Maternal- Fetal Infection
- Conditions
- Neonatal Infection
- Interventions
- Biological: Bacteriological analyses on clinical samples performed with swabs
- Registration Number
- NCT03371056
- Lead Sponsor
- Assistance Publique - Hôpitaux de Paris
- Brief Summary
The purpose of the protocol is to validate a novel point of care multiplex system to detect and characterize microorganisms responsible for neonatal sepsis, as well as biomarkers of infection, from a simple vaginal sample, in order to improve the prevention of perinatal bacterial infections.
- Detailed Description
Early-onset neonatal sepsis (EOS) is a major global public health challenge. Prevention during pregnancy and delivery, early diagnosis and treatment of perinatal infections are essential to avoid EOS. Risk factors for include prematurity, maternal Group B streptococcus (GBS) colonization, premature rupture of membranes (PROM), and chorioamnionitis. Screening and intrapartum antimicrobial prophylaxis administered to GBS-colonized women has reduced early onset GBS infections. However, other pathogens are frequently involved in EOS following preterm PROM and preterm birth (PTB), such as Gram-negative bacteria and Staphylococci, which are not covered by penicillin prophylaxis. The prevalence of neonatal infection arising from antibiotic-resistant bacteria is increasing, thus the challenge is to eliminate the widespread unnecessary use of broad-spectrum antibiotics to treat non-infected infants, while recognizing when antibiotics are truly needed. Rapid diagnostic test(s) to detect and quantify specifically pathogens in vaginal samples, could be a major breakthrough. Several rT- PCR ( reverse Transcriptase Polymerase Chain Reaction) tests are on the market, however so far no test is able to detect, quantify and characterize in terms of antibiotic resistance and virulence genes, a range of pathogens.
A novel multiplex platform, using microfluidics technology, is under development by Elvesys, Inc in France. This platform will be able to offer results within 15 minutes on-site.
In addition, the study of the vaginal microbiome may identify signatures associated with a risk of maternal-fetal infection, particularly in case of PROM or PTB. Advanced sequencing technology and metagenomics will be used to characterize these signatures, and may lead to further markers to be included in the point-of-care test. Finally, biomarkers of inflammation will be detected, including IL-6 (Interleukin).
In this study, the InSPIRe platform will be compared in the laboratory to conventional microbiological and immunological detection.
Four groups of pregnant women will be recruited in prospective cohorts : uneventful pregnancies, term PROM, preterm labor and preterm PROM.
The purpose of the InSPIRe project is to improve the prevention of perinatal bacterial infections, with the novel Elvesys point of care system to rapidly detect and characterize microorganisms responsible for neonatal sepsis from a single vaginal sample.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- Female
- Target Recruitment
- 2600
- Pregnant woman,
- Gestational age over 22 SA,
- Patient agreeing to sign informed consent,
- Patient aged at least 18 years old,
- Patient with health insurance,
- Singleton, twin or multiple pregnancy.
- Fetal death or non-viable fetus,
- maternal age under 18,
- Patient unable to express her consent,
- Patient under guardianship.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Women with premature delivery or premature delivery threat Bacteriological analyses on clinical samples performed with swabs Woman with high risk of infection \<37SA and Women with premature delivery or premature delivery threat Woman with high risk of infection > 37 SA Bacteriological analyses on clinical samples performed with swabs Women with premature rupture of membranes (\> 12 hours before labor) but \> 37 SA will be included. Women with premature rupture of membranes (<37SA) Bacteriological analyses on clinical samples performed with swabs Woman with high risk of infection \<37SA Woman at low risk of infection Bacteriological analyses on clinical samples performed with swabs Women with systematic vaginal sample for detection of GBS will be included.
- Primary Outcome Measures
Name Time Method Presence of Streptococcus B until 20 weeks
- Secondary Outcome Measures
Name Time Method Maternal fetal infection until 20 weeks + 3 days Infection is proved if at least a sample, generally sterile, is positive to a germ in association with a positive clinical, biological or radiologic sign of infection such as C-reactive protein or chest radiography.
Maternal local biomarkers definition until 20 weeks Presence or lack of RNA sequences and/or human specific protein detected by RT-PCR or ELISA-PCR depending on the presence or lack of a proved or suspected maternal fetal infection.
Vaginal dysmorphism until 20 weeks Defined by lactobacillus's decrease or loss in association with the spread of anaerobic flora.
Bacteriological signature definition until 20 weeks Presence or lack of specific bacteriological sequences detected by global sequencing and metagenomics analyses
Highlighting specific virulence markers until 20 weeks Like GBS clone CC17, Enterobacteriaceae that produce capsular antigen type K1. By usual molecular techniques.
A positive bacteriological result in the vaginal sample until 20 weeks A positive result is defined as the presence of one of the subsequent germ in the bacteriological culture:
* Escherichia coli (E. coli)
* Streptococcus pneumoniae,
* Group A Streptococcus
* Haemophilus ssp (influenzae, parainfluenzae)
* Staphylococcus aureus
* Streptococcus milleri group
* Enterococcus faecalis
* Other Gram-negative bacilli type enterobacteria (Klebsiella pneumonia, Proteus mirabilis)
* Anaerobics (Prevotella sp, bacteroid fragilis)Antibiotic resistance until 20 weeks Highlighted by a resistant profile in bacteriological culture for various classes of antibiotics such as β-lactamines, macrolides or aminoamides.
Chorioamnionitis until 20 weeks Clinical or paraclinical factors associated with risk of chorioamnionitis or maternal fetal infection such as prematurity, clinical signs (maternal fever, fetal tachycardia, increase in C-reactive protein, hyperleukocytosis, pus-like amniotic fluid) , oligohydramnios (defined by the greatest cistern \< 25 mm); increase in pro-calcitonin in umbilical cord ok histological signs of placental inflammation.
Clinical chorioamnionitis is defined as a maternal fever\> 39° (in one shot) with no other cause or \>38°(confirmed) in association with abnormal fetal heartbeat (\>160/min exceeding 10 min), maternal hyperleukocytosis (\>15000/mm3 without corticotherapy) or pus-like amniotic fluid.
Histological chorioamnionitis is defined by the presence of neutrophil polynuclears in amnion or chorion in association with the presence of neutrophil polynuclears in umbilical cord blood vessels.
Trial Locations
- Locations (3)
Hopital Louis Mourier
🇫🇷Colombes, France
Hôpital Cochin
🇫🇷Paris, France
Hopital Bichat
🇫🇷Paris, France