A Multi-Country Cross-Sectional Study of Vaginal Carriage of Group B Streptococci (GBS) and <i>Escherichia coli</i> in Resource-Poor Settings: Prevalences and Risk Factors



Cools, Piet, Jespers, Vicky, Hardy, Liselotte, Crucitti, Tania, Delany-Moretlwe, Sinead, Mwaura, Mary, Ndayisaba, Gilles F, van de Wijgert, Janneke HHM ORCID: 0000-0003-2728-4560 and Vaneechoutte, Mario
(2016) A Multi-Country Cross-Sectional Study of Vaginal Carriage of Group B Streptococci (GBS) and <i>Escherichia coli</i> in Resource-Poor Settings: Prevalences and Risk Factors. PLOS ONE, 11 (1). e0148052-.

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Abstract

<h4>Background</h4>One million neonates die each year in low- and middle-income countries because of neonatal sepsis; group B Streptococcus (GBS) and Escherichia coli are the leading causes. In sub-Saharan Africa, epidemiological data on vaginal GBS and E. coli carriage, a prerequisite for GBS and E. coli neonatal sepsis, respectively, are scarce but necessary to design and implement prevention strategies. Therefore, we assessed vaginal GBS and E. coli carriage rates and risk factors and the GBS serotype distribution in three sub-Saharan countries.<h4>Methods</h4>A total of 430 women from Kenya, Rwanda and South Africa were studied cross-sectionally. Vaginal carriage of GBS and E. coli, and GBS serotype were assessed using molecular techniques. Risk factors for carriage were identified using multivariable logistic regression analysis.<h4>Results</h4>Vaginal carriage rates in reference groups from Kenya and South Africa were 20.2% (95% CI, 13.7-28.7%) and 23.1% (95% CI, 16.2-31.9%), respectively for GBS; and 25.0% (95% CI, 17.8-33.9%) and 27.1% (95% CI, 19.6-36.2%), respectively for E. coli. GBS serotypes Ia (36.8%), V (26.3%) and III (14.0%) were most prevalent. Factors independently associated with GBS and E. coli carriage were Candida albicans, an intermediate vaginal microbiome, bacterial vaginosis, recent vaginal intercourse, vaginal washing, cervical ectopy and working as a sex worker. GBS and E. coli carriage were positively associated.<h4>Conclusions</h4>Reduced vaginal GBS carriage rates might be accomplished by advocating behavioral changes such as abstinence from sexual intercourse and by avoidance of vaginal washing during late pregnancy. It might be advisable to explore the inclusion of vaginal carriage of C. albicans, GBS, E. coli and of the presence of cervical ectopy in a risk- and/or screening-based administration of antibiotic prophylaxis. Current phase II GBS vaccines (a trivalent vaccine targeting serotypes Ia, Ib, and III, and a conjugate vaccine targeting serotype III) would not protect the majority of women against carriage in our study population.

Item Type: Article
Uncontrolled Keywords: Vagina, Humans, Escherichia coli, Streptococcus agalactiae, Candida albicans, Escherichia coli Infections, Streptococcal Infections, Prevalence, Risk Factors, Follow-Up Studies, Cross-Sectional Studies, Carrier State, Demography, Adolescent, Adult, Kenya, Rwanda, South Africa, Female, Young Adult, Serogroup
Depositing User: Symplectic Admin
Date Deposited: 15 Dec 2017 10:49
Last Modified: 05 Oct 2023 11:37
DOI: 10.1371/journal.pone.0148052
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3014236