Cost-effectiveness of intrapartum screening and treatment for maternal group B streptococci colonization

doi:10.1016/S0002-9378(11)90654-1

American Journal of Obstetrics and Gynecology

Volume 163, Issue 1, Part 1, July 1990, Pages 4-8

https://doi.org/10.1016/S0002-9378(11)90654-1 Get rights and content

Early-onset neonatal group B streptococci infection occurs in two cases per 1000 live births in the United States and is associated with a mortality rate >20%. Nearly 30% of infected infants have concomitant meningitis and half suffer permanent neurologic damage. Group B streptococci also account for at least 20% of postpartum metritis. The annual cost of group B streptococci infection in the United States is conservatively estimated at nearly 2000 neonatal deaths and >$500 million, excluding the costs of long-term neurologic handicaps. Intrapartum chemoprophylaxis with ampicillin is effective in curtailing transmission of group B streptococci from mother to infant. Methods have been developed to identify maternal colonization before delivery. We applied principles of decision analysis to evaluate cost-effectiveness of intrapartum screening for maternal group B streptococci colonization with various reported methods in cohorts of low- and high-risk women. In the United States intrapartum screening for group B streptococci is cost-effective and offers the potential to avert a significant number of neonatal deaths and postpartum infections.

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Cited by (55)

Group B Streptococcal Infections
2006, Infectious Diseases of the Fetus and Newborn Infant
Group B Streptococcal Infections
2005, Infectious Diseases of the Fetus and the Newborn Infant
The projected health benefits of maternal group B streptococcal vaccination in the era of chemoprophylaxis
2005, Vaccine
While maternal antibiotic prophylaxis has greatly reduced early-onset group B streptococcal (GBS) disease in the United States, a GBS vaccine currently under development could potentially prevent additional GBS cases and preterm births. A decision analytic model was created to compare preventive strategies using adolescent, maternal (prenatal), or postpartum vaccination with selective chemoprophylactic strategies. The current practice of culture-based chemoprophylaxis was predicted to prevent 55% of early plus late-onset GBS infections. Maternal vaccination strategies were superior to current practice, preventing 68–69% of all GBS infections and 4% of very preterm births (<32 weeks gestation). The most effective adolescent vaccination strategy combined vaccination with culture-based chemoprophylaxis for all women and prevented 66% of all GBS infections. All other strategies were similar in efficacy to current practice or inferior. Maternal GBS vaccination is predicted to prevent more cases of neonatal GBS disease than current practice and would prevent approximately one in 25 very preterm births.
Maternal-fœtal bacterial infection
2005, EMC - Gynecologie-Obstetrique
L'infection bactérienne néonatale par contamination maternofœtale a fait l'objet de nombreuses recommandations au cours de la dernière décennie du fait de sa fréquence et de sa gravité. Le but de ces démarches est le dépistage de Streptococcus agalactiae afin de l'éradiquer par une antibiothérapie per partum. La revue de la littérature tente d'en effectuer la synthèse, de présenter les recommandations françaises et nord-américaines publiées, et d'exposer les différents inconvénients de ces recommandations successives : leur difficulté d'application ; leurs risques maternels en rapport avec l'antibiothérapie, en particulier l'émergence des bactéries à Gram négatif résistantes ; leurs risques néonatals, certaines conséquences de ces stratégies aboutissant à l'impression de leur inefficacité (recrudescence des infections néonatales à bactéries résistantes, survenue plus tardive des sepsis, utilisation d'antibiothérapie à spectre de plus en plus large et augmentation des infections nosocomiales à bactéries résistantes) ; puis d'aborder les facteurs de risque d'infection et les propositions de prise en charge.
Numerous recommendations have been addressed this past decade in relation with the frequency and severity of bacterial infections of the newborn induced by maternal-fœtal contamination. They are principally aimed at promoting the Streptococcus agalactiae screening and its eradication by a per partum antibiotherapy. In this literature review we attempt to present a synthesis of the successive published French and American recommendations, with a focus on the related drawbacks: difficulty of application, maternal risk in relation with the antibiotherapy, i.e., the emergence of resistant Gram–bacteria, the neonatal risk, since the results of these strategies suggest their likeliness to be inefficacious (outbreak of bacteria-resistant neonatal infections, sepsis onset, use of antibiotherapies with wider spectrum, and increased rate of bacteria-resistant nosocomial infections). Finally we will consider the factors involved in the risk of infection, and propose some types of management.
Perinatal treatment to prevent early onset group B streptococcal sepsis
2002, Seminars in Neonatology
Performance of a group B streptococcal prophylaxis protocol combining high-risk treatment and low-risk screening
2000, American Journal of Obstetrics and Gynecology
Objective: This study was undertaken to evaluate a group B streptococcal protocol in a large community hospital that combined treatment of high-risk patients with rapid screening of low-risk patients. Study Design: In a prospective cohort study from 1994 through 1996 laboring patients in a level III community hospital were considered to be at high risk for neonatal group B streptococcal transmission if they were at <37 weeks' gestation, if they had rupture of membranes >12 hours, if they were known carriers of group B streptococci, if they had a temperature ≥100°F, if the gestation was complicated by fetal growth restriction or was a multiple gestation, or if they had a previous neonate infected with group B streptococci. High-risk patients were treated intravenously with antibiotics during labor. Low-risk patients were screened for group B streptococcal antigen by means of a rapid optical immunoassay. Patients with positive screening results were treated. Neonatal morbidity and mortality were evaluated. Results: Two of 9932 infants delivered had group B streptococcal sepsis diagnosed. In the 2 previous years without a protocol 9 cases of neonatal group B streptococcal sepsis had been diagnosed in 8188 deliveries (P =.0287 by Fisher exact test). The 2 cases of group B streptococcal sepsis during the protocol were as follows: 1 infant born to a high-risk mother with delay in treatment and 1 infant born to a low-risk mother with negative results of both culture and rapid screen during labor. During the previous period 7 infected infants had been born to high-risk mothers and 2 had been born to low-risk mothers. The maternal group B streptococcal carriage rate during the study was 18%. Group B streptococcal rapid optical immunoassay sensitivity was 81%. Elapsed time from screening to treatment was ≤2½ hours for 93% of patients. No maternal anaphylaxis, no increase in bacterial neonatal sepsis caused by organisms other than group B streptococci, and no protocol-related group B streptococcal antibiotic resistance were noted. Conclusion: Successful implementation and maintenance of a protocol combining treatment of high-risk patients with rapid screening of low-risk patients during labor reduced neonatal group B streptococcal sepsis. (Am J Obstet Gynecol 2000;182:1335-43.)

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Cost-effectiveness of intrapartum screening and treatment for maternal group B streptococci colonization

Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

J Hosp Infect

Am J Obstet Gynecol

J Pediatr

Am J Obstet Gynecol

Summary of the National Institutes of Health workshop on group B streptococcal infection

J Infect Dis

Institute of Medicine, National Academy of Sciences. Appendix P

A survey of infants with neonatal sepsis in US Army Hospitals

Milit Med

Carriage of group B streptococci during pregnancy: a puzzler

J Infect Dis

Group B streptococcal infection in newborns: prevention at last?

N Engl J Med