Perinatal Group B Streptococcal Infections and the New Guidelines

Abstract

After completing this article, readers should be able to: 1. Describe the current literature on surveillance studies and patient outcomes regarding group B Streptococcus (GBS) disease. 2. Discuss the current perinatal GBS prevention guidelines. 3. Describe the limitations of the “limited evaluation” in assessing newborns at risk for GBS disease. 4. Delineate the proposed management of asymptomatic infants at risk for GBS disease, with the goal of decreasing unnecessary testing and avoiding prolonged hospitalization. Group B Streptococcus (GBS), also known as S agalactiae , is an encapsulated gram-positive bacterium that is a common inhabitant of the human gastrointestinal and genitourinary tracts. Despite recent reductions in incidence, it remains the most common cause of neonatal bacterial infections in most developed countries. The most desirable approach suggested to eliminate neonatal GBS infection is the use of GBS vaccines prior to or early in pregnancy. However, until effective GBS vaccines become available, screening pregnant women for GBS colonization and providing intrapartum antibiotic prophylaxis (IAP) will continue to be the mainstay for prevention of GBS infection in neonates, as suggested by the Centers for Disease Control and Prevention (CDC). A 70% decline in the rate of early-onset GBS disease followed the introduction of the first national consensus guidelines in 1996. In 2002, new national guidelines were released based on evidence that the screening-based strategy was superior to a risk factor-based strategy for preventing GBS infections in the neonate. As a result of many obstetricians adopting the screening-based strategy, CDC data from 2004 showed a further decline in the incidence of early-onset GBS infection to 0.34 cases per 1,000 live births. This surpasses the Healthy People 2010 objective of a reduction in the incidence of early-onset disease to 0.5 cases per 1,000 live births for all races. It should be mentioned that different countries may demonstrate different results, but …