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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Intraamniotic infection is a common (2-4%) event in labor. The predictors of IAI include preterm labor or rupture of membranes, abnormal vaginal flora (e.g., GBS, sexually transmitted disease, bacterial vaginosis), obstetric manipulations (e.g., vaginal exams, internal fetal monitoring) in the presence of ruptured membranes, and diminished host response (due to smoking, drug abuse, obesity, immunodeficiency states, etc.). Group B Streptococcus and Enterobacteriaceae are the most important organisms associated with the polymicrobial infection. Anaerobes predict post-cesarean section complications. Neonatal pneumonia (2-5%) and early neonatal sepsis (1-4%) are the outcomes of the greatest concern and are caused by group B streptococcal or aerobic gram-negative rod infections. These outcomes are kept to a minimum if maternal antibiotic chemotherapy is started interpartum with agents that are safe, cross the placenta, and are active against GBS and Escherichia coli (e.g., ampicillin plus gentamicin). Anaerobic coverage should be added (clindamycin) if a cesarean section is performed. Antipyretics such as acetaminophen will reduce the hyperthermic stress on the fetus, and persistent fetal tachycardia after antipyretics may indicate fetal infection. Continuous electronic fetal monitoring is appropriate in cases of IAI, and providers should be prepared for neonatal resuscitation, early neonatal intravenous antibiotics, and respiratory support at delivery.
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PMID:Chorioamnionitis and intraamniotic infection. 829 82

Early-onset group B streptococci (GBS-EOS) sepsis may be prevented by intrapartum antibiotics administered for GBS maternal colonization, premature labor, or prolonged rupture of membranes. We sought to identify cases of neonatal GBS sepsis after apparent failure of intrapartum chemotherapy and to determine the factors associated with failure of intrapartum antibiotics in these cases. We identified 96 GBS blood culture-positive infants at five military medical centers from 1987 to 1990. Eighteen (18.7%) of these infants had mothers who had received intrapartum antibiotics; 16 of 18 cases were early-onset disease, 15 of which initially had symptoms at less than 1 hour of age. Two infants had late-onset disease develop at 3 weeks of age. At least one perinatal risk factor (prematurity, prolonged rupture of membranes > 12 hours, maternal fever) was present in each of the 16 cases. Indications for intrapartum antibiotics were suspected chorioamnionitis (13 cases), GBS colonization and prolonged rupture of membranes or prematurity (3), and GBS colonization alone (2). Maternal antibiotics included ampicillin (14 cases), cephadyl (1), vancomycin (1), clindamycin (1), and gentamicin alone (1). The median number of doses of ampicillin before delivery was 1 (range, 1 to 21), which was administered at a median of 4 hours (range, 1 to 84) before birth. The mean dose of ampicillin was 1.8 gm/dose (range, 1 to 2 gm/dose). Two of 16 (12.5%) infants with GBS-EOS died as a result of GBS sepsis. In our population of neonates with GBS-EOS, 18.4% (16 of 87) of the infants had positive blood cultures despite intrapartum antibiotics. Intrapartum antibiotics may fail to prevent GBS sepsis in a number of infants born to mothers colonized with GBS or to those with acute chorioamnionitis.
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PMID:Failure of intrapartum antibiotics to prevent culture-proved neonatal group B streptococcal sepsis. 816 86

Streptococci of Lancefield Group B (GBS) are known to cause maternal sepsis and neonatal infection, whereas streptococci Lancefield Group A (GAS) cause vulvo-vaginitis in both children and adults. Prevalence of SGB colonization of the lower genital tract of normal women is between 4-18%, with higher rates found in hospital personnel and delivery rooms. Such high carriage rates may be a significant factor in nosocomial transmission of GBS to neonates. Symptomatic infection is uncommon and usually secondary to other pathological states. Amnionitis is a complication of vaginal carriage of GBS and there is now evidence that chorioamnionitis is associated with pre-term labour and its attendant problems. GBS infection of the male genitalia has also been described. Intrapartum chemoprophylaxis has been shown to prevent early onset GBS disease of the neonate. Prevalence of GAS in the genital tract is lower than that for GBS, but is more likely to be symptomatic. The response to penicillin is usually prompt. Optimal drug regimens need to be determined, particularly for use in pregnancy.
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PMID:Streptococci and the genital tract. 884 14

In the last few years the importance of GBS as the cause of serious neonatal sepsis has become more evident. The number of cases of this infection clearly exceeds the number of other congenital infections, for which antenatal screening is performed. Asymptomatic colonization of the genital tract of the pregnant woman has the most important role in transmission of GBS and several risk factors are connected to neonatal infection. In order to assess the epidemiological situation in Tuscany, 5079 pregnant women have been recruited by the Obstetrical Department of 16 Hospitals and evaluated for the vaginal colonization by GBS. 3654 couples mother-neonate have also been studied to ascertain the transmission of this germ to the neonate. A vaginal swab was collected at the admission to the Hospital at delivery-time and swabs from several sites of the neonate were obtained just after birth. A blood-agar culture and a latex agglutination test were employed to detect the GBS. GBS was present in 6.6% of the vaginal cultures, with a wide variation in colonization rates. 2.2% of the neonates were positive. The transmission of GBS from the positive mother to the neonate occurred in 20% of the cases. Furthermore one positive neonate out of three was born from a negative mother. No correlation between GBS positivity and preterm delivery was found. The rates of prevalence of GBS in our population, both mother and neonates, suggest a situation that can no longer be neglected. Our data are probably underestimated because of the low sensibility of the culture method. A preventive strategy has to be employed to avoid serious neonatal sepsis. An antenatal screening that provides a vaginal culture at the 36th week of gestation and a chemoprophylaxis intra-partum in the positive cases appears to be the most effective approach.
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PMID:[Vaginal colonization of Streptococcus B in pregnancy]. 892 82

The release of endogenous vasoconstrictors together with changes in the vascular responses are central to the pathophysiology of sepsis. The effects of in vitro incubation for 20 h with heat-killed group B Streptococcus (GBS, 3 x 10(7) colony-forming units mL-1) on the vasoconstrictor responses to noradrenaline (NA, 10(-8) to 10(-4) M), the thromboxane A2 analog 9,11-dideoxy-11 alpha, 9 alpha-epoxymethanoprostaglandin F2 alpha (U46619; 10(-10) M to 10(-6) M) and endothelin-1 (ET-1, 10(-11) to 3 x 10(-9) M) were evaluated on isolated intrapulmonary and mesenteric arteries from 10-17-d-old piglets. The incubation with GBS reduced the maximal contractile response to NA and ET-1 (p < 0.01) in both arteries. The nitric oxide (NO) synthase (NOS) inhibitor N omega-nitro-L-arginine methyl ester (L-NAME; 10(-4) M) completely reversed this hyporesponsiveness. GBS-treated mesenteric arteries also showed a significant reduction of the maximal contractions induced by U46619 (p < 0.05) and this effect was inhibited by 10(-4) M L-NAME. In contrast, the maximal contractile responses to U46619 were similar in control and in GBS-treated pulmonary arteries. Addition of L-NAME did not modify the contractile responses to U46619 in GBS-treated pulmonary arteries. In conclusion, GBS-treated systemic arteries from neonatal piglets showed decreased responses to NA, U46619, and ET-1 due to enhanced NO release. GBS-treated pulmonary arteries also exhibited decreased responses to NA and ET-1 but not to U46619. Induction of NOS in vascular smooth muscle may play a key role in the hypotension and loss of systemic vascular responsiveness that occurs in GBS sepsis. The absence of pulmonary hyporesponsiveness to U46619 may partially explain the coexistence during sepsis of pulmonary hypertension and lung NOS induction.
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PMID:Effects of group B Streptococcus on the responses to U46619, endothelin-1, and noradrenaline in isolated pulmonary and mesenteric arteries of piglets. 894 58

Antibiotic treatment of the patient with preterm premature rupture of membranes remote from term significantly prolongs pregnancy and reduces amnionitis without increasing the risk of cesarean delivery. Antibiotic treatment reduces perinatal infectious morbidity including neonatal sepsis, GBS sepsis, and pneumonia. Stratified analysis of the currently available prospective trials also demonstrates a significant reduction in gestational-dependent morbidity, specifically respiratory distress and intraventricular hemorrhage with treatment. This is supported by a reduction in composite infant morbidity and other gestational age-dependent morbidities in the NICHD-MFMU trial. Although the optimal treatment regimen has not been determined, limited duration broad spectrum antibiotic treatment is justified in the setting of conservative management of pPROM remote from term. The patient with pPROM and documented pulmonary maturity near term may benefit more from expeditious delivery than from expectant management with antibiotics.
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PMID:Antibiotic therapy for preterm premature rupture of membranes. 964 77

Despite advances in the use of newer antimicrobials and aggressive supportive care, sepsis and its sequalae remain a major source of morbidity and mortality in the neonate. The VLBW neonate is especially at high risk. We and others have demonstrated that neonatal MNC are deficient in their production of G-CSF and GM-CSF, which, in part, may explain the neonates propensity to develop neutropenia during times of sepsis. G-CSF and GM-CSF have been shown to both enhance neonatal neutrophil superoxide production in vitro and to increase circulating neutrophil numbers through expansion of the NSP in the BM in neonatal rats and humans. G-CSF is protective (if given with or before antibiotics) during experimental GBS in the neonatal rat and appears to be well tolerated (both short term and 2 years after its use) in the human neonate. In a phase II randomized pilot multicenter study, GM-CSF prophylaxis in the VLBW neonate was well tolerated during 4 weeks of administration and was noted to have significantly reduced the incidence of nosocomial infections. Future efficacy and safety studies in more neonates need to be completed and assessed before the routine pharmacologic use of G-CSF or GM-CSF is recommended to prevent and treat neonatal sepsis.
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PMID:Rationale and potential use of cytokines in the prevention and treatment of neonatal sepsis. 977 42

This study was performed prospectively. Between 1. January 1995 and 31 December 1997, a modification of the screening-based strategy protocol was implemented. Antenatal screening cultures for GBS were performed at approximately 30-32 weeks of gestation. The protocol recommends the use of antibiotic prophylaxis to GBS positive women with any of the obstetric risk factors for early-onset of GBS disease. Our regiment for prophylaxis for patients in labor was ampicillin 2 g. intravenously then 1 g. i.v. every 4 hours until delivery. Before this study had started (1984-1994), there were 149 serious neonatal GBS infection (149/15,040 pregnancy, among them were 97 premature infants. Thirty-one infants suffered from connatal sepsis. We observed 29 lethal infection. Between January 01, 1995, and December 31, 1997, 4150 women participated in this investigation. The incidence of positive group B Streptococcus cultures from the vaginal samples was 11.6% (481/4150). During the study period (3 years), serious GBS infection was detected in 46 infants (1.1%). There were 9 cases of neonatal sepsis (0.2%), two of them suffered lethal infections (0.05%). There was no late onset of GBS disease and lethal outcome in the last two years. Our investigations bears clinical importance because we confirmed that group B streptococcal colonization is an important risk factor for neonatal infection. The selective intrapartum chemoprophylaxis is a safe and effective intervention to prevent early-onset severe GBS disease.
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PMID:[Intrapartum administration of antibiotics in the prevention of neonatal Streptococcus B infections]. 986 5

Streptococcus agalactiae (Group B streptococcus, GBS) is the most important pathogen causing neonatal sepsis. The role of bacterial proteins contributing to pathogenicity in GBS infections has not yet been clearly determined, but the C protein complex has been suggested to be involved in both virulence and protective immunity. The aim of this study was to assess the prevalence of GBS strains bearing the gene encoding for the beta antigen of the C protein among clinical isolates from 68 neonates with sepsis, 45 newborns colonized without clinical signs of infection, and 50 isolates from pregnant women. The prevalence of the beta antigen gene in all three groups was low (24% vs. 19% vs. 22%) [corrected], and the differences between groups were not statistically significant. Clinical characteristics and cytokine plasma levels did not differ between septic patients with beta antigen-positive and -negative strains. The beta-antigen gene was not found among serotype III isolates, which accounted for roughly half of all the strains isolated. Thus, polymerase chain reaction (PCR) analysis based on the beta antigen gene seems not helpful for distinguishing invasive from colonizing GBS strains. A vaccine based on peptide antigens from the beta antigen of the C protein would most probably not provide protection against the majority of GBS isolates. When analyzing the PCR products of the C protein beta antigen gene by DNA sequencing, a genetic heterogeneity was observed, revealing small repetitive genetic elements within the amplified fragment, an observation that should be studied further.
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PMID:Low prevalence of the immunoglobulin-A-binding beta antigen of the C protein among Streptococcus agalactiae isolates causing neonatal sepsis. 1051 91

PURPOSE: Maternal colonization with GBS is a major cause of neonatal sepsis and meningitis. While GBS transmission is assumed to be fecal-oral or person-to-person direct contact including possible sexual transmission, risk factors for colonization and carriage are poorly described. Basic descriptive epidemiologic information is needed in order to implement a prevention program such as the development of an effective vaccine.METHODS: As part of a study of heterosexual transmission of urinary tract infection (UTI), we describe the prevalence and co-colonization of GBS among college couples. Self-collected vaginal, urine and rectal specimens were cultured from women with UTI and their current sex partners ("case couples"), and from women without UTI and their current sex partners ("control couples").RESULTS: Thirty-four percent (98/285) of case women and 31% (56/182) of control women had at least one GBS isolate. 25% (45/177) of case men and 26% (32/122) of control men had at least one GBS isolate. Given that GBS was present in one partner, 45% of case (34/75) and 57% of control (24/42) couples were co-colonized. Using pulsed-field gel electrophoresis (PFGE) analysis, GBS isolates shared within couples were identical in most cases, but PFGE patterns differed across couples.CONCLUSIONS: Prevalence of GBS is high among sexually active college students and sexual contact is associated with increased transmission.
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PMID:Prevalence and co-colonization with group b streptococcus (Gbs) Among heterosexual college couples. 1101 7


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