Late antenatal carriage of group B <i>Streptococcus</i> by New Zealand women

Abstract

OBJECTIVES: To determine in New Zealand women the prevalence of group B Streptococcus (GBS) carriage late in pregnancy and to identify GBS colonisation risk factors, antibiotic susceptibility and serotype distribution. DESIGN: Prospective, observational study. SETTING: Community and hospital antenatal clinics in Wellington and Auckland during 1998-1999. SAMPLE: Convenience sample of 240 women between 35-37 weeks gestation. METHODS: Sociodemographic data, obstetric details and anogenital swabs were collected from each subject. Swabs were inoculated into selective media. GBS isolates underwent serotyping and antibiotic susceptibility testing. RESULTS: Two hundred and forty women (9% Maori, 11% Pacific) aged 15-41 years were recruited. Fifty-two (22%; 95% CI 17, 27) were colonised by GBS. Carriage was independently associated with younger age (59% < or = 30 years; adjusted OR 3.25; 95% CI 1.53, 6.95) and least social deprivation (57% NZ Dep 96 score +/- 3; adjusted OR 1.22; 95% CI 1.06,1.39). All GBS isolates were penicillin-susceptible, but resistance to clindamycin (15%) and erythromycin (7.5%) was detected and associated with serotype V strains. Predominant serotypes were: III (29%), Ia (21%), Ib (20%) and V (20%). CONCLUSIONS: Approximately 20% of New Zealand women carry GBS late in pregnancy, with young age a major risk factor. Increased risk in the socially advantaged, development of resistance to erythromycin and clindamycin, and emergence of new GBS serotypes are findings with important implications for prevention strategies requiring further confirmation.