[Contribution of direct bacteriologic examinations to the diagnosis of early materno-fetal bacterial infection: the Lille experience].
A prospective study was conducted in 3056 live-born infants delivered at the Jeanneade-Flandre maternity hospital of the Lille Teaching Hospital between January and August 1997. Clinical, laboratory test, and microbiological test findings were compared. A cohort of 1003 infants who remained in the maternity ward but were considered at increased risk of maternofetal infection (MFI) based on history and/or obstetrical criteria and/or neonatal criteria underwent routine collection of specimens including gastric fluid, auricular and anal swabs, amniotic fluid, and placental fragments. Microscopic examination of gastric fluid smears, the first result available to the clinician, was found to have 27.5% sensitivity (983 samples). Positive predictive value (PPV) was only 17.8% because of a high rate of colonization (16.8%), defined as absence of clinical symptoms and three peripheral specimens positive for the same organism. However, negative predictive value (NPV) was as high as 99.8% as a result of high sensitivity (97.8%) in the infected neonates. The gastric fluid smear was positive in 30% and 35% of neonates born to mothers with hyperpyrexia during early and late labor, respectively, and in 42% of neonates born to mothers with a history of group B streptococcus carriage during the pregnancy. Forty-two per cent of neonates with a history of fetal tachycardia had a positive gastric fluid smear. Diagnostic criteria for infection were three peripheral specimens positive for the same organism, C-reactive protein elevation, and/or one or more clinical signs suggestive of infection, and/or a positive central specimen (blood, CSF). The infection rate in infants who remained in the maternity ward was 1.6%. The most common causative organisms were group B streptococci. These findings illustrate the useful contribution of gastric fluid smears to the early diagnosis of MFI and confirm the predominant role of group B streptococci.
Trivier
D
D
Laboratoire de Bactériologie-Hygiène, Hôpital Calmette, CHRU, Lille, France.
Dubos
J P
JP
Mteyrek
M
M
Codaccioni
X
X
Courcol
R J
RJ
Husson
M O
MO
D001424:Bacterial Infections / Q000175:diagnosis*; D001431:Bacteriological Techniques; D005260:Female; D005602:France; D005865:Gestational Age; D006771:Hospitals, Maternity; D006801:Humans; D007231:Infant, Newborn; D008431:Maternal-Fetal Exchange; D011237:Predictive Value of Tests; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis*; D011446:Prospective Studies; D012307:Risk Factors