Effectiveness of intrapartum penicillin prophylaxis in preventing early-onset group B streptococcal infection: results of a meta-analysis.

OBJECTIVE: To determine the effectiveness of intrapartum penicillin prophylaxis in preventing early-onset group B streptococcal (GBS) infection in neonates of women whose birth canals are colonized by group B streptococci. DATA SOURCES: Articles published between 1966 and 1992 identified from MEDLINE, EMBASE, the Science Citation Index and the Oxford Perinatal Database; the bibliographies of primary studies, textbooks and review articles and published abstracts from major conferences and symposia. DATA SELECTION: Studies were selected if four criteria were met: (a) the target population was intrapartum women and neonates, (b) the intervention was penicillin prophylaxis, (c) invasive early-onset GBS infection was an outcome measure, and (d) the studies were controlled trials or cohort studies. Seven primary studies were identified, four of which were randomized controlled trials. DATA EXTRACTION: Explicit methodologic criteria were used by two of the authors to assess independently the study quality; one of the reviewers was blind as to author, institution and journal. The baseline characteristics of the population, intervention and outcome were summarized twice and checked for accuracy by two of the authors. DATA SYNTHESIS: Five of the studies showed a trend toward a beneficial effect of penicillin prophylaxis, and two showed a statistically significant effect. The pooled odds ratio indicated a 30-fold reduction (95% confidence interval 0.0013 to 0.17) in the incidence of early-onset GBS infection with intrapartum penicillin prophylaxis. Subgroup analyses did not change these results. The magnitude of improvement observed did not differ between women with prenatal risk factors (premature rupture of the membranes and premature labour) and those without these risk factors. CONCLUSIONS: There is accumulative evidence that intrapartum penicillin prophylaxis is effective in preventing early-onset GBS infection. Such therapy is beneficial to women whose birth canals are colonized with group B streptococci. Further studies are needed to determine the optimum timing and method of detecting vaginal colonization during pregnancy.     

Dispersal of a plasmid-borne chloramphenicol resistance gene in streptococcal and enterococcal plasmids

Plasmids coding for chloramphenicol resistance, five isolated from streptococci of groups A, B, and G, ten from enterococci (Enterococcus faecalis, Enterococcus faecium), and two from staphylococci, were tested for sequence homology with the chloramphenicol resistance gene of pIP501, a 30-kb plasmid originally isolated from a group B Streptococcus. The 6.3-kb HindIII fragment of pIP501, known to carry the chloramphenicol resistance gene, was cloned into pBR322. A 1.6-kb portion of the cloned fragment, which included most of the chloramphenicol resistance gene, was used as probe in DNA-DNA hybridization experiments. Sequence homology was detected between the probe and four of the streptococcal, seven of the enterococcal, and one of the staphylococcal plasmids. The absence of hybridization between this probe and one plasmid isolated from a group B Streptococcus, as well as three isolated from E. faecalis, indicated that there are at least two different plasmid-borne chloramphenicol resistance determinants in the streptococci and in the enterococci.     

Identification of a streptococcal penicillin-binding protein that reacts very slowly with penicillin.

Penicillin-binding protein (PBP) 5 of Streptococcus faecium ATCC 9790 has an unusually low affinity for penicillin (50% binding occurred at a penicillin level of 8 micrograms/ml after 60 min of incubation, and the protein only became labeled after 20 min of incubation with high concentrations of radioactive penicillin). PBPs with similar properties are carried by strains of Streptococcus durans, Streptococcus faecalis, and Streptococcus lactis but not by strains of groups A, B, C, and G streptococci or Streptococcus pneumoniae. The strains carrying the slow-reacting PBP demonstrated a sensitivity to penicillin that was several hundred times lower than that of strains not carrying it. Spontaneous mutants with minimal inhibitory concentrations of penicillin of 20, 40, and 80 micrograms/ml were isolated from S. faecium ATCC 9790. They all showed a dramatic increase in the amount of slow-reacting PBP produced. Mutants with increased penicillin resistance were also isolated from wild-type strains of S. durans, S. faecalis, and S. faecium. All of them carried a greater amount of the slow-reacting PBP than that carried by the parent. Finally, it was found that resistant S. faecium ATCC 9790 mutants grew normally in the presence of penicillin concentrations that were far above that saturating all PBPs except PBP 5. Cell growth was, on the contrary, inhibited by a penicillin concentration that saturated the slow-reacting PBP by 90%. This penicillin dose was equal to the minimal inhibitory concentration.     

Lack of anti-TSTA antibodies in mice immunized with a methylcholanthrene-induced fibrosarcoma

Summary The 3-methylcholanthrene (MCA)-induced BALB/c (H-2^d) fibrosarcoma C-1 bears a strong tumor-specific transplantation antigen (TSTA) which, in previous studies, appeared to be distinct from H-2^k alien antigens expressed by this tumor. To see whether a syngeneic anti-C-1 serum obtained by multiple immunizations with C-1 tumor cells contained anti-TSTA-specific antibodies, in vitro cytotoxicity tests were performed. The syngeneic anti-C-1 serum had a high cytotoxic activity on C-1 cells, which allowed an absorption analysis to be carried out. Absorption of the serum with C3Hf, AKR, or B10.BR normal lymphoid cells (all sharing H-2^k antigens) reduced the cytotoxic activity on C-1 cells to 30%–50%. This residual activity could not be absorbed by FMR+ or G+ murine leukemias, by ecotropic endogenous virus obtained from SC-1 cells infected with the C-1 virus, by embryonic cells, or by normal BALB/c or C57BL/6 lymphoid cells. Conversely, the serum activity was abrogated by absorbing with the MCA-induced BALB/c fibrosarcomas C-1, ST2, C-3, GI-17, or CMS-1, and significantly lowered by the MCA-induced C3Hf fibrosarcoma C3H-7. A significant reduction of the anti-C-1 cytotoxicity was also obtained by absorbing with the two BALB/c fibrosarcomas teflon-9 and SCS (both lacking TSTA), by means of fresh newborn BALB/c or C3Hf muscle cells or of in vitro-cultured newborn BALB/c fibroblasts. These results suggest that, in spite of the strong transplantation immunity elicited by C-1 cells, antibodies to the individual TSTA of C-1 were undetectable in the syngeneic anti-C-1 serum obtained from animals highly resistant to the challenge of C-1 cells.     

Gestational diabetes mellitus in a cynomolgus monkey with group A streptococcal metritis and hemolytic uremic syndrome.

Gestational diabetes mellitus was diagnosed retrospectively in a ten-year-old female cynomolgus monkey. The mother developed severe purulent group A streptococcal metritis resulting in fetal sepsis. After parturition, the mother died from signs consistent with hemolytic uremic syndrome.