Use Of Intrapartum Antibiotic Prophylaxis Research Articles

Group B Streptococcus rectovaginal colonization screening on term pregnancies: culture or polymerase chain reaction?

Objectives The aim of this study was to evaluate if screening Group B Streptococcus colonization by intrapartum polymerase chain reaction could improve intrapartum administration of antibiotic prophylaxis, compared with antepartum culture screening and analyze the sensitivity and specificity of polymerase chain reaction test. Methods 198 pregnant women with Group B Streptococcus colonization antepartum culture screening were included. When they arrived at hospital for delivery, two rectovaginal swabs were collected: for culture and polymerase chain reaction method. Results The rate of Group B Streptococcus colonization antepartum detected by culture was 16.7%; at delivery was 17.2% when detected by culture and 19.7% using polymerase chain reaction method. The rate of inconclusive polymerase chain reaction tests was 0.5%. Considering intrapartum culture screening as gold standard, sensitivity and specificity of polymerase chain reaction test for intrapartum Group B Streptococcus colonization was 97.1% and 95.7%, respectively. The global rate of discordance between antepartum and intrapartum Group B Streptococcus colonization was 6.6%. The rate of women not treated with intrapartum antibiotic prophylaxis in the setting of positive intrapartum culture was significantly lower using intrapartum polymerase chain reaction test (0.5%) than with antepartum culture method (3.5%, p = 0.035). Conclusion The use of intrapartum antibiotic prophylaxis can be more efficient when screening Group B Streptococcus colonization intrapartum by polymerase chain reaction test. Polymerase chain reaction method had a good performance in our study, with high sensitivity and specificity.

Epidemiologic Changes of Neonatal Early-onset Sepsis After the Implementation of Universal Maternal Screening for Group B Streptococcus in Hong Kong.

The epidemiology of neonatal early-onset sepsis (EOS) has changed with time and with changes in prevention strategy. Population-representative contemporary data provide insights on how to further improve EOS prevention and triage strategies. Neonates born in public hospitals in Hong Kong from January 1, 2006, to December 31, 2017 were included. The epidemiological characteristics of EOS and the use of intrapartum antibiotic prophylaxis (IAP) were compared between the 2 epochs before (January 1, 2006 to December 31, 2011) and after (January 1, 2012 to December 31, 2017) the territory-wide implementation of universal maternal group B Streptococcus (GBS) screening. EOS developed in 1.07‰ of live births (522/490,034). After the implementation of universal GBS screening, the EOS rate decreased in neonates born ≥34 weeks (1.17‰-0.56‰, P < 0.001) and remained similar in those born <34 weeks (7.8‰-10.9‰, P = 0.15), whereas the proportions of IAP coverage increased in both groups [7.6%-23.3% ( P < 0.001) and 28.5%-52.0% ( P < 0.001), respectively]. The major pathogen for EOS shifted from GBS to Escherichia coli , and for early-onset meningitis from GBS to Streptococcus bovis . IAP was associated with subsequent isolation of pathogens resistant to ampicillin [adjusted odds ratio (aOR) 2.3; 95% confidence interval (CI): 1.3-4.2], and second-generation [aOR 2.0; 95% CI: 1.02-4.3] and third-generation [aOR 2.2; 95% CI: 1.1-5.0] cephalosporins. Pathogen profile of EOS changed with the implementation of universal GBS screening. S. bovis has emerged as a more common pathogen associated with the risk of meningitis. IAP may not be as effective in reducing EOS rate among infants born <34 weeks as compared with those ≥34 weeks, and newer strategies may be needed.

Escherichia coli Is Overtaking Group B Streptococcus in Early-Onset Neonatal Sepsis.

The widespread use of intrapartum antibiotic prophylaxis (IAP) to prevent group B streptococcus (GBS) early-onset sepsis (EOS) is changing the epidemiology of EOS. Italian prospective area-based surveillance data (from 1 January 2016 to 31 December 2020) were used, from which we identified 64 cases of culture-proven EOS (E. coli, n = 39; GBS, n = 25) among 159,898 live births (annual incidence rates of 0.24 and 0.16 per 1000, respectively). Approximately 10% of E. coli isolates were resistant to both gentamicin and ampicillin. Five neonates died; among them, four were born very pre-term (E. coli, n = 3; GBS, n = 1) and one was born full-term (E. coli, n = 1). After adjustment for gestational age, IAP-exposed neonates had ≥95% lower risk of death, as compared to IAP-unexposed neonates, both in the whole cohort (OR 0.04, 95% CI 0.00–0.70; p = 0.03) and in the E. coli EOS cohort (OR 0.05, 95% CI 0.00–0.88; p = 0.04). In multi-variable logistic regression analysis, IAP was inversely associated with severe disease (OR = 0.12, 95% CI 0.02–0.76; p = 0.03). E. coli is now the leading pathogen in neonatal EOS, and its incidence is close to that of GBS in full-term neonates. IAP reduces the risk of severe disease and death. Importantly, approximately 10% of E. coli isolates causing EOS were found to be resistant to typical first-line antibiotics.

Genomic analysis of virulence factors and antimicrobial resistance of group B Streptococcus isolated from pregnant women in northeastern Mexico.

Group B Streptococcus (GBS) causes infections in women during pregnancy and puerperium and invasive infections in newborns. The genes lmb, cylE, scpB, and hvgA are involved with increased virulence of GBS, and hypervirulent clones have been identified in different regions. In addition, increasing resistance of GBS to macrolides and lincosamides has been reported, so knowing the patterns of antibiotic resistance may be necessary to prevent and treat GBS infections. This study aimed to identify virulence genes and antibiotic resistance associated with GBS colonization in pregnant women from northeastern Mexico. Pregnant women with 35-37 weeks of gestation underwent recto-vaginal swabbing. One swab was inoculated into Todd-Hewitt broth supplemented with gentamicin and nalidixic acid, a second swab was inoculated into LIM enrichment broth, and a third swab was submerged into a transport medium. All samples were subcultured onto blood agar. After overnight incubation, suggestive colonies with or without hemolysis were analyzed to confirm GBS identification by Gram staining, catalase test, hippurate hydrolysis, CAMP test, and incubation in a chromogenic medium. We used latex agglutination to confirm and serotype GBS isolates. Antibiotic resistance patterns were assessed by Vitek 2 and disk diffusion. Periumbilical, rectal and nasopharyngeal swabs were collected from some newborns of colonized mothers. All colonized women and their newborns were followed up for three months to assess the development of disease attributable to GBS. Draft genomes of all GBS isolates were obtained by whole-genome sequencing. In addition, bioinformatic analysis to identify genes encoding capsular polysaccharides and virulence factors was performed using BRIG, while antibiotic resistance genes were identified using the CARD database. We found 17 GBS colonized women out of 1154 pregnant women (1.47%). None of the six newborns sampled were colonized, and no complications due to GBS were detected in pregnant women or newborns. Three isolates were serotype I, 5 serotype II, 3 serotype III, 4 serotype IV, and 2 serotype V. Ten distinct virulence gene profiles were identified, being scpB, lmb, fbsA, acp, PI-1, PI-2a, cylE the most common (3/14, 21%). The virulence genes identified were scpB, lmb, cylE, PI-1, fbsA, PI-2a, acp, fbsB, PI-2b, and hvgA. We identified resistance to tetracycline in 65% (11/17) of the isolates, intermediate susceptibility to clindamycin in 41% (7/17), and reduced susceptibility to ampicillin in 23.5% (4/17). The tetM gene associated to tetracyclines resistance was found in 79% (11/14) and the mel and mefA genes associated to macrolides resistance in 7% (1/14). The low prevalence of colonization and the non-occurrence of mother-to-child transmission suggest that the intentional search for GBS colonization in this population is not justified. Our results also suggest that risk factors should guide the use of intrapartum antibiotic prophylaxis. The detection of strains with genes coding virulence factors means that clones with pathogenic potential circulates in this region. On the other hand, the identification of decreased susceptibility to antibiotics from different antimicrobial categories shows the importance of adequately knowing the resistance patterns to prevent and to treat GBS perinatal infection.

Understanding Factors in Group B Streptococcus Late-Onset Disease.

Group B streptococcus (GBS) infection remains a leading cause of sepsis, pneumonia, and meningitis in infants. Rates of GBS early onset disease have declined following the widcespread use of intrapartum antibiotic prophylaxis; hence, late-onset infections (LOGBS) are currently a common presentation of neonatal GBS dicsease. The pathogenesis, mode of transmission, and risk factors associated with LOGBS are unclear, which interfere with effective prevention efforts. GBS may be transmitted from the mother to the infant at the time of delivery or during the postpartum period via contaminated breast milk, or as nosocomial or community-acquired infection. Maternal GBS colonization, prematurity, young maternal age, HIV exposure, and ethnicity (Black) are identified as risk factors for LOGBS disease; however, further studies are necessary to confirm additional risk factors, if any, for the implementation of effective prevention strategies. This narrative review discusses current and previous studies that have reported LOGBS. Few well-designed studies have described this condition; therefore, reliable assessment of maternal GBS colonization, breastfeeding, and twin delivery as risk factors for LOGBS remains limited.

Group B Streptococcus Screening Guidelines in Pregnancy: A Critical Review of Compliance.

Colonization with Group B Streptococcus in pregnancy is a major risk factor for neonatal infection. Universal screening for maternal streptococcal colonization and the use of intrapartum antibiotic prophylaxis has resulted in substantial reductions of neonatal early-onset Group B Streptococcus disease. To achieve the best neonatal outcomes, it is imperative for maternity healthcare providers to adhere to screening and management guidelines. This literature review uses a systematic approach and aims to provide a synthesis of what is known about compliance with Group B Streptococcus screening protocols in a variety of global settings, including maternity homes, private obstetric practice, and hospital clinical environments. The review was carried out using electronic databases as well as hand-searching of reference lists. Included papers reported primarily on compliance with Group B Streptococcus screening guidelines, potential factors which influence compliance rates, and implementations and outcomes of interventions. Six international studies have been retained which all focused on adherence to Group B Streptococcus screening guidelines and demonstrated that different factors might have an influence on adherence to GBS screening protocols such as financial aspects and high caesarean section rates. Findings of relatively low compliance rates led to recognizing the need of developing improved strategies for optimising antenatal GBS screening adherence. Adhering to Group B Streptococcus screening guidelines to prevent neonatal infection is crucial. Various factors influence compliance rates such as financial aspects and high proportions of caesarean sections. The implementation of strategies and different forms of education can result in improved compliance rates.

Clinical Profile and Outcome of Group B Streptococcal Colonization in Mothers and Neonates in Ras Al Khaimah, United Arab Emirates: A Prospective Observational Study.

Background:Maternal Group B Streptococcus (GBS)/Streptococcus agalactiae colonization rates vary worldwide; however, no such recent data are available from the United Arab Emirates (UAE).Objective:The objective of this study was to determine the prevalence of GBS colonization among pregnant women attending an antenatal clinic of a hospital in Ras Al Khaimah, UAE, along with the antibiotic sensitivity pattern, the clinical profile and pregnancy (maternal and fetal) outcome.Methods:This prospective observational study routinely offered rectovaginal swab for GBS to all women attending the antenatal clinic at 35–37 weeks of pregnancy between January and December 2019. MASTASTREP kit and Vitek-2 identification system was used for culture and identification. Women with positive cultures were followed up for any maternal and neonatal complications and the use of intrapartum antibiotic prophylaxis (IAP).Results:A total of 2295 women were included, of which 158 (6.9%) had positive cultures for GBS colonization. The carriage rate was higher in women without any risk factors for early-onset GBS disease (EOGBS) (P < 0.01). The GBS isolates were about 97% susceptible to linezolid and vancomycin, 90% to benzyl penicillin and 95% to ampicillin. Resistance to trimethoprim/sulfamethoxazole, clindamycin, erythromycin, and levofloxacin were about 77%, 57%, 57%, and 10%, respectively. Urinary tract infection in GBS colonized women were more common in those aged ≤30 years (P = 0.009). Fetal outcome was favorable in women receiving IAP for GBS colonization. No neonate had culture proven EOGBS.Conclusion:The prevalence of GBS colonization in pregnant women as well as the overall maternal and neonatal complications is low in Ras Al Khaimah, UAE. IAP is effective in preventing early-onset sepsis in newborn, and thus should be initiated in those with GBS colonization. The cultured GBS showed sensitivity to most antibiotics.

Значення виявлення стрептокока групи В у пренатальному скринінгу з метою попередження розвитку ранніх інфекцій у новонароджених

Group B streptococcal infection (GBS) remains the most common cause of neonatal early sepsis and an important cause of late onset of sepsis in young children. The use of intrapartum antibiotic prophylaxis is the only currently effective strategy for the prevention of perinatal GBS infection in the early stages of the disease, that is, during the first week of life. GBS causes both early and late infections in newborns, but modern interventions are effective only to prevent diseases at an early stage. The American Academy of Pediatrics teamed up with the American College of Obstetricians and Gynecologists to confirm the use of universal antenatal microbiological testing to detect colonization of GBS in the mother to facilitate the appropriate introduction of intrapartum antibacterial prevention. All recommendations for the prevention of diseases caused by group B streptococcus proposed by the CDC (Centers for Disease Control and Prevention) refer to the 2010 recommendations. The CDC will support these resources until the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), and the American Society for Microbiology (ASM) publish all their updated guidelines. Key words: prenatal screening, culture method, group B streptococcus, S.agalactiae, microbiome, colonization.

Outcome of Late-onset Neonatal Sepsis at a Tertiary Hospital in Oman.

ObjectivesWe sought to determine the prevalence, pattern of causative organisms, and mortality of newborns with culture-proven late-onset sepsis (LOS) and to determine and compare the risk factors linked to late-onset gram-positive and late-onset gram-negative sepsis in Sultan Qaboos University Hospital (SQUH).MethodsWe conducted a cross-sectional retrospective study of data obtained between 1 January 2007 and 31 December 2014 (eight years) from infants in the neonatal intensive care unit (NICU) at SQUH. Infants born in SQUH (inborn) and other institutions (outborn) with positive blood cultures were included in the study.ResultsThe total number of live births and admissions during the study period were 26 289 and 3559, respectively. The total number of infants identified with LOS were 125 of whom 69 (55.2%) were gram-positive, 52 (41.6%) were gram-negative, and four (3.2%) were due to Candida species (spp.). The majority of infants (n = 113, 90.4%) were inborn; 69 (55.2%) were males and 56 (44.8%) were females. The prevalence of LOS among inborn admissions was 4.3 per 1000 live births. Most infections occurred in very low birth weight infants (n = 81, 64.8%). Eleven (8.8%) infants died due to gram-negative sepsis. Klebsiella pneumoniae followed by Pseudomonas aeruginosa were the leading cause of death. Maternal intrapartum antibiotics were the only independent risk factor correlating with gram-negative organisms in multivariate analysis (p = 0.003).ConclusionsLOS poses a burden in the NICU, which could be due to the increasing survival of premature babies. The main contributing organisms to LOS are gram-positive bacteria. Klebsiella spp. is a major cause of mortality in LOS. The use of intrapartum antibiotic prophylaxis in mothers might explain the positive correlation of maternal antibiotics as a risk factor with gram-negative infections.

Effect of intrapartum antibiotics on the intestinal microbiota of infants: a systematic review

IntroductionThe use of intrapartum antibiotic prophylaxis (IAP) has become common practice in obstetric medicine and is used in up to 40% of deliveries. Despite its benefits, the risks associated with...

Prevalence and treatment of group B streptococcus colonization based on risk factors versus intrapartum culture screening

ObjectivesTo estimate the prevalence of group B streptococcus at onset of labor and to compare the accuracy of intrapartum antibiotic prophylaxis based on a risk factor strategy versus an intrapartum screening. Study designIn this cross-sectional study, 700 women referred for intended vaginal delivery were tested for group B streptococcus at onset of labor by gold standard culture in vaginal and rectal swabs. The results were blinded, and intrapartum antibiotic prophylaxis was given to women with risk factors for group B streptococcus infection: previous neonatal group B streptococcus infection, group B streptococcus in urine and/or vagina in current pregnancy, gestational age <36 + 0 weeks, temperature ≥38.0 °C or rupture of membranes ≥18 h. ResultsOf 642 women, who delivered within three days of specimen collection, 170 (26.5%) received benzylpenicillin as intrapartum antibiotic prophylaxis based on risk factors. The prevalence of group B streptococcus at onset of labor was 17.8% (114/642), with 62 women positive for group B streptococcus in both the vagina and rectum, 12 in the vagina only and 40 in rectum only.Intrapartum antibiotic prophylaxis was administered correctly in 31.6% (36/114) of GBS positive women at time of delivery and 78.8% (134/170) of women who received antibiotics were actually GBS negative. The positive predictive value of intrapartum antibiotic prophylaxis based on risk factors was 21.2%. The sensitivity was 31.6% and the specificity was 74.6%. ConclusionThe accuracy of predicting maternal group B streptococcus infection from risk factors is low. Intrapartum group B streptococcus diagnostics is more precise and will not increase the overall use of intrapartum antibiotic prophylaxis.

Modelling the effect of the introduction of antenatal screening for group B Streptococcus (GBS) carriage in the UK

ObjectivesTo estimate the potential impact of the addition of culture-based screening for group B streptococcus (GBS) carriage in pregnancy to a risk-based prevention policy in the UK. We aimed to...

Test de dépistage rapide intra partum du portage vaginal de streptocoque du groupe B (SGB) pour le repérage des nouveau-nés à risque d’infection néonatale précoce à SGB. Étude observationnelle analytique dans une maternité de type III

Group B streptococcus (GBS) is the most common infectious agent responsible for early-onset bacterial sepsis (EOS) in term newborns. French prevention of perinatal GBS disease guidelines recommend screening for maternal vaginal GBS colonization at the 9th month of pregnancy, and use of intrapartum antibiotic prophylaxis (IAP) in case of detected GBS vaginal colonization. Peripheral bacterial sampling (gastric aspiration, ear, or meconium) and measurement of C-reactive protein (CRP) are performed in asymptomatic newborns in case of infectious risk factors and/or incomplete IAP. The aim of this study was to investigate the relation between a rapid intrapartum screening test for GBS during labor in term parturients and infants developing GBS EOS and in comparison to current recommendations. We conducted an observational analytic single-center study, with use of a rapid intrapartum GBS screening test, at Toulouse University Hospital. A total of 1416mother-newborn dyads were prospectively included between 31/01/2012and 17/08/2012. Vaginal GBS colonization was found at the 9th month of pregnancy in 148mothers (10.6%), and 176mothers (12.5%) were screened positively at delivery using intrapartum GBS rapid polymerase chain reaction assay (GBS PCR) (P=0.025). No confirmed neonatal GBS EOS was found. Nine infants had suspected GBS EOS because of a positive peripheral bacterial finding and elevated CRP. In these infants, seven pregnant mothers were GBS-positive with GBS PCR assay during labor, and four women were positive on prenatal culture at the 9th month of pregnancy. The diagnostic values of the two tests highlighted a nonsignificant superiority of intrapartum GBS PCR assay (AUC=0.83 [0.68-0.97] vs. 0.67 [0.50-0.84]), (P=0.057). The negative predictive value was improved with intrapartum PCR assay (negative likelihood ratio [LR]: 0.3 [0.1-0.9] vs. 0.6 [0.4-1.1]). Intrapartum GBS PCR assay provided its best positive predictive value in the absence of complete AIP and without other infectious factors (positive LR: 21.3 [15.4-29.5]). These results suggest that the intrapartum GBS PCR assay offers a better predictive value of GBS EOS than the usual vaginal culture swab at the 9th month but requires confirmation by large studies.

Current Status of Vaccine Development for Group B Streptococcus

The incidence of neonatal early-onset sepsis due to group B Streptococcus (GBS) has decreased with the use of intrapartum antibiotic prophylaxis, but GBS infection remains a significant clinical concern. Early-onset disease still occurs among term infants born to women falsely screened GBS-negative, and premature infants still disproportionately suffer from both early-onset and late-onset GBS infection. In addition, there is no current strategy for preventing GBS disease among elderly and immunocompromised, nonpregnant adults. The development of GBS vaccines with efficacy across serotypes may address many of the clinical gaps left by GBS intrapartum antibiotic prophylaxis. Multiple preclinical and human phase I studies have been completed demonstrating the safety and immunogenicity of candidate glycoconjugate GBS vaccines. Phase III vaccine trials are needed to determine the clinical efficacy of maternal and nonpregnant adult vaccination.

PLD.33 Intrapartum antibiotic prophylaxis against early onset Neonatal Group B Streptococcal (GBS) sepsis in women known to be colonised; how good are we?

ObjectivesEvaluate practice in tertiary care obstetric unit on the prevention of early-onset neonatal GBS disease.BackgroundThe single most important risk factor for early-onset GBS infection is maternal colonisation leading to fetal...

Synchronous Recurrence of Group B Streptococcal Late-Onset Sepsis in Twins

Group B Streptococcus (GBS) remains the leading cause of neonatal sepsis and meningitis in industrialized countries. Whereas the use of intrapartum antibiotic prophylaxis has led to a significant decline in early-onset sepsis, the incidence of late-onset sepsis has remained unchanged. Whether late-onset sepsis usually originates from established mucocutaneous GBS colonization of the infant or whether it results from an acute exogenous GBS infection remains controversial. Here we report on twins who both twice developed GBS sepsis in a strikingly parallel fashion, with both instances originating from a single hypervirulent GBS clone. Factored together, the presentation as cervical soft tissue infection in both cases, the synchronicity of the episodes, and the detection of GBS DNA in breast milk all strongly suggest an enteral mode of transmission with a short incubation period.

Infeção tardia por streptococcus agalactiae – um caso de artrite séptica neonatal

Introduction: The incidence of early -onset group B streptococcus (GBS) disease has decreased substantially due to universal antenatal culture screening of pregnant women for GBS colonization at 35 -37 weeks of gestation and the widespread use of intrapartum antibiotic prophylaxis. However, the incidence of late-onset GBS disease has remained constant in the past decade and it is unaffected by maternal intrapartum chemoprophylaxis. Late-onset GBS infection affects infants who had an unremarkable maternal obstetric and early neonatal history. Other sources rather than vertical route, like horizontal transmission from hospital or community, albeit less frequently proved, can justifies late onset GBS disease.Case report: This case report illustrates a late-onset GBS disease, presenting as neonatal septic arthritis on a caucasian term infant, with unknown route of transmission and highlights the morbidity associated.Discussion: Additional research pertaining to the transmis- sion of late-onset GBS infections is required to develop effective preventive methods.

Early Onset Neonatal Group B Streptococcal Sepsis

Early onset neonatal group B streptococcal (GBS) sepsis is a serious neonatal illness with high morbidity and mortality. The disease can present in two forms: early clinical manifestation with respiratory distress soon after birth or late presentation with gradual onset of signs of sepsis. The former carries a high risk for serious cardiovascular complication with persistent pulmonary hypertension; the latter is often complicated with meningitis that may lead to serious neurodevelopmental impairment. An important advance in the past three decades is the development and implementation of preventive strategy for this disease by universal screening and identification of maternal GBS carriers and/or risk factors with subsequent use of intrapartum antibiotic prophylaxis. The strategy has resulted in a significant reduction of the disease from 1.5 to 0.3/1,000 live births over the past three decades. Some women may have unknown GBS status. The American Academy of Pediatrics has developed an algorithm as guidance for the management of the newborns.

Dermo-hypodermite et septicémie à Escherichia Coli par translocation digestive chez un nouveau-né : à propos d’un cas

The burden of neonatal bacterial infections continues. They remain a significant cause of death and morbidity, despite recommendations for prevention. The epidemiology of these infections has changed. Currently the two most causative pathogens for early-onset neonatal sepsis and for late-onset sepsis in term infants are Group B streptococci (GBS) and Escherichia coli. E.coli's role is increasingly important since the widespread use of intrapartum antibiotic prophylaxis. In late-onset infections, one of the suggested pathophysiological mechanisms is microbial translocation in the gut secondary to digestive colonization, particularly when E.coli is isolated in blood cultures. This can occur either before or after birth. Bacterial sepsis can be associated with various non-specific peripheral manifestations involving skin and soft tissues. We report the case of a full-term, 26-day-old newborn admitted to the hospital for fever. She presented with dermohypodermitis of the left trunk and was diagnosed with E.coli septicemia. She was discharged in good condition after appropriate intravenous antibiotic therapy.

Empirical Antibiotic Therapy for Suspected Early-Onset Bacterial Sepsis

We are writing in response to the recently published article, “Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis” by Richard Polin and the American Academy of Pediatrics Committee on the Fetus and Newborn (COFN).1 We agree with Dr Polin and the committee that empirical antimicrobial initiation and cessation are based on scientific principles modified by art and experience. The review is thorough and well referenced. However, we are concerned that the algorithms provided in this report may lead to increased use and duration of empirical antibiotics. Universal screening for maternal group B streptococcal (GBS) colonization and use of intrapartum antibiotic prophylaxis have resulted in substantial reduction in early-onset GBS among newborns. Despite this progress, GBS remains the leading cause of early-onset neonatal sepsis in the United States, with continued burden of disease.2 In 2010, the Centers for Disease Control and Prevention issued revised Guidelines for the Prevention of Perinatal Group B Streptococcal Disease.3 The algorithm included in the 2010 Centers for Disease Control and Prevention guidelines identifies only 2 categories of infants for empirical treatment: those with signs of sepsis …