Intrapartum chemoprophylaxis of early-onset group B streptococcal disease

doi:10.1016/0028-2243(91)90045-M

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 40, Issue 1, 5 June 1991, Pages 57-62

https://doi.org/10.1016/0028-2243(91)90045-M Get rights and content

Abstract

A randomized study in 121 pregnant women carrier of group B streptococci is undertaken in order to assess the administration of 500 mg of intrapartum ampicillin intravenously to interrupt mother-to-fetus group B streptococcal transmission. In the prophylaxis group there was a significant reduction in neonatal colonization (3.7 vs. 42.9%) and in severe neonatal colonization (0 vs. 25%). There was no case of group B streptococcal sepsis in the prophylaxis group compared to 4.6% (3 cases) in the control group (P > 0.05). Clinically infected newborns represented 3.3% in the prophylaxis group vs. 13.8% in the control group. When the organism was isolated during delivery in the vagina or aminiotic fluid, prophylaxis was quickly followed by second negative cultures. Ampicillin levels in the amniotic fluid were detected early, and they increased significantly till the third hour. Bactericidal levels in the umbilical cord were detected in 60% of newborns. All these findings support the usefulness of ampicillin prophylaxis in the prevention of early-onset group B streptococcal sepsis.

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Cited by (61)

Selective or universal screening for GBS in pregnancy (review)
2018, Early Human Development
Citation Excerpt :
LOD is thought to result mainly from environmental transmission and is beyond the scope of this review [3]. In the 1980s, clinical trials and observational studies demonstrated that EOGBS may be prevented by the administration of antibiotics during labour to women colonised with GBS [4,5]. As a result, intrapartum antibiotic prophylaxis (IAP) was widely introduced into practice for women identified as being at increased risk of having a baby with EOGBS, based on bacteriological screening, the presence of clinical risk factors or a combination thereof.
Group B streptococcus (GBS) is the most common cause of early-onset neonatal sepsis in many countries and responsible for significant perinatal morbidity and mortality worldwide. Intrapartum antibiotic prophylaxis has been the mainstay of efforts to prevent early-onset GBS disease in recent decades, however it is unclear if women should be targeted based on the presence of clinical risk factors or by screening for GBS colonisation during pregnancy. Universal bacteriological screening of women in late pregnancy has been widely adopted but questions remain regarding its benefits and potential harms. Newer approaches to screening based on rapid point-of-care testing require further evaluation in randomised controlled trials to inform evidence-based practice. Given current preventive strategies do not protect against late onset disease and other sequelae of infection, maternal vaccination against GBS may present the best opportunity to reduce the global burden of invasive GBS disease in the future.
Effectiveness of intrapartum antibiotic prophylaxis for early-onset group B Streptococcal infection: An integrative review
2018, Women and Birth
Citation Excerpt :
Selective reporting bias can be defined as the selective revealing or suppression of information. Selective reporting bias was evident in two studies.2,20 For example, the approach by Boyer and Gotoff2 has been criticised by Ohlsson and Shah4 as indicating a high degree of selective reporting bias and provision of incomplete outcome data.
In some countries, up to 30% of women are exposed to intrapartum antibiotic prophylaxis for prevention of early-onset group B Streptococcal infection. Intrapartum antibiotic prophylaxis aims to reduce the risk of neonatal morbidity and mortality from this infection. The intervention may adversely affect non-pathogenic bacteria which are passed to the newborn during birth and are considered important in optimising health. Since many women are offered intrapartum antibiotic prophylaxis, effectiveness and implications of this intervention need to be established. This review considers clinical trials and observational studies analysing the effectiveness of intrapartum antibiotic prophylaxis.
An integrative literature review was conducted. One systematic review, three clinical trials and five observational studies were identified for appraisal.
Randomised controlled trials found intrapartum antibiotic prophylaxis effective but all retrieved randomised clinical trials had significant methodological flaws. High quality observational studies reported high rates of effectiveness but revealed less than optimal adherence to screening and administration of the prophylaxis. Scant consideration was given to short term risks, and long-term consequences were not addressed.
Studies found intrapartum antibiotic prophylaxis to be effective. However, evidence was not robust and screening and prophylaxis have limitations. Emerging evidence links intrapartum antibiotic prophylaxis to adverse short and longer-term neonatal outcomes.
Our review found high quality evidence of the effectiveness of intrapartum antibiotic prophylaxis was limited. Lack of consideration of potential risks of the intervention was evident. Women should be enabled to make informed decisions about GBS management. More research needs to be done in this area.
Evaluation of four chromogenic media for the isolation of Group B Streptococcus from vaginal specimens in pregnant women
2015, Pathology
Direct culture onto four commercial chromogenic media, selective for the isolation of Group B Streptococcus (GBS), were compared with the conventional pre-enrichment Centers for Disease Control and Prevention (CDC) method for the ability to isolate GBS from 242 pregnant women’s self-collected vaginal/perineal swabs. The sensitivities and specificities for direct culture on to chromogenic agar were 92% and 100% for StrepBSelect(Bio-Rad Laboratories), 96% and 100% for Brilliance GBS (Thermo-Fisher Scientific), 94% and 100% for CHROMagar StrepB (CHROMagar, Dutec Diagnostics), 86% and 100% for ChromID Strepto B (bio-Merieux). CDC recommended broth pre-enrichment then culture on blood containing selective agar had a sensitivity and specificity of 90.0% and 100% respectively. The chromogenic agar tested produced comparable results to the pre-enrichment CDC method.
Genital infections and pregnancy
2014, Revista Medica Clinica Las Condes
La flora vaginal normal, conformada por múltiples microorganismos, juega un rol fundamental en la mantención de un ambiente adecuado de defensa contra ciertas infecciones durante el embarazo. Cuando se altera puede dar origen a Vaginosis Bacteriana, caracterizada por la presencia de múltiples bacterias en número mayor a lo habitual y que en el embarazo pueden potencialmente desencadenar efectos adversos, tanto en la madre como en el feto. Lo mismo ocurre con otro tipo de infecciones vaginales, como Clamydia y Gonorrea, que además de tener un impacto por ser las principales ETS, sus consecuencias en el feto pueden implicar secuelas de por vida. Si bien Estreptococo grupo B en la vagina no corresponde a una infección propiamente tal, su oportuna identificación y tratamiento durante el embarazo y parto, ha mostrado ser útil en la prevención de secuelas del recién nacido. El siguiente artículo aborda las principales infecciones cérvico vaginales, sus características y potenciales daños tanto para la madre como para su hijo.
The normal vaginal flora, made of multiple microorganisms, plays a main role in the maintenance of a suitable environment for defense against certain infections during pregnancy. When altered, can lead to Bacterial Vaginosis, characterized by the presence of multiple bacteria in greater numbers than usual, and during pregnancy can trigger potentially adverse effects on the mother and the fetus. The same goes for other vaginal infections such as Chlamydia and Gonorrhea, which besides having an impact for being the main STDs, its consequences in the fetus may carry lifelong threats. While Group B Streptococcus located in the| vaginal area does not imply an infection, its early Identification and treatment during pregnancy and childbirth has proved to be useful in preventing neonatal damages. The following article addresses the main cervix vaginal infections, their characteristics and potential harm to both the mother and her child.
Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence
2013, Women and Birth
The approach to the prevention of early onset GBS disease in the newborn varies considerably from country to country. The Centre for Disease Control in the United States advocates universal culture based screening with the administration of intra-partum antibiotics, usually benzylpenicillin or ampicillin, to women who are colonised with GBS. National groups in the UK and New Zealand advocate a risk-based approach where intra-partum antibiotics are given to women with identified risk factors. The Canadian Taskforce on preventive health care has identified a third approach; where intra-partum antibiotics are given to women with a positive GBS culture and an identified risk factor. There are no national guidelines or consensus in Australia.
The aim of this paper is to explore the evidence for screening and intrapartum prophylaxis for GBS. The three main methods of detection and management of GBS in pregnancy are described and the implications for women and midwifery practice are addressed. It is hoped that this discussion will provide women, midwives and other clinicians with a summary of the evidence, risks and benefits to enable informed decision making.
GROUP B STREPTOCOCCAL INFECTIONS
2009, Feigin and Cherry's Textbook of Pediatric Infectious Diseases, Sixth Edition

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European Journal of Obstetrics & Gynecology and Reproductive Biology

Abstract

References (22)

The differential leukocyte count in the assessment and outcome of early-onset neonatal group B streptococcal disease

J Pediatr

Prospective studies of group B streptococcal infections in infants

J Pediatr

Perinatal group B streptococcal colonization and infection

Am J Obstet Gynecol

Prevention of neonatal group B streptococcal sepsis by the use of rapid screening test and selective intrapartum chemoprophylaxis

Am J Obstet Gynecol

Single-dose penicillin prophylaxis of neonatal group B streptococcal disease: conclusion of a 41 month controlled trial

Lancet

Antibiotic-killing kinetics of group B Streptococci

J Pediatr

Group B streptococcal infections

Ampicillin prevents intrapartum transmission of group B Streptococcus

JAMA

The effect of intrapartum chemoprophylaxis on the vertical transmission of group B streptococci

Br J Obstet Gynaecol

Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis

N Engl J Med

Colonizacion materna por ‘Streptococcus’ grupo B II. Influencia de la patología del embarazo

Acta Ginecol

Cited by (61)

Selective or universal screening for GBS in pregnancy (review)

Effectiveness of intrapartum antibiotic prophylaxis for early-onset group B Streptococcal infection: An integrative review

Evaluation of four chromogenic media for the isolation of Group B Streptococcus from vaginal specimens in pregnant women

Genital infections and pregnancy

Assisting women to make informed choices about screening for Group B Streptococcus in pregnancy: A critical review of the evidence

GROUP B STREPTOCOCCAL INFECTIONS