteria that may be potentially transferred to
the neonate during labor and delivery would be inappropriate for ESBL-E screening
in pregnant women. The low ESBL-E carriage rate among pregnant women likely reflects
the prevalence in the general population.
Keywords
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Article info
Publication history
Published online: July 19, 2019
Accepted:
July 18,
2019
Received in revised form:
July 16,
2019
Received:
April 11,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
