Intrapartum Prophylaxis Research Articles

Trends of Early Onset Group B Streptococcus infections and Observed Racial and Geographic Disparities Associated with GBS Infections in Tennessee, 2005-2021

Background: Group B Streptococcus (GBS) is one of the most common causes of bacterial sepsis in newborns. In 2002, the Center for Disease Control and Prevention (CDC) recommended universal screening of all pregnant women for GBS colonization and administering intrapartum prophylaxis to colonized pregnant women to prevent GBS infection in newborns. To identify racial disparities in GBS infections in Tennessee, we compared the incidence of early-onset GBS infection among Black and White infants from 2005-2021. Methods: GBS infections identified from normally sterile sites are reportable in Tennessee. We analyzed GBS data reported to surveillance systems from 2005 to 2021. We linked the surveillance data with the population data to calculate incidence rates. We excluded cases with unknown race status (9%) and other races (0.2%) as we do not have denominator data to calculate the incidence rate. Database linkage and data analyses were performed in SAS V.9.4. Results: A total of 399 early-onset GBS cases were reported from 2005–2021; 150 (37.59%) were Black, 212 (53.13%) were White, and 36 (9.02%) were of unknown race, and one (0.20%) reported as Other for race. While the incidence rates of early-onset GBS for all races declined from 0.23 per 1000 live births in 2005 to 0.18 per 1000 live births in 2021, Blacks experienced the largest decline in incidence from 0.6 per 1000 live births in 2005 to 0.37 in 2021. Among Whites, there was a slight decline in 2021 (0.13/1000 live births) compared to the rate in 2005 (0.21/1000 live births). The mean incidence rate of early onset GBS among Blacks (0.52 per 1000 live births) is significantly higher than the mean rates among Whites (0.20 per 1000 live births) (p value < 0 .001) from 2005 to 2021. Shelby County, one of the 95 counties in Tennessee, is predominantly Black (54.6%) and reported 27.8% of all early-onset GBS. Conclusion: There was a significant decline in early-onset GBS infections among Blacks and some reductions among Whites, indicating the effectiveness of the prevention strategies. However, Blacks have significantly higher rates than their White counterparts. In addition, 27.8% of the cases are reported from one county, signaling geographic disparities as well. Further investigation is warranted to identify risk factors and causes of observed racial and geographic disparities to help reduce the infection rate among vulnerable populations and high-risk geographic areas.

PeRinatal, neOnatal, and Maternal OuTcomEs with azithromycin prophylaxis in pregnancy and labour (PROMOTE-PROPHYLAXIS): systematic review and meta-analysis

Initial randomised controlled trials (RCTs) showed that prophylactic azithromycin in pregnant women improved maternal and neonatal outcomes; however, the recent evidence did not show any benefit to neonatal survival. There is conflicting evidence over the role of azithromycin prophylaxis in antenatal and intrapartum periods. We explored whether azithromycin prophylaxis in pregnant women improves maternal and neonatal outcomes. For this systematic review and meta-analysis registered on PROSPERO [CRD42023411093], we searched seven databases (PubMed, Scopus, Embase, Cochrane Library, EBSCOHost, ProQuest, and Web of Science) and clinical trial registries until 04/23/2024, for RCTs evaluating antenatal/intrapartum azithromycin prophylaxis against placebo/routine care in pregnant women. The primary outcome was neonatal mortality. Intrapartum and antenatal administration were assessed separately. We used random-effects meta-analysis. The risk of bias was assessed using the Cochrane RoB 2 tool. The GRADE approach was used to evaluate the certainty of the evidence. Screening 2161 records retrieved 20 RCTs (56,381 participants). Intrapartum azithromycin may make little or no difference to neonatal mortality [5 RCTs, 44,436 participants; Risk Ratio (RR): 1.02, 95% CI 0.86-1.20, I 2 =0%, very low certainty], and maternal mortality [3 RCTs, 44,131 participants, RR: 1.26, 0.65-2.42, I 2 =0%, low certainty]. Similarly, antenatal azithromycin may have little or no effect on neonatal mortality [3 RCTs; 5304 participants; RR: 0.74, 0.35-1.56, I 2 =43%, very-low certainty] and maternal mortality [3 RCTs; 8167 participants RR: 1.62, 0.67-3.91, I 2 =0%, low certainty]. There is no data on long-term adverse outcomes and antimicrobial resistance. Low to very low certainty evidence suggests that intrapartum or antenatal azithromycin prophylaxis in pregnant women might not reduce maternal or neonatal mortality. None.

Macrolide resistance among Streptococcus agalactiae during COVID-19 public health emergency in Brazil.

During COVID-19 public health emergence, azithromycin was excessively used in Brazil, as part of a controversial "early treatment", recommended by former national health authorities. Excessive usage of macrolides may increase resistance rates among beta-hemolytic streptococci. Therefore, this study aimed to investigate the occurrence of resistance to erythromycin and clindamycin among Streptococcus agalactiae recovered from February 2020 to May 2023. Bacterial isolates (n = 116) were obtained from pregnant women and submitted to antimicrobial susceptibility testing, investigation of macrolide resistance phenotypes and genotypes, and identification of capsular type. The overall rate of erythromycin not susceptible (NS) isolates was 25.9%, while resistance to clindamycin was 5.2%. Drug efflux, associated with the M phenotype and mef(A) gene, was the prevalent mechanism of resistance (80%). Capsular type Ia was predominant (39.8%), followed by II, III, and V (17.7% each). A higher diversity of types was observed in the last years of the study. Type IV has had an increasing trend over time, being the fourth most common in 2023. The majority of the isolates that expressed the M phenotype presented capsular type Ia, while those with iMLS phenotype presented capsular type V. Despite no causal relationship can be established, azithromycin excessive usage may be a possible factor associated with this higher rate of erythromycin NS isolates, compared with most previous national studies. On the other hand, resistance to clindamycin has not changed significantly. Therefore, in the studied clinical setting, clindamycin remains a useful alternative to intrapartum prophylaxis among penicillin-allergic pregnant women.

1626. Group B Streptococcus detection rate and clindamycin resistance among reproductive-age women and early-onset sepsis in neonates in Korea from 2003 to 2022

Abstract Background Group B Streptococcus (GBS) is the leading cause of early-onset sepsis (EOS) in neonates and intrapartum penicillin prophylaxis is recommended for pregnant women with GBS colonization to prevent vertical transmission. For pregnant women with penicillin allergy, clindamycin is recommended. In this study, we retrospectively examined the GBS detection rate and clindamycin resistance rate among Korean women of reproductive age and EOS in neonates in the last 20 years from a single center. Methods From 2003 to 2022, microbiologic studies on genital/rectal swab pairs from females of reproductive age (15-49 years) were reviewed. Among the total number of tests, the number of GBS positive results were extracted and GBS detection rates per year were calculated. Multiple tests from the same person within a year were counted as once. Among the GBS isolates, the clindamycin resistance rate was calculated. The total study period was divided into two periods (period 1 for 2003-2012 and period 2 for 2013-2022) by 10 years and GBS detection rates and clindamycin resistance rates were compared (Chi-square test). EOS caused by GBS in neonates was investigated among all neonates who received sepsis work-up within 3 days after birth. Results For the past 20 years, a total of 14,571 women were tested 16,879 times and GBS was isolated in 1,054 tests (6.2%). GBS detection rate increased from 1.7% (101/6,066) in period 1 to 8.8% (953/10,813) in period 2 (p< 0.001, OR 5.708, 95% CI 4.638-7.025). Among the GBS isolates, clindamycin resistance rates were 29.7% (30/101) in period 1 and 41.1% (392/953) in period 2 (p=0.026, OR 1.654, 95% CI 1.059-2.583). In a separate database, among 9,280 neonates who underwent blood culture or CSF culture studies within 3 days after birth, 9 patients were diagnosed with EOS by GBS and 4 patients died within 30 days. Conclusion Close monitoring is needed on the epidemiology of increasing GBS detection rate and clindamycin resistance rate in GBS isolates from Korean women of reproductive age. Disclosures All Authors: No reported disclosures

Incidence of group B streptococcus early-onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: a multicenter retrospective study

BackgroundThe difference in incidence of early onset sepsis (EOS) caused by Group B Streptococcus (GBS) among term neonates whose mothers receive first versus second-line intrapartum prophylaxis is poorly described. ObjectiveTo compare the incidence of GBS EOS in term neonates born to mothers who receive first, second-line or no intrapartum antibiotics, and describe the short term and survival outcomes of neonates who developed GBS EOS stratified by maternal antepartum prophylaxis. Study DesignThis was a retrospective review of electronic medical records. We queried the Pediatrix Medical Group Clinical Data Warehouse to evaluate the outcomes of term neonates born to GBS positive mothers between 2003 – 2020, and compared the incidence and outcomes of neonates with GBS EOS whose mothers received first versus second-line/no intrapartum prophylaxis. ResultsAmong 496,180 neonates, 104,196 (21%) were born to GBS positive mothers. Out of 97,983 GBS positive mothers with adequate prenatal antibiotic documentation, 49,234 (50%), 12,679 (13%) and 36,070 (37%) received first-line, second-line and no intrapartum prophylaxis, respectively. Incidence of GBS EOS among all neonates with maternal GBS carriage was 0.22% (231/104,196). Neonates whose mothers received second-line intrapartum antibiotics and no antibiotics had higher risk of GBS EOS infection compared to first-line intrapartum antibiotics [adjusted odds ratio (aOR) 4.12, 95% confidence interval (CI): 2.66 – 6.38 and aOR 3.80, 95% CI: 2.66 – 5.44, respectively]. No statistically significant difference in the risk of GBS EOS in neonates born to mothers who received second-line versus no antibiotics (aOR 0.92, 95% CI: 0.64 – 1.33). ConclusionNeonates exposed to second-line maternal GBS prophylaxis had increased risk of GBS EOS compared to those exposed to first-line maternal GBS prophylaxis. There was no statistically significant difference in GBS EOS incidence between second-line versus no antibiotics in mothers with GBS carriage.

Group B Streptococcus vaccines: progress and potential

Group B Streptococcus (GBS, Streptococcus agalactiae) is a pathogen that causes sepsis and meningitis, particularly in newborns, as well as severe infections in the elderly and those at high risk. For many years, the administration of intrapartum antimicrobial prophylaxis (IAP) has been a standard method to prevent neonatal GBS infection. However, IAP may be unsuitable in low-income settings due to its high cost and difficult accessibility to medical institutions. Additionally, IAP may lead to the emergence of antimicrobial-resistant bacteria. Hence, an alternative method for the control of GBS, such as a vaccine, is needed. An effective vaccine will likely prevent the further spread of GBS and be cost-effective compared with IAP. GBS vaccines have been under development for the past two decades, and several candidates have shown potential. In this review, we discuss the current development of GBS vaccines, including types and their implementation in different target populations.

Cervicovaginal and rectal colonization by group B Streptococci in Mexican women with full-term pregnancies.

A pregnant woman rectally or vaginally colonized by group B Streptococcus can infect her newborn. Prospective, cross-sectional, analytical 24-month study in pregnant women. Women in labor with ≥ 36 weeks of gestation were included. Pregnancy was classified as normal or high-risk. Main risk factors of the pregnant women were analyzed. Rectal and vaginal samples were obtained, placed in Todd-Hewitt broth and subsequently inoculated in 5% sheep blood agar. Identification was carried out by biochemical tests and latex agglutination. 3,347 pregnant women were included. Mean age was 25.6 ± 5.3 years, 95.5% received antenatal care; 2,213 (66%) had normal-risk pregnancies, and in 1,370 (41%), delivery was by cesarean section. Overall colonization was 4.3% (145/3,347), and it was higher in the 30-34 years age group (6.8%). Serotype I (58%) was the most common. The percentage of colonization in this population was low. A routine cervicovaginal and rectal culture program in pregnant women and the intrapartum antimicrobial prophylaxis program are controversial in our region.

Sorting Out the Risks and Benefits of the #797 Recommended Intrapartum Vancomycin Dosing Approach.

ACOG Committee Opinion #797 proposed intrapartum vancomycin dosing guidelines in the absence of thorough evaluation of its risk versus benefit profile on the maternal and neonatal systems. The previously published serum and cord-blood concentration-time data of vancomycin given to mothers in the intrapartum period was analyzed in this work with a two-compartment pharmacokinetic (PK) model. Monte Carlo simulation was used to establish exposure for the studied population for doses of 1000 mg to 2000 mg every 8 h for gestational ages (GA) of 33 to 40 weeks and for birth times up to 4-h intervals. Probabilities of target attainment (PTA) were calculated for efficacy and toxicity indices unique to the peripartum maternal and neonatal population. Neonatal evaluations indicate uniformly high PTAs for the evaluated dosing regimens when the efficacy target is considered. On the other hand, the PTAs for potentially nephrotoxic exposure is expected to reach undesirable levels when three or more doses were to be administered. The risk is profoundly high in GA below 36 weeks and birth times beyond 20 h after the initiation of intrapartum prophylaxis and with doses greater than 1250 mg. Maternal vancomycin exposures seem reasonable up to two intrapartum doses given at 8 h intervals when the dose is kept to 1250 mg or less. Most mothers (up to 83%) who receive three or more doses of the commonly administered regimens are subjected to nephrotoxic exposures. Thus, it appears that the current recommendations by #797 for dosing of vancomycin pose considerable risk to mother and newborn alike, especially in cases with lengthy duration of preterm labor. Capping of doses at 1250 mg may be considered to minimize the need for therapeutic drug monitoring (TDM) interventions. Alternatively, and irrespective of the baseline maternal renal function, TDM for all cases requiring more than two doses of 1500 mg or higher must be assured.

A cohort study of intrapartum group B streptococcus prophylaxis on atopic dermatitis in 2-year-old children

ObjectiveTo understand the occurrence of atopic dermatitis (AD) in children aged 2 years on exposure to maternal group B streptococcus (GBS) antibiotic prophylaxis (IAP).DesignRetrospective cohort study of 2909 mother–child pairs.SettingTaixing People’s Hospital in Eastern China.ParticipantsTerm infants born 2018–2019, followed longitudinally from birth to 2 years.ExposuresThe GBS-IAP was defined as therapy with intravenous penicillin G or ampicillin or cefazolin ≥ 4 h prior to delivery to the mother. Reference infants were defined as born without or with other intrapartum antibiotic exposure.OutcomesThe logistic regression models were employed to analyze the effect of intrapartum GBS prophylaxis on AD in 2-year-old children during delivery. Analysis was a priori stratified according to the mode of delivery and adjusted for relevant covariates.ResultsThe cohorts showed that preventive GBS-IAP was potentially associated with increased incidence of AD in children delivered vaginally according to logistic regression models before and after covariate-adjusted treatment (OR: 6.719,95% CI: 4.730–9.544,P < 0.001;aOR: 6.562,95% CI: 4.302–10.008, P < 0.001).ConclusionProphylactic treatment of intrapartum GBS may raise the risk of AD in vaginally delivered children. These findings highlight the need to better understand the risk between childhood AD and current GBS-IAP intervention strategies.

Group B Streptococcus and Pregnancy: Critical Concepts and Management Nuances

Group B Streptococcus (GBS) is a common pathogen with an effective treatment. However, it remains a significant cause of neonatal sepsis, morbidity, and mortality. The screening and management of this infection are some of the first concepts learned during medical training in obstetrics. However, effective screening and evidence-based management of GBS are nuanced with many critical caveats. The objectives of this review are to discuss the essential aspects of GBS screening and management and to highlight recent changes to recommendations and guidelines. Original research articles, review articles, and guidelines on GBS were reviewed. The following recommendations are based on review of the evidence and professional society guidelines. Screening for GBS should occur between 36 weeks and the end of the 37th week. The culture swab should go 2 cm into the vagina and 1 cm into the anus. Patients can perform their own swabs as well. Penicillin allergy testing has been shown to be safe in pregnancy. Patients with GBS in the urine should be treated at term with antibiotic prophylaxis, independent of the colony count of the culture. Patients who are GBS-positive with preterm and prelabor rupture of membranes after 34 weeks are not candidates for expectant management, as this population has higher rates of neonatal infectious complications. Patients with a history of GBS colonization in prior pregnancy who are GBS-unknown in this current pregnancy and present with labor should receive intrapartum prophylaxis. Work on the GBS vaccine continues. Although all of the efforts and focus on neonatal early-onset GBS infection have led to lower rates of disease, GBS still remains a major cause of neonatal morbidity and mortality requiring continued vigilance from obstetric providers.

Foetal and neonatal exposure prediction and dosing evaluation for ampicillin using a physiologically-based pharmacokinetic modelling approach.

Ampicillin is frequently used in neonates for the treatment of sepsis and as an intrapartum prophylaxis option for Group B Streptococcus. Pharmacokinetic data to guide ampicillin dosing in neonates and during the intrapartum period are limited. The objective of this study was to build a physiologically-based pharmacokinetic (PBPK) model to characterize the disposition of ampicillin in neonates and foetuses and to inform corresponding optimal dosing regimens. An adult ampicillin PBPK model was first developed using the Simcyp® simulator. The adult model was then scaled to neonates by accounting for maturational changes in physiological parameters and age-dependent drug disposition or extended to a pregnancy model for mothers and foetuses. Models were verified using collected mean or individual-level concentration data from the literature. The developed adult PBPK model included elimination via glomerular filtration, OAT3-mediated tubular secretion and biliary excretion as well as hepatic metabolism, and 89.8% of the observed mean concentrations in adults were within a 2-fold range of model mean predictions. Most of the observed individual-level observations in neonates (78.4%) and foetuses (about 65% in two studies) were within the 90% prediction intervals. The recommended 50 mg/kg every 8 h (q8h) ampicillin regimen achieved the 75% fraction time of total drug concentration above minimum inhibitory concentration (T > MIC) target for an MIC ≤8mg/L in >90% virtual neonates, and 1g ampicillin for pregnant women provided adequate foetal exposure (>0.25 mg/L) for 4h prior to delivery. A PBPK model was developed to characterize ampicillin's disposition in neonates, pregnant women, and foetuses, and the model supported optimal dosing evaluation in these vulnerable populations.

IMPLEMENTING A REFERRAL PROTOCOL FOR PENICILLIN ALLERGY TESTING OF PREGNANT WOMEN

<h3>Introduction</h3> Recent American College of Obstetrics and Gynecology (ACOG) guidelines advocate for the safety of penicillin allergy testing in pregnant women. Penicillin allergy de-labeling allows for preferred peripartum antibiotic therapy for Group B Streptococcus (GBS) prophylaxis and reduces IV antibiotics and neonatal ICU (NICU) care for newborns. Yet, there remains widespread hesitance to perform penicillin allergy testing on pregnant women. <h3>Methods</h3> This is a prospective cohort study. We developed a single-academic center referral protocol for pregnant patients with penicillin allergy to be evaluated by allergy and immunology (A/I) prior to delivery. The primary endpoint is rate of penicillin allergy de-labeling. Secondary endpoints included use of intrapartum antibiotics for GBS prophylaxis in the mother and IV antibiotic use in the neonates. <h3>Results</h3> The study is ongoing, and to-date we have seen 18 pregnant women in A/I clinic for penicillin allergy evaluation. Thirteen patients completed allergy testing. Of these, 11 (85%) were de-labeled and two experienced positive amoxicillin oral challenge (one delayed rash and one immediate possibly IgE-mediated symptom). Six patients have delivered, one was GBS-positive and successfully received preferred penicillin (ampicillin) for intrapartum prophylaxis without event. <h3>Conclusion</h3> Implementing a referral pathway directly from the obstetrics clinic for penicillin allergy evaluation is a streamlined method to potentially remove penicillin allergy labels in pregnant patients prior to delivery. In our study, the majority of patients were successfully de-labeled. Further data is needed to assess safety outcomes as well as use of alternative antibiotics and need for IV antibiotics in the neonate.

Screening della colonizzazione vagino-rettale da streptococco di gruppo B in gravidanza

Group B beta-haemolytic streptococcus (GBS) is a bacterium that colonizes the genito-intestinal tract of many women and is one of the main causes of neonatal sepsis if screening and antibiotic prophylaxis are not carried out during pregnancy. The best strategy for identifying colonized women (and therefore subjecting them to intrapartum antibiotic prophylaxis) is based on universal cultural screening with the execution of a vagino-rectal swab at 36-37 weeks of gestational age. In 2007, the prevalence of GBS-colonized pregnant women was on average 15.5% in the Piedmont Region (Italy) laboratories that followed the international culture guidelines, while it was 10.5% in the laboratories that did not follow them. In 2010 the Piedmont Regional Health Department carried out an awareness-raising intervention that led to an increase in the average prevalence of GBS (19.2% in 2018), resulting in a net reduction in false negatives. Accurate identification of the carriers to undergo intrapartum prophylaxis makes it possible to prevent the greatest number of early neonatal infections.

Group B streptococcus — a pathogen not restricted to neonates

ObjectivesThis was a retropective study of invasive group B streptococcal (GBS) infections isolated from blood, cerebrospinal fluid (CSF), synovial fluid, peritoneal fluid, pleural fluid, pericardial fluid and corpus vitreum in a defined region in southwest Sweden over a 14-year period. DesignInformation on all invasive GBS infections was obtained from all four bacteriological laboratories in the region, with data obtained from individual patient records. ResultsGBS was isolated from normally sterile body fluids in 1244 samples (579 from females and 665 from males) from 1101 patients. Of these patients, 196 were neonates. The incidence in neonates (0–27 days) was 7.3 per 100 000 live births per year, but there was a significant decrease from 2012 when risk-factor-based intrapartum antibibiotic prophylaxis was implemented. The great majority of neonatal infections were very early-onset infections. The incidence rates in children (28 days to 17 years), adults (18–64 years) and elderly patients (≥ 65 years) were 1.3, 3.6, and 12.9 per 100 000 per year, respectively. The majority of children and adults had severe underlying diseases, but severe infections were also seen in individuals with no risk factors. ConclusionsGBS is an important pathogen in all age groups. Intrapartum antibiotic prophylaxis significantly decreases very early-onset infections.

298 Need for intrapartum antibiotics prophylaxis in women with prior history of gbs carriage

Introduction: The incidence of early onset neonatal GBS(EOGBS) disease in the UK and Ireland is 0.57/1000 births. Intrapartum antibiotic prophylaxis (IAP) reduces the risk. Previous colonisation is associated with 50% carriage in the current pregnancy. In these women, RCOG recommends IAP with a history of neonatal infection, otherwise offering the option of screening at 35-37 weeks. In Ireland, there is no national consensus on IAP in prior GBS colonisation. Currently at University Hospital Waterford (UHW), all women with prior GBS colonisation receive IAP.

Impact of intrapartum antibiotics on the developing microbiota: a review.

The perinatal period sets the basis for the later physiological and immune homeostasis of the individual, with the intestinal microbiota being an important contributor to driving this homeostasis development. Therefore, the initial establishment and later development of the microbiota during early life may play a key role in later health. This early establishment of the intestinal microbiota is known to be affected by several factors, with gestational age, delivery mode, and feeding habits being extensively studied ones. Other factors are not so well understood, although knowledge has been accumulating in the last years. Among them, a factor of great relevance is the effect of perinatal exposure to antibiotics. Administration of intrapartum antimicrobial prophylaxis (IAP) to women during the delivery process represents the most common form of exposure to antibiotics during the perinatal period, present in around 30% of deliveries. During the last decade, evidence has accumulated demonstrating that IAP alters intestinal microbiota development in neonates. Moreover, recent evidence indicates that this practice may also be altering the infant intestinal resistome by increasing the levels of some antibiotic resistance genes. This evidence, as reviewed in this manuscript, suggests the interest in promoting the rational use of IAP. This practice has significantly reduced the risk of neonatal infections, but now the accumulating knowledge suggests the need for strategies to minimize its impact on the neonatal microbiota establishment.

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.

Impact of Intrapartum Antibiotic Prophylaxis on Offspring Microbiota.

Infants are born into a world filled with microbes and must adapt without undue immune response while exploiting the microbiota's ability to produce otherwise unavailable nutrients. The process by which humans and microbes establish this relationship has only recently begun to be studied with the aid of genomic methods. Nearly half of all pregnant women receive antibiotics during gestation to prevent maternal and neonatal infection. Though this has been largely successful in reducing early-onset sepsis, we have yet to understand the long-term consequences of antibiotic administration during gestation to developing infants. Studies involving antibiotic use in infants suggest that dysbiosis during this period is associated with increased obesity, allergy, autoimmunity, and chronic diseases in adulthood, however, research around the limited doses of intravenous antibiotics used for intrapartum prophylaxis is limited. In this mini review, we focused on the state of the science regarding the effects of intrapartum antibiotic prophylaxis on the newborn microbial colonization process. Although, the literature indicates that there is wide variety in the specific bacteria that colonize infants from birth, limited parenteral antibiotic administration prior to delivery consistently affects the microbiota of infants by decreasing bacteria in the phylum Bacteroidetes and increasing bacteria in the phylum Proteobacteria, thus altering the normal pattern of colonization that infants experience. Delivery by cesarean section and formula feeding magnify and prolong this effect. Our mini review shows that the impact of intravenous antibiotic administration during gestation has on early colonization, growth, or immune programming in the developing offspring has not been well studied in human or animal models.

Prevention of mother-to-child transmission of HIV infection

This review aims to evaluate the prevention strategies of perinatal HIV infections and their efficacy worldwide, both in resource-limited and in resource-rich regions. Furthermore, it presents the most recent aspects of obstetric management of HIV-infected mothers. The introduction of combined antiretroviral therapy (ART) has decreased mother-to-child HIV transmission in high-income settings to historically low levels. Efforts to implement antiretroviral agents in resource-limited countries were also successful in reducing perinatal transmission. However, there are differences in prevention strategies between low and high-resource settings regarding the mode of delivery and infant feeding advice. The three-part prevention strategy (antepartum, intrapartum, and infant prophylaxis) is the most effective approach. Viral load suppression by antiretroviral treatment up to the time of birth is the most effective way to reduce perinatal transmission. Viral load and not HIV status should be used to determine the mode of delivery. Furthermore, the duration of prolonged rupture of membranes is not associated with an increased risk of HIV transmission in women with low viral load. Breastfeeding is contraindicated for mothers living with HIV in resource-rich settings, whereas in low-income areas breastfeeding remains the main nutritional source for infants. ART should be initiated as early as possible in newly diagnosed pregnant women and should be continued for life. Preventive strategies of perinatal HIV transmission have become extraordinarily successful, especially due to the introduction of antiretroviral therapy. Key strategies in the prevention of mother- to-child transmission are prompt identification and treatment of HIV-infected mothers and postpartum infant prophylaxis.

Preventing group B Streptococcus neonatal disease with intrapartum prophylaxis: a retrospective study to detect its use in case of unknown colonization status.

Group B Streptococcus (GBS) is the leading cause of neonatal morbidity and mortality in developed countries. This study aims primarily to estimate the prevalence of maternal GBS positivity and secondarily to evaluate the compliance and the effectiveness of the current GBS prevention protocol. This retrospective study has considered 27382 single pregnancies carried to delivery between 2001 and 2014 at our Obstetrics and Gynecology clinic. All women carrying a singleton pregnancy in the considered period were eligible to be included in this study. The GBS swab was positive in 17.66% of cases, negative in 51.93%, and unknown in 30.41%. Data collected revealed that out of the total of GBS-positive women, 3362 were treated with antibiotic prophylaxis, and 1331 were not. There were no differences between cases admitted to Neonatal Intensive Care Unit and perinatal deaths between treated and non-treated GBS-positive pregnancies. Moreover, the data showed that 74.62% of patients between 34 and 37 weeks of gestation at the time of delivery were treated with antibiotic prophylaxis unnecessarily, and 25.38% of patients >37 weeks of gestation whose GBS status at delivery was unknown would have required intrapartum antibiotic prophylaxis. The only risk factor for chorioamnionitis among GBS-positive women in multivariate logistic regression analysis was an early gestational age (OR 0.61; 95% CI: 0.56-0.66; P<0.05). GBS prevalence was found to be 17.66%, and prophylaxis in colonized patients was carried out correctly according to our internal procedure allowing a low incidence of adverse outcomes. Finally, the only risk factor associated with chorioamnionitis in GBS patients was early gestational age at delivery.