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Maternal Carriage of Group B Streptococcus and Escherichia coli in a District Hospital in Mozambique

Madrid, Lola, MD, MSc*,†; Maculuve, Sonia Amós, MD*; Vilajeliu, Alba, MD, MSc; Sáez, Emma, MD, MSc, PhD; Massora, Sergio, MSc*; Cossa, Anelsio*; Varo, Rosauro, MD, MSc*,†; Sitoe, Antonio, MD*; Mosqueda, Noraida; Anselmo, Rui*; Munguambe, Khatia, MSc, PhD*; Soto, Sara M., PhD; Moraleda, Cinta, MD, MSc, PhD*,§; Macete, Eusebio, MD, PhD*; Menéndez, Clara, MD, MSc, PhD*,†,¶; Bassat, Quique, MD, MSc, PhD*,†,‖,**

The Pediatric Infectious Disease Journal: November 2018 - Volume 37 - Issue 11 - p 1145–1153
doi: 10.1097/INF.0000000000001979
Maternal-Neonatal Reports

Background: In low-income countries, data on prevalence and effects of group B Streptococcus (GBS) and Escherichia coli (E. coli) colonization among pregnant women are scarce, but necessary to formulate prevention strategies. We assessed prevalence of GBS and E. coli colonization and factors associated among pregnant women, its effect in newborns and acceptability regarding the utilized sampling methods in a semirural Mozambican hospital.

Methods: Pregnant women were recruited from June 2014 to January 2015, during routine antenatal clinics at gestational age ≥ 34 weeks (n = 200); or upon delivery (n = 120). Maternal risk factors were collected. Vaginal and vagino-rectal samples for GBS and E. coli determination were obtained and characterized in terms of antimicrobial resistance and serotype. Anti-GBS antibodies were also determined. Neonatal follow-up was performed in the first 3 months after birth. Semistructured interviews were performed to investigate acceptability of sample collection methods.

Results: In total, 21.3% of women recruited were GBS carriers, while 16.3% were positive for E. coli. Prevalence of HIV was 36.6%. No association was found between being colonized by GBS and E. coli and maternal risk factors. GBS isolates were fully susceptible to penicillin and ampicillin. Serotypes V (32.4%), Ia (14.7%) and III (10.3%) were the most commonly found and 69.2% of the women tested had immunoglobuline G antibodies against GBS. E. coli isolates showed resistance to ampicillin in 28.9% and trimethoprim/sulfamethoxazole in 61.3% of the cases.

Conclusion: Prevalence of GBS and/or E. coli colonization among pregnant women is high in this semirural community and comparable with those reported in similar settings. Four serotypes accounted for nearly 70% of all isolates of GBS. Population-based data on infant GBS infections would enable the design of prevention strategies for GBS disease in Mozambique.

From the *Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique

ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain

Gavi, the Vaccine Alliance, Geneva, Switzerland

§Sección de Enfermedades Infecciosas de Pediatría, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de investigación Hospital 12 de Octubre, Madrid, Spain

Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain

Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain

**ICREA, Pg. Lluís Companys 23, 08010 Barcelona, Spain.

Accepted for publication January 7, 2018.

Supported by Instituto de Salud Carlos III (ISCIII) through a program Miguel Servet obtained by Quique Bassat (Plan Nacional de I+D+I 2008–2011, grant number: CP11/00269). Sara M. Soto has a fellowship from the program I3, of the ISCIII. During the duration of the study, Lola Madrid had a fellowship from the program Rio Hortega of the ISCIII (grant no.: CP13/00260). The CISM receives financial support from the Spanish Agency for International Cooperation. SM, AV, ES, SM, AC, RV, AN, NM, RA, KM, CM, EM and CM have nothing to declare.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Lola Madrid, MD, MSc, ISGlobal, Rosselló 132, 4-2ª, 08036, Barcelona, Spain. E-mail: lola.madrid@isglobal.org.

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