Screening for Group B Streptococcus: A Private Hospital's Experience (original) (raw)
Related papers
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 ,
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.
Prevention of Perinatal Group B Streptococcal Disease Revised Guidelines from CDC
Group B streptococcus (GBS) emerged as the leading infectious cause of neonatal morbidity and mortality in the United States in the 1970s (1--4). Initial case series reported case-fatality ratios as high as 50%. In the early 1980s, clinical trials demonstrated that administering antibiotics during labor to women at risk of transmitting GBS to their newborns could prevent invasive disease in the first week of life (i.e., early-onset disease) (5). As a result of the collaborative efforts of clinicians, researchers, professional organizations, parent advocacy groups, and the public health community in the 1990s, recommendations for intrapartum prophylaxis to prevent perinatal GBS disease were issued in 1996 by the American College of Obstetricians and Gynecologists (ACOG) (6) and CDC , and in 1997 by the American Academy of Pediatrics (8).
Prevention of Perinatal Group B Streptococcal Disease
Group B streptococcus (GBS) emerged as the leading infectious cause of neonatal morbidity and mortality in the United States in the 1970s (1--4). Initial case series reported case-fatality ratios as high as 50%. In the early 1980s, clinical trials demonstrated that administering antibiotics during labor to women at risk of transmitting GBS to their newborns could prevent invasive disease in the first week of life (i.e., early-onset disease) (5). As a result of the collaborative efforts of clinicians, researchers, professional organizations, parent advocacy groups, and the public health community in the 1990s, recommendations for intrapartum prophylaxis to prevent perinatal GBS disease were issued in 1996 by the American College of Obstetricians and Gynecologists (ACOG) (6) and CDC , and in 1997 by the American Academy of Pediatrics (8).
The Israel Medical Association journal: IMAJ
Previous assessments of maternal group B Streptococcus carrier rates in women delivering at Shaare Zedek Medical Center ranged between 3.5 and 11% with neonatal sepsis rates of 0.2-0.9/1000 live births. Because of low colonization and disease rates, routine prenatal cultures of GBS were not recommended and intrapartum prophylaxis was mainly based on maternal risk factors. To determine whether this policy is still applicable. We performed prospective sampling and follow-up of women admitted for labor and delivery between February 2002 and July 2002. Vaginal and rectal cultures were obtained before the first pelvic examination. GBS isolation was performed using selective broth medium and identified by latex agglutination and serotyping. Demographic data were collected by means of a standardized questionnaire. Data on the newborns were collected throughout 2002. Of the 629 sampled women, 86 had a positive culture and a carrier rate of 13.7%. A borderline significantly higher carriage r...
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.