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Evaluation of a pattern of culture for detecting Streptococcus agalactiae carriage using GBS modified medium
Evaluación de una pauta de detección de colonización vaginorrectal por Streptococcus agalactiae usando medio de cultivo GBS modified
Jerónimo Jaqueti
, Laura Molina, Isabel García-Arata, Santiago Prieto-Menchero
Corresponding author
Laboratorio Clínico, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
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"cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Evaluation of a pattern of culture for detecting <span class="elsevierStyleItalic">Streptococcus agalactiae</span> carriage using GBS modified medium" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "682" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jerónimo Jaqueti, Laura Molina, Isabel García-Arata, Santiago Prieto-Menchero" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Jerónimo" "apellidos" => "Jaqueti" "email" => array:1 [ 0 => "jeronimo.jaqueti@salud.madrid.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Laura" "apellidos" => "Molina" ] 2 => array:2 [ "nombre" => "Isabel" "apellidos" => "García-Arata" ] 3 => array:2 [ "nombre" => "Santiago" "apellidos" => "Prieto-Menchero" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Laboratorio Clínico, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de una pauta de detección de colonización vaginorrectal por <span class="elsevierStyleItalic">Streptococcus agalactiae</span> usando medio de cultivo GBS <span class="elsevierStyleItalic">modified</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The detection of colonisation by <span class="elsevierStyleItalic">Streptococcus agalactiae</span> (GBS) using a culture of rectovaginal exudate (RVE) in weeks 35–37 of pregnancy and intrapartum antibiotic prophylaxis have proven to be effective in the prevention of vertical transmission of GBS.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The use of Granada medium (GM) and of chromogenic media, which enable easier identification of group B streptococcus (GBS) and seem to have a greater or similar sensitivity to the use of enrichment broth (EB) and subculture in blood agar, has been widespread for a number of years.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the Spanish Recommendations updated in 2012, several options for the processing of the sample were listed: incubation of the RVE in Todd-Hewitt EB with gentamicin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>nalidixic acid or with colistin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>nalidixic acid and subculture in blood agar; direct seeding of the sample in Granada broth; direct seeding in a plate of GM and in EB, and subculture this if the plate is negative after 18–24<span class="elsevierStyleHsp" style=""></span>h; or seed directly in a plate of GM and incubate in anaerobiosis until 48<span class="elsevierStyleHsp" style=""></span>h.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The characteristics of the culture medium GBS modified agar (RPD Microbiology), modification of the New Granada Medium, have been evaluated in our laboratory for the detection of GBS in RVE. According to the summary of product characteristics for the medium, the modifications consist of the suppression of glucose and pyruvate and the reduction of the starch content and increased horse serum.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The RVE in Amies transport medium were preserved at room temperature until they were seeded, firstly in half of a plate of GBS, and then in a tube with Todd-Hewitt broth (Todd Hewitt with gentamicin and nalidixic acid, Becton Dickinson, Sparks, MD, USA; or Todd-Hewitt with CNA, Oxoid, Wesel, Germany) incubated at 37<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> for 20–24<span class="elsevierStyleHsp" style=""></span>h, with subsequent reseeding in the other half of the same plate of GBS. All the plates were incubated until 48<span class="elsevierStyleHsp" style=""></span>h in a CO<span class="elsevierStyleInf">2</span> atmosphere, placing a cover slip on the seeding area, in accordance with the method described by Rosa-Fraile et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The unclear colonies (not clearly orange) were checked using a specific agglutination test (Pastorex Strep B, Bio-Rad, Marnes-la-Coquette, France).</p><p id="par0030" class="elsevierStylePara elsevierViewall">A total of 80 RVE were seeded simultaneously in GBS and in GM (Becton Dickinson GmbH, Germany).</p><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 436 RVE were processed in GBS. In the direct seeding there were 73 positives (16.7%) and 79 (18.1%) in the seeding after enrichment. Taking into account both patterns, 84 positive results (19.3%) were obtained. The sensitivity, considering the sum of the positive results for any of the two patterns as the gold standard, was 86.9% for the direct seeding and 94.1% for the seeding after enrichment (non-significant differences, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.113). The kappa index was 0.863.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 18 discrepancies were observed: in 12 GBS was isolated only in subculture after enrichment, and in the other six, only in direct culture.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the comparison with GM, GBS was isolated in 21 cases: 19 by both media, one only in GM and another only in GBS (in both, after the subculture from Todd-Hewitt broth). The concordance was 97.5% and the kappa index was 0.933.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Previously, differences were reported in the results when comparing the direct seeding and an EB and subculture, attributable to various factors.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,5–7</span></a> The Todd-Hewitt broth may improve the detection in samples with limited concentration of GBS<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a>, while the false negatives observed in the subculture could be due to overgrowth of other bacteria, in particular Enterococci or resistant Gram-negative bacteria, such as <span class="elsevierStyleItalic">Pseudomonas</span> or <span class="elsevierStyleItalic">Proteus</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a>. There may also be differences in the concentration of the inoculum, as some seedings are done directly from the swab and others from the EB.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although a good concordance is observed between both patterns and the differences are not significant, the sensitivity is greater in the seeding after culture. The culture using both patterns in the same plate increases the detection of colonised pregnant women without a significant cost increase, and the use of the same plate for each patient makes it impossible to have cross-contamination. The growth in the direct seeding makes it possible to bring the diagnosis forward by one day in most cases.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Lastly, a good concordance has been observed when comparing the results of GBS modified agar with those of GM.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from public or commercial sector agencies or non-profit organisations.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jaqueti J, Molina L, García-Arata I, Prieto-Menchero S. Evaluación de una pauta de detección de colonización vaginorrectal por <span class="elsevierStyleItalic">Streptococcus agalactiae</span> usando medio de cultivo GBS <span class="elsevierStyleItalic">modified</span>. Enferm Infecc Microbiol Clin. 2019. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.eimc.2018.12.005">https://doi.org/10.1016/j.eimc.2018.12.005</span></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Declive de la incidencia de la sepsis perinatal por estreptococo del grupo B (Barcelona 1994–2001). Relación con las políticas profilácticas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Andreu" 1 => "I. Sanfeliu" 2 => "L.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 17 | 9 | 26 |
| 2024 September | 6 | 4 | 10 |
| 2024 August | 9 | 4 | 13 |
| 2024 July | 12 | 6 | 18 |
| 2024 June | 9 | 4 | 13 |
| 2024 May | 8 | 1 | 9 |
| 2024 April | 19 | 3 | 22 |
| 2024 March | 11 | 2 | 13 |
| 2024 February | 7 | 1 | 8 |
| 2024 January | 14 | 2 | 16 |
| 2023 December | 21 | 6 | 27 |
| 2023 November | 11 | 5 | 16 |
| 2023 October | 9 | 2 | 11 |
| 2023 September | 11 | 1 | 12 |
| 2023 August | 7 | 0 | 7 |
| 2023 July | 5 | 1 | 6 |
| 2023 June | 9 | 0 | 9 |
| 2023 May | 9 | 3 | 12 |
| 2023 April | 4 | 0 | 4 |
| 2023 March | 9 | 3 | 12 |
| 2023 February | 7 | 2 | 9 |
| 2023 January | 8 | 3 | 11 |
| 2022 December | 9 | 1 | 10 |
| 2022 November | 10 | 6 | 16 |
| 2022 October | 10 | 6 | 16 |
| 2022 September | 7 | 6 | 13 |
| 2022 August | 12 | 14 | 26 |
| 2022 July | 7 | 6 | 13 |
| 2022 June | 6 | 6 | 12 |
| 2022 May | 13 | 4 | 17 |
| 2022 April | 9 | 8 | 17 |
| 2022 March | 11 | 5 | 16 |
| 2022 February | 14 | 5 | 19 |
| 2022 January | 14 | 4 | 18 |
| 2021 December | 14 | 13 | 27 |
| 2021 November | 11 | 7 | 18 |
| 2021 October | 6 | 6 | 12 |
| 2021 September | 8 | 10 | 18 |
| 2021 August | 12 | 7 | 19 |
| 2021 July | 5 | 5 | 10 |
| 2021 June | 13 | 6 | 19 |
| 2021 May | 14 | 11 | 25 |
| 2021 April | 19 | 10 | 29 |
| 2021 March | 14 | 7 | 21 |
| 2021 February | 5 | 5 | 10 |
| 2021 January | 9 | 6 | 15 |
| 2020 December | 8 | 5 | 13 |
| 2020 November | 6 | 3 | 9 |
| 2020 October | 6 | 2 | 8 |
| 2020 September | 5 | 6 | 11 |
| 2020 August | 12 | 7 | 19 |
| 2020 July | 6 | 3 | 9 |
| 2020 June | 9 | 2 | 11 |
| 2020 May | 1 | 0 | 1 |
| 2019 December | 2 | 2 | 4 |
Show all
