High Prevalence of Group B Streptococcus Colonization among Pregnant Women in Amman, Jordan

Background: Little is known of the burden of Group B Streptococcus(GBS) colonization among pregnant women in the Middle East. We conducted a pilot study to determine the prevalence of GBS among pregnant women in Amman, Jordan, where GBS testing is not routine.

Methods: We collected rectal/vaginal swabs from women who presented in labor at Al-Bashir Hospital, a large government-run hospital in Amman, Jordan. Three methods were used to identify GBS: Strep B Rapid Test (Creative Diagnostics), blood agar media (Remel) with confirmed with BBL Streptocard acid latex test (Becton Dickinson), and CHROMagar StrepB (Remel). Results were read by a local microbiologist. We defined gold standard for GBS+ as a positive blood agar culture confirmed by latex agglutination and positive CHROMagar. Demographic and clinical data were also collected. We present proportions for categorical variables and medians and interquartile ranges (IQR) for continuous variables.

Results: In April and May 2015, 200 women were enrolled at a median age of 27 years (IQR: 23-32); 89.0% were Jordanian nationals and 71.9% completed secondary school. Median gestational age was 37.3 weeks (IQR: 32.3-40.4) and nearly all women reported prenatal care (median 9 visits; IQR: 8-12). Pre-pregnancy median BMI was 21.4 (IQR: 24.1-28.0) and 14.5% reported an underlying medical condition. Median gravidity was 3 pregnancies (IQR: 2-5) and parity was 2 births (IQR: 1-3). Obstetric complications included gestational hypertension (9.5%), gestational diabetes (5.5%), and UTI (51.0%), of which 86.0% reported treatment. Overall, 39 (19.5%) of women were positive for GBS on blood agar media and CHROMagar, while 67 (33.5%) were positive by rapid test (36% sensitivity, 67% specificity). No demographic or clinical differences were noted between GBS+ and GBS-negative women. Penicillin allergy was reported in 5.0%.

Conclusion: A high proportion of women presenting for labor at Al-Bashir were colonized with GBS. The rapid diagnostic was less sensitive and specific than culture. These results support expanded research in the region, including defining the GBS resistance patterns, serotyping information, and risk factors. It also emphasizes the need for improved rapid GBS diagnostics for developing world settings.