Group B streptococcus in obstetrics: unsolved problems

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For several decades, among all possible pathogens of neonatal infections, group B streptococcus has been one of the leading positions. Sepsis, meningitis, and pneumonia are among the most common clinical manifestations of neonatal infection associated with group B streptococcus. In this review, our goal was to analyze the literature demonstrating a worldwide approach to the prevention of vertical transmission of group B streptococcus from mother to child. When writing the review, scientific publications of foreign and domestic authors from the PubMed database were studied. The review considers the drugs of choice for intranatal antibiotic prophylaxis, and their pharmacodynamic, and pharmacokinetic features. The analysis details the problem of the growth of resistance of group B streptococcus to antibacterial drugs. The antimicrobial activity of lactoferrin was noted at a minimum inhibitory concentration of 500 μg/ml. The presented review also reflects the protective and therapeutic effects of oral intake of probiotics containing Lactobacillus acidophilus, Lactobacillus salivarius, Lactobacillus rhamnosus GR-1, and Lactobacillus reuteri RC-14 . Based on the analysis, it can be concluded that penicillin G and ampicillin have the most pronounced bactericidal effect against group B streptococcus. At the same time, the most common side effects of β-lactam penicillins include an allergic reaction with the possible development of anaphylactic shock. Given this, the antibiotics of the first-line reserve group include cefazolin, clindamycin, and vancomycin. At the same time, it is important to take into account the decrease in the therapeutic concentration of clindamycin with a change in the alpha-1-acid glycoprotein in the blood of the mother and fetus, the nephrotoxic effect of vancomycin and the cross-a llergic reaction of cefazolin with antibiotics of the penicillin group. A promising direction in solving the problem of group B streptococcus is the development of new strategies for the prevention of perinatal infection of the fetus and newborn based on a more detailed study of the effects of lactoferrin and probiotics.

About the authors

Victor E. Radzinsky

Peoples’ Friendship University of Russia

ORCID iD: 0000-0003-4956-0466
Moscow, Russian Federation

Olga K. Doronina

Peoples’ Friendship University of Russia

ORCID iD: 0000-0002-4288-353X
Moscow, Russian Federation

Anton S. Olenev

Moscow Multidisciplinary Clinical Center «Kommunarka»

ORCID iD: 0000-0001-9632-6731
Moscow, Russian Federation

Olga V. Stetsyuk

Moscow Multidisciplinary Clinical Center «Kommunarka»

Author for correspondence.
ORCID iD: 0000-0001-8600-7112
Moscow, Russian Federation


  1. Phares CR, Lynfield R, Farley MM, Mohle-B oetani J, Harrison LH, Petit S, Craig AS, Schaffner W, Zansky SM, Gershman K, Stefonek KR, Albanese BA, Zell ER, Schrag SJ. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008;299(17):2056-2065.
  2. Baker CJ, Byington CL, Polin RA. Policy Statement - Recommendations for the prevention of perinatal group B streptococcal disease. Pediatrics. 2011;128(3):611-616.
  3. Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease: Revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(10):1-36.
  4. Faro S, Brehm B, Smith F, Mouzoon M, Greisinger A, Wehmanen O, Turrentine MA. Screening for group B streptococcus: a private hospital’s experience. Infect Dis Obstet Gynecol. 2010;451096:1-4. doi:
  5. Maisey HC, Doran KS, Nizet V. Recent advances in understanding the molecular basis of group B Streptococcus virulence. Expert Rev Mol Med. 2008;10:1-27.
  6. Asghar, S, Khan, JА, Mahmood MS, Arshad MI. A Crosssectional Study of Group B Streptococcus-Associated Sepsis, Coinfections, and Antibiotic Susceptibility Profile in Neonates in Pakistan. Adv Neonatal Care. 2020;20(4):59-69. doi: 10.1097/anc.0000000000000701
  7. Joachim A, Matee MI, Massawe FA, Lyamuya EF. Maternal and neonatal colonisation of group B streptococcus at Muhimbili National Hospital in Dar es salaam, Tanzania: prevalence, risk factors and antimicrobial resistance. BMC Public Health. 2009;9:437-444.
  8. Ezeonu I, Agbo M. Incidence and anti-microbial resistance profile of group B Streptococcus infection in pregnant women in Nsukka, Enugu state, Nigeria. Afr J Microbiol Res. 2014;8(1):91-95.
  9. Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, HarrisonLH, Lynfield R, VagnonePS, BurzlaffK, SpinaNL, Dufort EM, Schaffner W, ThomasAR, FarleyMM, JainJH, Pondo T, McGeeL, Beall BW, SchragSJ. Epidemiology of Invasive Early-O nset and Late- Onset Group B Streptococcal Disease in the United States, 2006 to 2015: Multistate Laboratory and Population- Based Surveillance. JAMA Pediatr. 2019;173(3):224-233. doi: 10.1001/jamapediatrics.2018.4826
  10. ACOG Committee Opinion number 797. Prevention of group B streptococcal early-o nset disease in newborns. Obstet Gynecol. 2020;135(2):51-72. doi: 10.1097/AOG.0000000000003668
  11. Scasso S, Laufer J, Rodriguez G, Alonso JG, Sosa CG. Vaginal group B streptococcus status during intrapartum antibiotic prophylaxis. Int J Gynaecol Obstes. 2015;129(1):9-12.
  12. Russian Society of Obstetricians and Gynecologists. Clinical recommendations: Singleton birth, spontaneous delivery in the occipital presentation (normal delivery). Ministry of Health of the Russian Federation. 2021;1-66. (In Russian).
  13. Kukes VG, Sychev DA. Clinical pharmacology: textbook. GEOTAR-Media. 2017;5:1-1024. (In Russian).
  14. Berardi A, Pietrangiolillo Z, Reggiani ML, Bianco V, Gallesi D, Rossi K, FacchinettiF, Ferrari F. Are postnatal ampicillin levels actually related to the duration of intrapartum antibiotic prophylaxis prior to delivery? A pharmacokinetic study in 120 neonates. Arch Dis Child Fetal Neonatal Ed. 2018;103(2):152-156.
  15. Shenoy ES, Macy E, Rowe T, Blumenthal KG. Evaluation and management of penicillin allergy: a review. JAMA. 2019;321:188-199.
  16. Mitchell FT, Pearlman MD, Chapman RL, Bhatt-M ehta V, Faix RG. Maternal and transplacental pharmacokinetics of cefazolin. Obstet Gynecol. 2001;98(6):1075-1079. doi: 10.1016/s0029-7844(01)01629-5
  17. Philipson A, Stiernstedt G, Ehrnebo M. Comparison of the pharmacokinetics of cephradine and cefazolin in pregnant and non-pregnant women. Clin Pharmacokinet. 1987;12:136-144. doi. org/10.2165/00003088-198712020-00004
  18. Popovic J, Grujic Z, Sabo A. Influence of pregnancy on ceftriaxone, cefazolin and gentamicin pharmacokinetics in caesarean vs. non pregnant sectioned women. J Clin Pharm Ther. 2007;32:595-602.
  19. Berg BR, Houseman JL, Steeg ZE, Le Bar WD, Newton DW. Antimicrobial Susceptibilities of Group B Streptococcus Isolates from Prenatal Screening Samples. Journal of Clinical Microbiology. 2014;52(9):3499-3500. doi: 10.1128/jcm.01781-14
  20. Wear CD, Towers CV, Brown MS, Weitz B, Porter S, Wolfe L. Transplacental passage of clindamycin from mother to neonate. J. Perinatol. 2016;36(11):960-961.
  21. Muller AE, Mouton JW, Oostvogel PM, Dörr PJ, Voskuyl RA, DeJongh J, Steegers EA, Danhof M. Pharmacokinetics of clindamycin in pregnant women in the peripartum period. Antimicrob Agents Chemother. 2010;54(5):2175-2181.
  22. Onwuchuruba CN, Towers CV, Howard BC, Hennessy MD, Wolfe L, Brown MS. Transplacental passage of vancomycin from mother to neonate. Am J Obstet Gynecol. 2014;210(4):352-354.
  23. Towers CV, Weitz B. Transplacental passage of vancomycin. The Journal of Maternal- Fetal & Neonatal Medicine. 2017;31(8):1021 doi: 10.1080/14767058.2017.1306049
  24. López Y, Parra E, Cepas V, Sanfeliú I, Juncosa T, Andreu A, XercavinsM, PérezJ, SanzS, VergaraA, Bosch J, SotoSM. Serotype, virulence profile, antimicrobial resistance and macrolide-r esistance determinants in Streptococcus agalactiae isolates in pregnant women and neonates in Catalonia, Spain. Enferm Infecc Microbiol Clin. 2018;36(8):472-477. doi: 10.1016/j.eimc.2017.08.006
  25. Assefa S, Desta K, Lema T. Group B streptococci vaginal colonization and drug susceptibility pattern among pregnant women attending in selected public antenatal care centers in Addis Ababa, Ethiopia. BMC Pregnancy Childbirt. 2018;18(1):135-144. doi: 10.1186/s12884-018-1791-4
  26. Ábrók M, Tigyi P, Kostrzewa M, Burián, Deák J. Evaluation of the Results of Group B Streptococcus Screening by MALDI-TOF MS among Pregnant Women in a Hungarian Hospital. Pathogens. 2020;9(1):1-7. doi: 10.3390/pathogens9010001
  27. Ali MM., Woldeamanuel Y, Asrat D, Fenta DA, Beall B, Schrag S, McGee L. Features of Streptococcus agalactiae strains recovered from pregnant women and newborns attending different hospitals in Ethiopia. BMC Infect Dis. 2020;20(1):848-857. doi: 10.1186/s12879-020-05581-8
  28. Nascimento CS, Santos NFB., Ferreira RC, Taddei CR. Streptococcus agalactiae in pregnant women in Brazil: prevalence, serotypes, and antibiotic resistance. Braz J Microbiol. 2019;50(4):943-952. doi: 10.1007/s42770-019-00129-8
  29. Hijona JJ, Carballo AL, Sánchez MS, Dyachkova N, Expósito JF, Alcázar JL. Vaginal antiseptics reduce the risk of perinatal infection with group B streptococci.J Matern Fetal Neonatal Med. 2019;32(16):2741-2745. doi: 10.1080/14767058.2018.144919
  30. Ohlsson A, Shah VS, Stade BC. Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection. Cochrane Database Syst Rev. 2014;12:1-51.
  31. Becker KW, Skaar EP. Metal limitation and toxicity at the interface between host and pathogen. FEMS Microbiol Rev. 2014;38:1235-1249.
  32. Manzoni P, Dall’Agnola A, Tomé D, Kaufman DA, Tavella E, Pieretto M, MessinaA, LucaD, Bellaiche M, MoscaA, PiloquetH, Simeoni U, Picaud JC, VecchioAD. Role of Lactoferrin in Neonates and Infants: An Update. Am J Perinatol. 2018;35(6):561-565.
  33. Rai D, Adelman AS, Zhuang W, Rai GP, Boettcher J, Lönnerdal B. Longitudinal changes in lactoferrin concentrations in human milk: a global systematic review. Crit Rev Food Sci Nutr. 2014;54:1539-1547. doi: 10.1080/10408398.2011.642422
  34. Lu J, Francis JD, Guevara MA, Moore RE, Chambers SA, Doster RS, Eastman AJ, RogersLM, NobleKN, Manning SD, Damo SM, Aronoff DM, TownsendSD, Gaddy JA. Antibacterial and Anti-biofilm Activity of the Human Breast Milk Glycoprotein Lactoferrin against Group B Streptococcus. Chembiochem. 2021;22(12):2124-2133. doi: 10.1002/cbic.202100016
  35. Hanson L, Vusse LV, Forqie M, Malloy E, Singh M, Scherer M, Kleber D, Dixon J, Hryckowian AJ, Safdar N. A randomized controlled trial of an oral probiotic to reduce antepartum group B Streptococcus colonization and gastrointestinal symptoms. Am J Obstet Gynecol MFM. 2023;5(1):100748. doi: 10.1016/j.ajogmf.2022.100748
  36. Ho M, Chang YY, Chang WC, Lin HC, Wang MH, Lin WC, Chiu TH. Oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 to reduce Group B Streptococcus colonization in pregnant women: A randomized controlled trial. Taiwan J Obstet Gynecol. 2016;55(4):515-518. doi: 10.1016/j.tjog.2016.06.003
  37. Liu Y, Huang Y, Cai W, LiD, Zheng W, Xiao Y, Liu Y, Zhao H, Pan S. Effect of oral Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 on vaginal Group B Streptococcus colonization and vaginal microbiome in late pregnancy. Nan Fang Yi Ke Da Xue Xue Bao. 2020;40(12):1753-1759. doi: 10.12122/j.issn.1673-4254.2020.12.09
  38. Martín V, Cárdenas N, Ocaña S, Marín M, Arroyo R, Beltrán D, BadiolaC, FernándezL, RodríguezJM. Rectal and Vaginal Eradication of Streptococcus agalactiae in Pregnant Women by Using Lactobacillus salivarius CECT 9145, A Target-s pecific Probiotic Strain. Nutrients. 2019;11(4):810-832. doi: 10.3390/nu11040810

Copyright (c) 2023 Radzinsky V.E., Doronina O.K., Olenev A.S., Stetsyuk O.V.

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