Assessment of two methods for rapid intrapartum detection of vaginal group B streptococcal colonisation.

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Abstract
To compare two methods for the rapid detection of intrapartum vaginal carriage of group B streptococci (Streptococcus agalactiae) with standard culture techniques and to establish their suitability for routine use. Vaginal swabs from 266 patients in labour were incubated in glucose broth in an anaerobic atmosphere for four to six hours. The Wellcogen Strep B latex particle agglutination test kit was subsequently used for antigen detection. In the second part of the study swabs from 117 women were assessed for the presence of group B streptococci using the ICON STREP B immuno-concentration assay (Hybritech). Both methods were compared with standard semiquantitative culture on Columbia horse blood agar and Islam's medium. In the first study vaginal carriage of group B streptococci was shown in 38 of 266 (14.3%) patients by culture. Latex particle agglutination with the Wellcogen kit detected 30 of these positive results (sensitivity 78.9%, specificity 100%). In those patients with moderate to heavy colonisation (> 10(4) colony forming units per millilitre) antigen was detected in all (26/26) culture positive patients (sensitivity 100%, specificity 100%). In the second study 16 (13.7%) patients were culture positive. The ICON test detected 11 positive results (sensitivity 68.8%, specificity 100%) and for heavy colonisation (10(5) cfu/ml) detected nine of nine cases (sensitivity 100%, specificity 100%). The ICON test took 10 to 15 minutes to perform. These tests are potentially useful for the rapid detection of group B streptococci vaginal colonisation in labour, particularly heavy colonisation. Both tests are insufficiently sensitive to replace standard culture methods.