Early-onset Group B Streptococcal Sepsis Research Articles

Right-Sided Bochdalek Hernia Associated with Group B Streptococcal Sepsis in a Preterm Neonate.

We report here a compelling case of a premature female newborn who was originally treated for breathing difficulties that arose a few hours after delivery. The initial chest radiograph showed no abnormalities, and the blood culture detected sepsis caused by group B streptococcus (GBS). The antibiotic treatment was modified accordingly. Later on, she experienced a gradually increasing opacification in the right side of her chest, which did not respond to medical treatment. A subsequent imaging examination conducted a few days later indicated the presence of a hernia in the right side of the diaphragm. The neonate, who was 14 days old, received surgical intervention to fix the abnormality in the diaphragm. The procedure was successful, and there were no complications during the postpartum period. This case report aims to emphasize the distinctive correlation between early-onset GBS sepsis and the postponed occurrence of right-side diaphragmatic hernia.

Timing of Symptoms of Early-Onset Sepsis after Intrapartum Antibiotic Prophylaxis: Can It Inform the Neonatal Management?

The effectiveness of "inadequate" intrapartum antibiotic prophylaxis (IAP administered < 4 h prior to delivery) in preventing early-onset sepsis (EOS) is debated. Italian prospective surveillance cohort data (2003-2022) were used to study the type and duration of IAP according to the timing of symptoms onset of group B streptococcus (GBS) and E. coli culture-confirmed EOS cases. IAP was defined "active" when the pathogen yielded in cultures was susceptible. We identified 263 EOS cases (GBS = 191; E. coli = 72). Among GBS EOS, 25% had received IAP (always active when beta-lactams were administered). Most IAP-exposed neonates with GBS were symptomatic at birth (67%) or remained asymptomatic (25%), regardless of IAP duration. Among E. coli EOS, 60% were IAP-exposed. However, IAP was active in only 8% of cases, and these newborns remained asymptomatic or presented with symptoms prior to 6 h of life. In contrast, most newborns exposed to an "inactive" IAP (52%) developed symptoms from 1 to >48 h of life. The key element to define IAP "adequate" seems the pathogen's antimicrobial susceptibility rather than its duration. Newborns exposed to an active antimicrobial (as frequently occurs with GBS infections), who remain asymptomatic in the first 6 h of life, are likely uninfected. Because E. coli isolates are often unsusceptible to beta-lactam antibiotics, IAP-exposed neonates frequently develop symptoms of EOS after birth, up to 48 h of life and beyond.

MANIFESTATION OF MATERNAL VAGINAL COLONIZATION OF GROUP B STREPTOCOCCUS IN PRETERM PREMATURE RUPTURE OF MEMBRANES

Objectives: To look at the manifestation of maternal vaginal colonization of Group B Streptococcus in pre-term premature rupture of membranes.Methods and materials: This cross sectional study was conducted at Department of Obstetrics and Gynecology, Lady Reading Hospital, Peshawar from November 02 ,2020 to May 02, 2021. By using chi square test, Group B streptococcus (GBS ) was stratifi ed among age, gravidy, parity, BMI and booking status to see the eff ect modifi cation value ≤ 0.05 was taken as significant. Those co comorbidities that aff ect the results were excluded. All data was entered, processed, and analyzed on SPSS version 21.0.Results: Out of total 126 patients, mostly in 15-25 Years of age [04(3.17%),P value,0.889] were reported as compare to 26-35 Years of age 03(2.38%) and 0.79% years among 36-45 Years. Simailrly the frequency of Group B streptococcus (GBS) was prevalent among 15-20 kg/m2 category [04(3.17%),P value,0.083] as compare to 21-25 kg/m2 02(01.58%) and 26-30 kg/m2 having 02(01.58%)Conclusion: The gastrointentinal and vaginal epithelium of healthy women colonized by Group B Streptococcus(GBS) pose a greater risk of serious pathologies in the susceptible infant by a transmission during parturition or ascending intrauterine infection. The incidence of early-onset GBS sepsis has decreased as a result of universal screening and intra partum antibiotic prophylaxis.

Análise da Prevalência e Conduta das Gestantes Colonizadas por Estreptococo do Grupo B e Evolução de seus Recém-Nascidos segundo o guideline de 2010 do Centers for Disease Control and Prevention (CDC)

OBJECTIVE: To evaluate the implementation of the 2010 Centers for Disease Control and Prevention (CDC) guidelines by the obstetrics and neonatology teams of a tertiary public hospital located in Rio de Janeiro, Brazil. METHODS: This retrospective study included the medical records of pregnant women who underwent vaginal-rectal swabs at the hospital between Nov. 1, 2014 and Oct. 31, 2015. Of the 595 included swabs, 122 were positive for Group B Streptococcus (GBS). After excluding incomplete medical records, malformations, and women who delivered at other hospitals, 85 pregnant women with positive swabs and 92 newborns were included. RESULTS: The prevalence of maternal colonization was 20.5%. The time to vaginal/rectal swab collection ranged from 18 to 39 weeks of gestation, with a mean of 34.9 weeks. Thirty-three of the 85 included pregnant women (38.9%) were not properly managed, since in 19 cases delivery occurred within less than four hours of antibiotic administration, and in 14 prophylaxis was not initiated when indicated. Five of the 92 included newborns (5.4%) were not properly managed, mainly due to unnecessary screening for infection; screening was incomplete in one case, since blood culture was not ordered although the guidelines in effect required it. Of the 86 newborns with management considered adequate, 53 (61.6%) had mothers who were also adequately managed. Thirty-three (57.75%) of the newborns managed adequately had mothers submitted to inadequate obstetric management. CONCLUSIONS: Although the 2010 CDC guidelines for prevention of early sepsis by GBS has been implemented in the hospital, we have detected failures in maternal intrapartum prophylaxis and newborn assessment. Failure to adhere to the established guidelines yields missed opportunities to prevent early-onset GBS sepsis.

Duration of intrapartum ampicillin prophylaxis and neonatal outcomes

At least 4 hours (hrs) of intrapartum ampicillin (amp) is recommended in patients colonized by Group B Streptococcus (GBS) to prevent early-onset GBS sepsis. However, shorter durations are known to have some protective effect. We compared neonatal outcomes based on the duration of intrapartum amp prophylaxis in the current era of neonatal care in a single center.

Preventing early-onset group B streptococcal sepsis: clinical risk factor-based screening or culture-based screening?

Two strategies are available for prevention of early-onset group B streptococcal (GBS) sepsis - clinical risk factor-based screening and routine culture-based screening of pregnant women for GBS colonisation. In our hospital, we switched from the former to the latter approach in 2014. We compared the incidence of early-onset GBS sepsis during 2001-2015 between infants born to pregnant women who were screened for GBS colonisation and those born to women who were not screened. Among 41,143 live births, there were nine cases of early-onset GBS sepsis. All infants with GBS sepsis were born to pregnant women who were not screened for GBS colonisation. The incidence of early-onset GBS sepsis among infants of women who were not screened was 0.41 per 1,000 live births (95% confidence interval [CI] 0.19-0.77) when compared to infants of women who were screened, for whom the sepsis incidence was zero per 1,000 live births (95% CI 0-0.19; p = 0.005). Our data suggests that routine culture-based screening of pregnant women for GBS colonisation is a better preventive strategy for early-onset GBS sepsis in neonates when compared to clinical risk factor-based screening.

Screening-based and Risk-based Strategy for the Prevention of Early-onset Group B Streptococcus/Non-group B Streptococcus Sepsis in the Neonate: A Systematic Review and Meta-analysis.

Screening-based and risk-based strategies are the 2 strategies for preventing group B streptococcus (GBS) diseases in neonates. We aimed to compare the effects of these 2 strategies in reducing the incidence of early-onset GBS sepsis (GBS-EOS) and their effects on the incidence of non-GBS sepsis. PubMed, Embase, Web of Science and The Cochrane Central Register of Controlled Trials were searched for the period from January 1, 1996, to December 31, 2018. Randomized controlled trials and cohort studies that compared the effects of risk-based and screening-based strategies were eligible for the meta-analysis. The I statistic was used for assessing the statistical heterogeneity across studies. Pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using the random effects model. There were 18 cohort studies comparing the incidence of GBS-EOS between the 2 strategies, involving a total of 604,869 newborns and 791 GBS-EOS cases. The heterogeneity across studies was moderate (I = 45%), and the pooled analysis yielded a 55% decreased risk of GBS-EOS for screening-based versus risk-based strategy (RR = 0.45; 95% CI: 0.34-0.59). For total early onset non-GBS sepsis (non-GBS-EOS), 7 studies with low heterogeneity (I = 18%) had a pooled RR of 0.91 (95% CI: 0.74-1.11), whereas for ampicillin resistant Escherichia coli-EOS, a subgroup of non-GBS-EOS, 3 studies with very low heterogeneity (I = 0%) had a pooled RR of 1.28 (95% CI: 0.74-2.21) for screening-based strategy compared with risk-based strategy. Compared with risk-based strategy, screening-based prophylaxis was associated with a reduced risk of GBS-EOS.

While waiting for a vaccine: opportunities for optimization of neonatal group B streptococcal (GBS) disease prevention in Israel.

To quantify effects of different strategies for decreasing neonatal early onset GBS sepsis (EOGBS) in Israel. A risk allocation model for EOGBS among infants ≥ 35w was adapted to Israeli data. Effects of strategies for antepartum (APS) and intrapartum (IPS) screening, and intrapartum (IAP) and/or postpartum antibiotic prophylaxis (PAP) were calculated. Estimated EOGBS attack rates (AR) with APS in 90%, IAP in 90%, may reduce AR to 0.18/1000. A rapid intrapartum test would further decrease AR to 0.16/1000, while reducing IAP from 21.3 to 12.5% of women. For babies with risk factors and GBS+ who do not receive IAP, further risk reduction could be achieved by PAP. IAP remains the main intervention to decrease EOGBS. IAP and PAP together may reduce EOGBS present incidence by 40%. Combining rapid intrapartum screening with selective IAP and selective PAP for remaining gaps, would be the most efficient strategy.

Neonatal early-onset blood stream infection caused by group B Streptococcus: analysis of 55 cases

Objective To investigate the clinical characteristics, prenatal risk factors and antibiotic resistance of neonatal early-onset blood stream infection caused by group B Streptococcus (GBS) and to provide evidence for the management of GBS infection. Methods From January 1, 2001 to May 31, 2017, 55 neonates diagnosed with GBS-associated early-onset blood stream infection in the International Peace Maternity & Child Health Hospital were enrolled. They were divided into two groups: GBS early-onset sepsis (GBS EOS) group (n=40) and bacteremia group (n=15). Clinical data were retrospectively analyzed and compared between the two groups with two independent-samples t test and Chi-square test. Results The incidence of neonatal GBS-associated early-onset blood stream infection was 0.31‰(55/179 738). Those neonates with bacteremia had no clinical manifestations. However, in the GBS EOS group, the main manifestations were respiratory abnormalities [respiratory distress (35%, 14/40) and apnea (10%, 4/40)], jaundice (40%, 16/40) and poor perfusion [low blood pressure, etc. 32%(13/40)], and the main abnormal results of blood routine test were increased C-reaction protein [>10 mg/L, 100% (40/40)] and elevated white blood cell count [>25×109/L, 78% (31/40)]. Compared with GBS EOS group, bacteremia group had a lower rate of vaginal delivery [1/15 vs 52% (21/40), χ2=9.549, P=0.002] and higher rates of maternal fever [15/15 vs 55% (22/40), χ2=10.034, P=0.002], chorioamnionitis [15/15 vs 68% (27/40), χ2=6.384, P=0.012] and empirical administration of antibiotics to infants [15/15 vs 70% (28/40), χ2=5.759, P=0.016]. All tested GBS strains were susceptible to penicillin, ampicillin and vancomycin, but resistant to clindamycin (42%, 22/53) and erythromycin (46%, 24/52). Conclusions GBS is one of the predominant pathogens causing neonatal early-onset blood stream infection. Respiratory distress, apnea, jaundice and poor perfusion are the main manifestations. Penicillin and ampicillin are the treatment choice for neonatal early-onset GBS infection. Active and appropriate intrapartum management of pregnancies with high risk of intrauterine GBS infection as well as prophylactic prescription of antibiotics to infants may help to prevent or alleviate the symptoms of neonatal early-onset blood stream infection. Key words: Bacteremia; Streptococcus agalactiae; Streptococcal infections; Microbial sensitivity tests; Infant, newborn

Perinatal Risk Factors for Neonatal Early-onset Group B Streptococcal Sepsis after Initiation of Risk-based Maternal Intrapartum Antibiotic Prophylaxis-A Case Control Study.

To identify the perinatal risk factors for early-onset Group B Streptococcus (EOGBS) sepsis in neonates after inception of a risk-based maternal intrapartum antibiotic prophylaxis strategy in 2004. Case control study. All newborn with early onset GBS sepsis (born between 2004 and 2013) were deemed to be "cases" and controls were selected in a 1:4 ratio. More than three per vaginal (PV) examinations [odds ratio (OR) 8.57, 95% confidence interval (CI) 3.10-23.6] was a significant risk factors. Peripartum fever (OR 3.54, 95% CI 1.3-9.67), urinary tract infection (OR 2.88, 95% CI 1.08-7.63), meconium-stained amniotic fluid (MSAF) (OR 2.52, 95% CI 1.18-5.37) and caesarean section (OR 1.99, 95% CI 1.16-3.43) were also found to be associated with EOGBS sepsis. Multiple vaginal examinations are the strongest risk factors for peripartum Group B Streptococcal (GBS) sepsis. The association of MSAF and caesarean section indicates that foetal distress is an early symptom of perinatal GBS infection.

76: Preventing early-onset group B streptococcal sepsis (EOGBS): is there a role for repeat screening at term?

76: Preventing early-onset group B streptococcal sepsis (EOGBS): is there a role for repeat screening at term?

Early-onset neonatal group B streptococcus sepsis following national risk-based prevention guidelines.

Neonatal infection with group B streptococcus (GBS) is an important cause of infant mortality. Intrapartum antibiotics reduce early-onset GBS sepsis, but recommendations vary as to whether they should be offered following antenatal screening or based on risk factors alone. We aimed to determine the incidence of early-onset GBS sepsis in NewZealand fiveyears after the publication of national risk-based GBS prevention guidelines. Prospective surveillance of early-onset GBS sepsis (defined as infection in the first 48h of life) was undertaken between April 2009 and March 2011 through the auspices of the New Zealand Paediatric Surveillance Unit as part of a survey of infection presenting in the first week of life. There were 29 cases of confirmed early-onset GBS sepsis, including one case of meningitis, giving an incidence rate of 0.23 per 1000 (95% CI 0.16-0.33) live births. Three infants (10.3%) died. In 16 cases (55%), a maternal risk factor qualifying the mother for intrapartum antibiotics was present, but only five (31%) received this intervention. A retrospective review of the major hospital laboratory databases for this period identified two additional cases. A secondary sensitivity analysis taking account of these cases provided an estimated national incidence of 0.26 (95% CI 0.18-0.37) per1000 live births. Ten years after a similar survey and fiveyears after promoting a single, risk-based prevention protocol nationally, the incidence of early-onset GBS disease in New Zealand has more than halved, but opportunities remain to further reduce the rate.

Screening for Group B streptococcus should be routine in pregnancy: AGAINST: Current evidence does not support the introduction of microbiological screening for identifying carriers of Group B streptococcus

For this argument, I am referring to microbiological screening, with swabs taken from the vagina and/or rectum in late pregnancy, with the intention of identifying carriers of Group B streptococcus (GBS), so that intrapartum antibiotic prophylaxis (IAP) can be offered, with the aim of preventing early-onset GBS sepsis in newborns in the UK. Given this, the question of whether screening should be routine has already been answered. The evidence has been reviewed by the National Institute for Health and Care Excellence (NICE), the Royal College of Obstetricians and Gynaecologists (RCOG), and most comprehensively by the National Screening Committee (NSC; www.screening.nhs.uk/groupbstreptococcus), and there is agreement that the current evidence does not support the introduction of microbiological screening. These bodies have acknowledged that not all countries, when reviewing this evidence, have reached the same conclusion (Verani et al. Revised guidelines from CDC MMWR 2010;59(RR10);1–36); however, given the situation in the UK, a clear policy decision has been reached. So what do we do with this policy? Well, the first question to ask is ‘how do we enact and monitor a policy of NOT initiating a screening programme?’ Most of our efforts are directed at auditing and monitoring the offer and uptake of programmes, using clinical governance processes to ensure adherence to the programme, with rigorous quality control. Should we not do the same when we have a policy of not offering screening? Should trusts audit their own practice to ensure adherence to national policy? And what role does the Care Quality Commission have in ensuring that trusts do this? Adherence to national policy, whether that is to screen or not to screen, is important when making sure that scarce resources are used most effectively. What new evidence could change this policy? Before initiating a new programme, the NSC want to see a randomised controlled trial comparing the new programme with existing care. This has infrequently happened with many existing screening programmes (e.g. cervical cancer) and, with the promise of a GBS vaccine constantly ‘round the corner’, the time and expense of running a trial of antenatal GBS screening seems unlikely to happen. In my view there are two main issues that hamper the assessment of harms and benefits of antenatal GBS screening. The first is the artefact introduced by using GBS culture-positivity when assessing the outcome of the use of IAP. The presence of antibiotic in the baby's circulation will inhibit the growth of the organism, despite the clinical picture of sepsis. This artefact means we remain uncertain how effective IAP really is. The second is the huge number of women who require IAP for the small number of symptomatic neonatal infections that are likely to be prevented, with the resulting concerns about the impact that antibiotics given at the time of labour may have on the longer-term outcomes for a large number of babies. This uncertainly about impact was highlighted by the follow-up of the ORACLE trial (Kenyon et al. Lancet 2008;376:1319–27), but extends well beyond that, with concerns that selection pressure applied to the developing microbiota may have profound long-term health consequences (Bedford Russell & Murch BJOG 2006;113:758–65; Quigley Gastroenterol Hepatol 2013;9:560–69). Added to which, there is growing international pressure to limit the use of antibiotics in the face of increasing resistance and a lack of new antibiotic development (www.gov.uk/government/uploads/system/uploads/attachment_data/file/138331/CMO_Annual_Report_Volume_2_2011.pdf). Being able to identify women and babies who would most benefit from antibiotics would be an important step in balancing the benefits versus harms of such a programme. Member of RCOG Greentop Guideline development group and advisor to the National Screening Committees review of Screening for Group B streptococcal infection in pregnancy 2012. ■

Serotype distribution and antimicrobial susceptibility of group B streptococci in pregnant women: results from a Swiss tertiary centre

To evaluate the rates of penicillin, clindamycin and erythromycin resistance and the serotype distribution among isolates of group B streptococcus (GBS) obtained from pregnant women at the University Hospital of Bern in Switzerland. We prospectively collected screening samples for GBS colonisation at the University Women's Hospital Bern, Switzerland, between March 2009 and August 2010. We included 364 GBS isolates collected from vaginal, cervical or vaginal-perianal swabs at any gestation time. The minimal inhibitory concentrations for penicillin, clindamycin and erythromycin were established using Etest with 24 hours of incubation, and inducible clindamycin resistance was tested with double disk diffusion tests. Serotyping was done with a rapid latex agglutination test or, if not conclusive, with polymerase chain-reaction (PCR) testing. We looked for significant associations between resistance patterns, age groups, serotype and ethnicity. All isolates were susceptible to penicillin. Resistance rates were 14.5% for erythromycin and 8.2% for clindamycin. Of 364 isolates, 5.8% were susceptible to clindamycin but not to erythromycin, although demonstrating inducible clindamycin resistance. Hence, the final reported clindamycin resistance rate was 14%. Serotype III was the most frequent serotype (29%), followed by V (25%) and Ia (19%). Serotype V was associated with erythromycin resistance (p = 0.0007). In comparison with all other ethnicities, patients from Asia showed a higher proportion of erythromycin and clindamycin resistance (p = 0.018). No significant association between resistance patterns and age groups was found. In pregnant women with GBS colonisation, penicillin is the antibiotic of choice for intrapartum prophylaxis to prevent neonatal early-onset GBS sepsis. In women with penicillin allergy and at high risk for anaphylactic reaction, clindamycin may be an alternative. The resistance rate for clindamycin at our institution was 14%; therefore, susceptibility must be tested before administration.

Cervical Insufficiency: A New Issue for Guidelines on Prevention of Perinatal Group B Streptococcal Disease?

The updated Guidelines on Prevention of Perinatal Group B Streptococcal Disease, issued by the Centers for Disease Control and Prevention, actually represent the mainstay in the prevention of neonatal early-onset group B streptococcal (GBS) sepsis. According to these guidelines, patients with possible preterm delivery are screened for GBS colonization and offered intrapartum prophylaxis only if they enter preterm labor or experience preterm premature rupture of the membranes. Nonetheless, the fulfillment of these recommendations seems to be suboptimal in clinical practice, as it is heavily influenced by the knowledge of the colonization status. We report here 2 cases of blood culture-proven, early-onset neonatal GBS sepsis involving preterm infants delivered by mothers who had midtrimester cervical insufficiency and bulging membranes. Midtrimester acute cervical insufficiency strongly predicts preterm delivery. These women are liable to miss intrapartum antibiotic prophylaxis because they typically have shorter labor, and the test results for GBS status are unlikely to be available before delivery. We believe that women with midtrimester cervical insufficiency and bulging membranes should be screened for GBS infection soon after hospital admittance if the gestational age is close to the threshold of fetal viability. A timely diagnosis of GBS colonization may not only increase the number of patients receiving targeted intrapartum antibiotic prophylaxis but would also allow consideration of the administration of antepartum antibiotic prophylaxis. Indeed, as further outlined in this report, GBS intraamniotic infection may dramatically occur before the onset of preterm labor or preterm premature rupture of the membranes.

Efficacy of Maternal and Neonatal Chemoprophylaxis for Early-Onset Group B Streptococcal Disease

To estimate the rate of early-onset group B streptococcal (GBS) neonatal sepsis with combined maternal and neonatal chemoprophylaxis. Since 1995, GBS chemoprophylaxis at our institution has consisted of intrapartum antibiotic prophylaxis to all women with identified risk factors. In addition, a single dose of penicillin G was administered within 1 hour of birth to all newborns without clinical signs or symptoms of infection. All neonates born between January 1, 2000, and December 31, 2008, and who developed early-onset (occurring at 72 hours of age or younger) invasive bacterial disease were identified. Incidence rates for sepsis resulting from GBS and other organisms were estimated. Compliance with risk factor identification and appropriate treatment was also ascertained. Rates of β-lactam resistance among cases of neonatal disease caused by Gram-negative organisms were calculated. Ninety-four cases of early-onset GBS sepsis were identified among 143,467 live births with a rate of 0.66 per 1,000 births (0.53-0.80 per 1,000). Of available GBS sensitivities, 8.8% demonstrated clindamycin resistance, and 26.6% were resistant to erythromycin. Thirty-four cases of non-GBS early-onset sepsis were identified for a rate of 0.24 per 1,000 live births. Of available sensitivity reports, 42.1% of Gram-negative isolates were sensitive to β-lactams. No significant difference in rates of early-onset GBS disease was found between the years 1995 and 2008. The sustained rates in early-onset GBS sepsis from 1995 to 2008, along with the low rates of neonatal disease caused by other pathogens, confirms the continued feasibility and efficacy of a combined maternal and neonatal GBS chemoprophylaxis.

A36 Persistent pulmonary hypertension secondary to MAS and early onset GBS sepsis

A36 Persistent pulmonary hypertension secondary to MAS and early onset GBS sepsis

Intrapartum Evidence of Early-Onset Group B Streptococcus

To estimate if neonates with early-onset group B streptococcus (GBS) sepsis have clinical evidence of fetal infection during labor or at delivery. Retrospective cohort study of all neonates diagnosed with GBS sepsis by culture and clinical findings within the first 72 hours of life from January 1, 2000, through December 31, 2008, at Parkland Health and Hospital System. Medical records were reviewed and maternal, neonatal, and delivery data were ascertained. These neonates then were compared with all neonates delivered during the same time period. During the study period, 143,384 live-born neonates were delivered at our institution; 94 were diagnosed with early-onset GBS sepsis. The majority of these neonates (n=93) were diagnosed with early-onset GBS within the first hour of life. Neonates with early-onset GBS sepsis had a significant increase in preterm delivery, cesarean delivery (total and for fetal distress), 1- and 5-minute Apgar scores of 3 or lower, umbilical cord pH less than 7.0, and a base deficit of 12 mmol/L or higher. In addition, nulliparity differed between those with early-onset GBS and those without (74% compared with 33%, P<.001) as did chorioamnionitis rates (62% compared with 8%, P<.001). We believe that these findings are compelling evidence that fetuses with early-onset GBS may have signs of sepsis peripartum. We hypothesize that these data support the concept that early-onset GBS represents a spectrum of infection that often precedes birth.

Early onset group B streptococcus sepsis: guidelines review

Group B streptococcus (GBS) is the commonest cause of early onset sepsis in UK newborns. Several risk factors for early onset GBS sepsis (EOGBS) have been described. The presence of these risk factors provides an opportunity for intrapartum antibiotic prophylaxis (IAP) and forms the basis of current UK EOGBS prevention guidance. Having observed poor compliance with national guidelines in a review of EOGBS cases within the UK Neonatal Infection Surveillance Network (NeonIN), we reviewed 14 NeonIN unit guidelines. We found substantial variation in recommendations within and between units on indications for IAP and treatment of asymptomatic neonates, and discrepancies between obstetric and neonatal guidelines, potentially increasing infants’ risk of infection. The lack of high quality evidence in this area and related ambiguity in national guidance may have contributed to diverse local approaches. A common approach would permit prospective evaluation of an EOGBS prevention strategy, generating an evidence base to benefit future guidelines.

Gestantes colonizadas pelo Streptococcus do grupo B e seus recém-nascidos: análise crítica da conduta adotada no Instituto Fernandes Figueira, Fundação Oswaldo Cruz

OBJETIVO: Avaliar a aplicação do protocolo do Centers of Disease Control (CDC, 2002) quanto à profilaxia da sepse neonatal precoce por Streptococcus do grupo B (SGB). MÉTODOS: Estudo retrospectivo com revisão de prontuários de 125 gestantes colonizadas pelo SGB e 133 recém-nascidos, no período de janeiro/2003 a dezembro/2006. A conduta intraparto foi considerada correta quando a gestante recebia antibioticoprofilaxia pelo menos quatro horas antes do parto, ou quando não recebia, mas era submetida a parto cesáreo eletivo. A conduta intraparto foi considerada incorreta quando a gestante recebia antibioticoprofilaxia menos de quatro horas antes do parto, a prescrição antibiótica estava incorreta ou quando não havia profilaxia prescrita. RESULTADOS: A prevalência de colonização materna pelo SGB foi de 4,7%. A época de coleta do swab vaginal/retal variou entre 14 e 40 semanas de gestação, com média de 32 semanas. Das gestantes colonizadas, 54 (43%) receberam conduta intraparto correta. Dos 133 recém-nascidos estudados, 95 (71%) receberam avaliação diagnóstica corretamente, 17 (13%) evoluíram com sepse clínica e um (0,75%) apresentou sepse comprovada. A incidência de sepse foi maior em recém-nascidos cujas mães não receberam profilaxia intraparto corretamente, porém esta associação não apresentou diferença estatística significativa (18 versus 7%, p&gt;0,05). CONCLUSÕES: Apesar de o protocolo para prevenção de sepse precoce pelo SGB estar implementado na instituição, ainda é possível observar falhas na profilaxia intraparto materna. Essas falhas representam oportunidades perdidas na prevenção da sepse precoce pelo SGB.