Application of the French guidelines for preventing neonatal group B streptococcal disease in a university hospital (original) (raw)
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IMPROVING RATE OF GBS SCREENING IN ANTENATAL PATIENT TO IMPROVE NEONATAL OUTCOME
Background: Group B-streptococcus is a kind of bacteria that can be present in the vagina of pregnant ladies with a liability to be inhaled by the neonate though its passage in the birth canal during labour with a possibility of neonatal mortality and morbidity ranges from simple RDS* to death, screening all pregnant women for the presence of GBS* help to improve neonatal outcome. Objective: The study was planned to show the effect of group of B-streptococcus on neonatal outcome in normal vaginal delivery. Materials and methods: This is a prospective study counted on retrospective analysis (with ethical approval)in Al-Dhaid teaching hospital-Sharjah/UAE from June 2015 till October 2015. Swab from vagina and another from rectum is taken from all pregnant ladies attending antenatal care (1000 pregnant lady), swab from both sit placed into a selective (enrichmentbroth) media which encourage the growth of GBS. If bacteria growth in the broth it will be considered as positive.Urine test done to those in doubt of vagina GBS but negative test.So we divided the patient admitted through antenatal care to labour room to screened and unscreened patient and we compare the neonatal outcome of both. The pregnant women attend at 34-35 week and the swab is taken for culture and sensitivity those women are compared with other women attending to labour room or antenatal care without screening for a reason or another. Those with positive screening test covered with penicillin doses in the first stage of labour (8-10 hours)before labour. Results:- In this study: 1. Incidences of screened patient are much higher than unscreened patient throughout the months 2. Incidence of hospital stay and receiving unnecessary antibiotics are much less in screened than unscreened 3. Financial burden in screened patient are much less than unscreened because of less hospital stay, less antibiotics use, less neonatal stay in SCABU 4. Our incidence of infected women among screened group is 25.7% 5. 1-2% of neonatal got infected in unscreened compared to 0.02% in screened with 3% got complicated in unscreened ladies compared to 0.01% in screened. Conclusion: Screening of GBS in pregnant ladies with antibiotics cover prior to labour by normal vaginal delivery reduce perinatal mortality and morbidity.
Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference
Journal of Maternal-Fetal and Neonatal Medicine, 2014
Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecologyobstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.
Group B Streptococci Colonization in Pregnant Women: Is Screening Necessary?
Journal of SAFOG, 2013
Objectives: Group B Streptococcus (GBS) has been recognized as the leading cause of serious neonatal infections through mother-fetal vertical transmission in the west, however, in India, its spectrum is largely under estimated. The present study was carried out to find the incidence of rectovaginal carriage of GBS in parturient women, association with risk factors in mother and to study the neonatal outcome. Materials and methods: A one year cross-sectional prospective study was carried out in 905 parturient women admitted at a tertiary care center meeting the selection criteria over a period of one year from June 2007 to May 2008. The inclusion criteria were all pregnant women admitted to the labor room after 35 ± 1 week of gestation. Rectal and vaginal swabs were taken and cultured on selective Todd-Hewitt broth medium followed by sub culture on blood agar and confirmation by Latex agglutination test from all the women meeting the inclusion criteria. The outcomes measured were the incidence, antenatal risk factors in mother and the neonatal outcome. Analysis was done using paired 't' test, chi-square test and a p-value of <0.05 was taken as statistically significant. Results: Incidence of group B Streptococcus (GBS) was 12.15% and detection rate was increased by 4.6% with the inclusion of rectal swabs for culture. GBS carriage was significantly increased with preterm birth (OR 8.3, 95% CI,1.1-15.5), premature rupture of membranes (OR 7.5, 95% CI, 1.1-13.4), prolonged duration of ruptured membranes more than 10 hours (OR 21, 95% CI,15.2-34.2) and intrapartum temperature more than 38°C(OR 3.1, 95% CI, 0.43-6.66). Birth weight less than 2.5 kg and neonatal intensive care admissions were significantly more (35.45%) in infants of GBS positive women. Conclusion: GBS colonization was more frequent in women with risk factors. GBS pick up rate was increased by the inclusion of both rectal and vaginal swabs.
Pediatric Infectious Disease Journal, 2011
Background-Most early-onset group B streptococcal (GBS) disease in recent years has occurred in newborns of prenatally GBS-negative mothers who missed intrapartum antibiotic prophylaxis (IAP). We aimed to assess the accuracy of prenatal culture in predicting GBS carriage during labor, the IAP use and occurrence of early-onset GBS disease. Methods-We obtained vaginal-rectal swabs at labor for GBS culture from 5497 women of ≥32 weeks gestation and surface cultures at birth from newborns during 2/5/08-2/4/09 at three hospitals in Houston Texas and Oakland California. Prenatal cultures were performed by health care provider during routine care, and culture results obtained from medical records. The accuracy of prenatal culture in predicting intrapartum GBS carriage was assessed by positive (PPV) and negative (NPV) predictive values. Mother-to-newborn transmission of GBS was assessed. Newborns were monitored for early-onset GBS disease. Results-GBS carriage was 24.5% by prenatal and 18.8% by labor cultures. Comparing prenatal with labor GBS cultures of 4696 women, the PPV was 50.5% and NPV 91.7%. IAP, administered to 93.3% of prenatally GBS-positive women, was 83.7% effective in preventing newborn's GBS colonization. Mother-to-newborn transmission of GBS occurred in 2.6% of elective Cesarean deliveries. Two newborns developed early-onset GBS disease (0.36/1000 births): one's prenatal GBS culture was negative, the other's unknown. Conclusions-IAP was effective in interrupting mother-to-newborn transmission of GBS. However, ~10% of prenatally GBS-negative women were positive during labor and missed IAP while ~50% of prenatally GBS-positive women were negative during labor and received IAP. These findings emphasize the need for rapid diagnostics during labor.
Timing of Group B Streptococcus Screening in Pregnancy: A Systematic Review
Gynecologic and Obstetric Investigation, 2010
The objective of this review was to determine the best timing for group B streptococcus screening in pregnancy. The conclusion in support of the recommendation to screen at 35 to 37 weeks did not appear to be based on the data presented and should be interpreted cautiously. Searching MEDLINE and EMBASE were searched from 1966 to February 2009. The full search strategy was reported. Bibliographies of included studies were screened for additional articles. Study selection Studies that reported the outcome of maternal antenatal and antepartum GBS screening with sufficient data to enable calculation of positive and negative predictive values were eligible for inclusion. Studies were excluded if participants received antibiotics during pregnancy or labour, prior to culture being taken or where it was unclear whether they had done so. Women in the included studies were cultured for GBS in the antenatal period and during delivery. Sampling sites included vaginal, endocervical, anorectal, urethra, urine, perianal and rectal. Most studies used selective culture media. Two reviewers independently assessed studies for inclusion. Any disagreements were resolved by consensus. Assessment of study quality Two reviewers assessed methodological quality based on eight items: adequate description of population; well-defined point of inclusion in the study; well-defined timing of antenatal cultures; use of selective medium and chosen culture sites; completeness of follow-up and/or clear description of drop-outs; and reporting of sufficient data to construct a 2x2 table. An overall validity score (zero to 9) was calculated. Studies that scored below 5 were considered to be of poor quality. Data extraction Data were extracted to populate 2x2 tables that related GBS screening results to the reference standard (outcome at delivery). Sensitivity and specificity and positive predictive values (PPVs) and negative predictive values (NPVs), with 95% confidence intervals (CIs), were calculated for each data set. Data were independently extracted by two reviewers. Methods of synthesis Studies were summarised narratively and grouped into prospective and retrospective study designs. Results of the review Nine studies (n=25,664) were included in the review; 8,898 study participants were cultured for GBS both in the antenatal period and during delivery. Seven studies were prospective and two were retrospective. Study quality scores ranged from 4 to 8. PPVs for all GBS cultures ranged from 43% to 100% (mean 69%). NPVs ranged from 80% to 100% (mean 94%).
PLOS ONE, 2016
The aims of this study were to describe the adherence to CDC guidelines for intrapartum antibiotic prophylaxis (IAP) and to identify possible factors influencing noncompliance with guidelines. We conducted a retrospective study in Italy. Our cohort included women in whom antenatal Group B Streptococcus (GBS) screening was not performed, was performed, but results were not available at the time of labor or delivery and women who were positive for GBS colonization. The indications for complete execution of IAP according to revised CDC guidelines was evaluated. It was considered adequate when performed with a recommended antibiotic at least four hours prior to delivery. The cohort included 902 women. Among those who had performed rectal and vaginal swabs (or recto-vaginal swabs), results were available in 86.9% of vaginal swabs and in 87.1% of rectal swabs and GBS was detected in 59.8% of vaginal swabs and in 71% of rectal swabs. 49.2% women had indication for GBS prophylaxis. Among these, 91.1% received an antibiotic during labor. Totally appropriate IAP was performed in 36.3% deliveries, an inappropriate antibiotic was administered in 10.4% women, the remaining 45.3% women received partially appropriate IAP; of these, 15.5% had received antibiotics through an inappropriate route of administration, 18.2% an inappropriate dosage regimen. Overall, 27.5% women received intrapartum ampicillin with inappropriate timing. Multivariate analysis showed that totally appropriate prophylaxis was significantly more likely in women who had no previous live birth, who had vaginal delivery, and a positive result at antenatal GBS screening. Despite satisfactory GBS screening implementation, there is still a substantial gap between optimal and actual IAP. We hypothesize that the complexity of the CDC guidelines may partially explain this shortcoming. Future efforts will include initiatives focused at enabling and reinforcing adherence to evidence-based prevention practices.
European Journal of Pediatrics, 2015
Implementation of guidelines for group B streptococcal (GBS) prepartum screening (PS) rarely has been prospectively evaluated. To assess PS at 35-37 weeks of gestation and compare its predictive value to that of an intrapartum screening (IS) within 7 days of delivery, a surveillance cohort study was conducted at a tertiary care center in Freiburg, Germany, during 2011-2012. Study participants included 937 pregnant women who had intrapartum cultures taken for vaginal and rectal GBS colonization. Colonization status was compared to PS, and intrapartum antibiotic prophylaxis (IAP) rates calculated. The neonates were tested for GBS transmission via cultures from their throats and external ear canals. While 67.5 % (633/937) of study participants had a PS, only 22.7 % (144/633) underwent a fully guideline-compatible PS. However, maternal GBS colonization rates were similar when comparing PS (18.5 % [117/ 633]) versus IS (17.0 % [133/784]). The positive predictive value of a positive PS result for GBS positivity at delivery was 77.2 %. Women with a positive PS received IAP in 89.3 % of cases (75/84). The capsular serotype distribution pattern of colonizing GBS strains has not changed in comparison to our 2003-2004 study-one with a similar study design. Conclusions: Improved strategies for adoption of prepartum GBS screening are needed. What is Known: • The prediction of prepartum GBS screening for intrapartum colonization status has not been well studied. • Longitudinal studies of GBS screening are needed for screening program evaluations and vaccine development. What is New: • The rate of GBS screening has improved over 10 years, and intrapartum GBS colonization prediction was accurate. • Serotype distribution was stable and suggests the potential long-term efficacy of GBS vaccines.
2008
In industrialised countries, Group B streptococci (Streptococcus agalactiae, GBS) have been a leading cause of morbidity and mortality among newborns for more than 30 years. Resulting in pneumonia, sepsis and meningitis, GBS affects 0.5 to three of every 1,000 live births in different populations. 1-6 Over 80% of cases occur in the first six days after birth-early-onset disease (EOD)-and of these most occur within 12-24 hours of birth. 3,7 EOD is typically related to maternal carriage of GBS in the genital tract, with vertical transmission occurring prior to or during labour and delivery. A second peak of disease incidence occurs around one month after birth-late-onset disease (LOD)-and accounts for the remaining 20% of cases. 2 In LOD, GBS is acquired perinatally ,