Clayton Salano
Women Health Project, Mombasa Kenya - Laboratory coordinator
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I first became interested in group B streptococcus research when I observed an increase in streptococcus bacteria in vaginal smear slides of pregnant women compared to nonpregnant women in a study I worked on as a research assistant. This observation led me to do a study on the rectovaginal prevalence of GBS in our population, an area that had received little focus. This study was part of my MSc studies at the University of Nairobi. After my master's studies, I took a Ph.D. fellowship in infectious diseases and global health at the University of Manitoba. As part of this, I followed up on my Msc study by conducting a study on the vertical transmission of GBS in our population. This study is ongoing and the results will be out in 2024. To advance my research skills, I have taken courses in research management, conducting research, and project management. I also work as a laboratory coordinator in multisite clinical trials. My interest in GBS led to join the Young ISSAD committee to promote GBS research and raise awareness of the same.
Prevalence, antimicrobial susceptibility patterns, serotypes and risk factors for group B streptococ
Background/ hypothesis
Estimates of Group B Streptococcus (GBS) disease burden, antimicrobial susceptibility, and serotypes in pregnant women are limited for many resource-limited countries including Kenya. We evaluated the prevalence, antimicrobial susceptibility patterns, serotypes, and risk factors associated with rectovaginal GBS colonization among pregnant women receiving antenatal care at Kenyatta National Hospital (KNH) between August and November 2017.
Methods
Consenting pregnant women between 12 and 40 weeks of gestation were enrolled. An anorectal swab and a lower vaginal swab were collected and cultured on Granada agar for GBS isolation. Positive colonies were tested for antimicrobial susceptibility to penicillin G, ampicillin, vancomycin, and clindamycin. Serotyping was performed by latex agglutination. Logistic regression was used to identify factors associated with GBS colonization.
Results
A total of 292 women were enrolled. The median age was 30 years (Interquartile range {IQR} 26–35) with a median gestational age of 35 weeks (IQR 30-37). Overall GBS was identified in 20.5% of participants. Antimicrobial resistance was at 72.4% against penicillin G, ampicillin (55.2%), clindamycin (30.4%), and vancomycin (24.1%). All ten GBS serotypes were isolated with 69.8% of GBS-positive participants being colonized by more than one serotype. None of the risk factors was associated with GBS colonization.
Conclusion
The prevalence of GBS colonization was high among antenatal women at KNH with a high proportion of GBS isolates being resistant to commonly prescribed intrapartum antibiotics. Hence, other measures like GBS vaccination are potentially useful approaches to GBS prevention and control in this population. Screening of pregnant mothers for GBS colonization should be introduced and antimicrobial susceptibility tests performed on GBS-positive samples to guide antibiotic prophylaxis
Association between vaginal washing and GBS colonization in women seeking pregnancy
Introduction
Vaginal washing has no known health benefits and has been associated with adverse reproductive health outcomes. This analysis tested the hypothesis that vaginal washing is associated with group B streptococcus (GBS) colonization during the periconception period and the first trimester of pregnancy.
Method
Women planning pregnancies contributed monthly visits during which vaginal fluid specimens were collected and urine pregnancy testing was performed. In women who became pregnant, additional vaginal fluid samples were collected at 9-12 weeks gestation. Broad-range 16S rRNA gene PCR with next-generation sequencing was performed to identify bacterial species. Generalized estimating equations with a log link, Poisson family, and independent correlation structure were used to generate prevalence ratios comparing the prevalence of GBS detection at vaginal washing visits versus non-vaginal washing visits.
Results
The 196 women who became pregnant contributed 506 samples collected at periconception 196 (38.9%), early first trimester 151 (29.8%), and first trimester 159 (31.4%) visits. The prevalence of GBS at the three time periods was 20/196 (10.2%), 11/151 (7.3%), and 2/159 (1.3%) respectively. Recent vaginal washing was reported by 51/196 (26.0%), 27/151 (17.9%), and 32/159 (20.1%) participants at the three-time points. Compared to visits with no vaginal washing, there was no increased prevalence of GBS detection at visits where vaginal washing with water was reported (PR 0.51, 95% CI 0.16 - 1.62), but the prevalence of GBS detection was substantially higher at visits when vaginal washing using water and soap was reported (PR 4.66, 95% CI 1.51, 14.33) (Table 1).
Conclusion
Vaginal washing with soap and water was associated with more than four-fold higher GBS prevalence during the periconception period and first trimester. Our findings underscore the need for strategies to discourage this practice.
Clayton Salano
Women Health Project, Mombasa Kenya - Laboratory coordinator
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