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

Sheehy, Annabel; Davis, Deborah; Homer, Caroline

doi:10.1016/j.wombi.2012.10.004

Cited by 11 publications

(8 citation statements)

References 35 publications

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“…When data are compared from jurisdictions that use universal screening and IAP, versus a method based on risk factors, reported EOGBS rates are mixed, with either no change [25] increases in some jurisdictions [26,38] and decreases in others [21]. It should be noted, however, that some clinicians use a combination of the two standard methods of selecting women most at risk of having a baby affected by this infection [39] so comparison between countries, and even areas within countries, is problematic.…”

Section: Discussionmentioning

confidence: 99%

Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016

et al. 2019

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Background Intrapartum antibiotic prophylaxis (IAP) to reduce the likelihood of neonatal early-onset group B streptococcal infection (EOGBS) has coincided with major reductions in incidence. While the decline has been largely ascribed to IAP following either universal screening or a risk-based approach to identify mothers whose babies may most benefit from IAP, there is lack of high quality evidence to support this view. Aims To describe management of maternal GBS colonisation in one local health district using universal screening and assess rates of EOGBS over time. Methods A retrospective cohort study was undertaken to describe compliance with GBS management, to determine the incidence of EOGBS and association between rates and maternal screening. Linking routinely collected maternity and pathology data, we explored temporal trends using logistic regression and covariates for potential effect modifiers. Results Our cohort included 62,281 women who had 92,055 pregnancies resulting in 93,584 live born babies. Screening occurred in 76% of pregnancies; 69% had a result recorded, 21.5% of those were positive for GBS. Prophylaxis was used by 79% of this group. Eighteen babies developed EOGBS, estimated incidence/1000 live births in 2006 and 2016 was 0.35 (95% CI, 0.07 to 0.63) and 0.1 (95% CI, 0 to 0.2) respectively. Seven of 10 term babies with EOGBS were born to mothers who screened negative. Data were unable to provide evidence of difference in rates of EOGBS between screened and unscreened pregnancies. We estimated the difference in EOGBS incidence from crude and weighted models to be 0 (95% CI, -0. 2 to 0.17) and -0.01 (95% CI, -0.13 to 0.10) /1000 live births respectively. Conclusion No change was detected in rates of EOGBS over time and no difference in EOGBS in babies of screened and unscreened populations. Screening and prophylaxis rates were modest. Limitations of universal screening suggest alternatives be considered.

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Section: Discussionmentioning

confidence: 99%

Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016

et al. 2019

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“…For instance, the number needed to be screened to reduce one early-stage complication is large, and there is little evidence that the guidelines prevent late-onset complications. 12 Furthermore, the use of peripartum antibiotics, which would include GBS prophylaxis in the intrapartum period, may negatively impact the developing neonatal gut microbiome and place that child at risk for other future diseases. 13 Little is known, however, about the role of GBS in the developing human microbiota.…”

Section: Introductionmentioning

confidence: 99%

Maternal group B Streptococcus and the infant gut microbiota

Cassidy‐Bushrow

Sitarik

Levin

et al. 2015

J Dev Orig Health Dis

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Early patterns of gut colonization may predispose children to adult disease. Exposures in utero and during delivery are associated with the infant gut microbiome. Although ~35% of women carry group B strep (GBS; Streptococcus agalactiae) during pregnancy, it is unknown if GBS presence influences the infant gut microbiome. As part of a population-based, general risk birth cohort, stool specimens were collected from infant’s diapers at research visits conducted at approximately 1 and 6 months of age. Using the Illumina MiSeq (San Diego, CA) platform, the V4 region of the bacterial 16S rRNA gene was sequenced. Infant gut bacterial community compositional differences by maternal GBS status were evaluated using permutational multivariate analysis of variance. Individual operational taxonomic units (OTUs) were tested using a zero-inflated negative binomial model. Data on maternal GBS and infant gut microbiota from either 1 (n=112) or 6 month (n=150) old samples was available on 262 maternal-child pairs. Eighty women (30.5%) were GBS+, of who 58 (72.5%) were given intrapartum antibiotics. After adjusting for maternal race, prenatal antifungal use and intrapartum antibiotics, maternal GBS status was statistically significantly associated with gut bacterial composition in the 6 month visit sample (Canberra R2=0.008, P=0.008; Unweighted UniFrac R2=0.010, P=0.011). Individual OTU tests revealed that infants of GBS+ mothers were significantly enriched for specific members of the Clostridiaceae, Ruminococcoceae, and Enterococcaceae in the 6 month samples compared to infants of GBS- mothers. Whether these taxonomic differences in infant gut microbiota at 6 months lead to differential predisposition for adult disease requires additional study.

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“…El tiempo requerido para el cultivo es una de las limitaciones actuales que debe tenerse en cuenta, ya que el uso sugerido de antibióticos por vía intravenosa debe iniciarse 4 horas antes del parto y en algunos casos el trabajo de parto puede cursar solo con 2 horas de duración, es por esto que es necesario desarrollar pruebas que permitan obtener resultados confiables en un corto tiempo; entre las propuestas está el uso de la identificación serológica mediante aglutinación de látex con antisueros para el SGB con una sensibilidad y especificidad del 98 y 99.5%, respectivamente (14); Un ejemplo es el ensayo Xpert® SGB, (15,16,17) que usa sondas de DNA mediante la amplificación la cadena de la polimerasa con transcriptasa reversa (PCR-RT) (12), lo que permite identificar partes específicas del ácido desoxirribonucleico del SGB, con una sensibilidad del 87% y una especificidad del 96% (17). Se ha diseñado también una prueba rápida basada en inmunoblot, en la cual se utiliza una membrana de nitrocelulosa cubierta con anticuerpos específicos para el SGB, con la que se logra identificar la colonización por este microorganismo en un máximo de 6.5 horas, con una sensibilidad del 97.1% y una especificidad del 88.4% (18).…”

Section: Tamizajeunclassified

“…Existen diferentes indicaciones para el manejo de la profilaxis antibiótica para el SGB (15,17):  Neonato previo con infección por SGB.  Bacteriuria por SGB durante cualquier trimestre del embarazo actual.…”

Section: Uso De Antibióticosunclassified

Prevención de la infección por Streptococcus del grupo B en gestantes

Sánchez

Arango

Díaz

et al. 2017

MedUNAB

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ResumenIntroducción: La infección neonatal por Streptococcus del Grupo B en mujeres gestantes es un problema creciente a nivel mundial y tiene múltiples consecuencias para el recién nacido, su prevención impacta directamente la morbimortalidad neonatal. Objetivo: Brindar al lector información relevante sobre la importancia clínica, nuevos métodos de tamizaje y formas de prevención de la infección por Streptococcus del Grupo B en gestantes, que será de utilidad para evitar complicaciones del binomio materno-fetal. Metodología: En esta revisión de la literatura, se estudiaron 53 artículos, abordando evidencia tanto en el ámbito local e internacional, utilizando las bases de datos PubMed, ScienceDirect y Google Scholar, dentro los criterios de búsqueda se tuvo en cuenta el año de publicación, incluyendo artículos que fueron publicados a partir del año 2011. Resultados: La comunidad internacional ha desarrollado guías y planes de prevención; en la actualidad, para una profilaxis y prevención adecuada se proponen diversos métodos, partiendo del tamizaje para las maternas, uso de antibióticos durante el embarazo y parto, además del desarrollo de vacunas maternas para prevenir infecciones. Conclusiones: La colonización por Streptococcus del Grupo B en gestantes y el riesgo que conlleva para el recién nacido y su madre, exige una constante actualización en técnicas de tamizaje, prevención y manejo. Numerosos avances en estos campos vienen llevándose a cabo en los últimos años y su fortalecimiento y desarrollo será clave para impactar positivamente la morbi-mortalidad materno-fetal. Abstract Introduction:The neonatal infection by Group B Streptococcus in pregnant women is a growing problem worldwide and has multiple consequences for the newborn, so its prevention directly impacts neonatal morbimortality. Objective: To provide the reader with relevant information about the clinical importance, new screening methods and ways to prevent Group B Streptococcus infection in pregnant women which will be useful to avoid complications in the pairing of maternal-fetal. Methodology: In this review of literature, 53 articles were studied addressing local and international evidence by using PubMed, ScienceDirect and Google Scholar databases; within the search criteria the year of publication was taken into account to do so, thus articles published from 2011 were included. Results: The international community has developed guidelines and prevention plans for this infection. Currently, for an adequate prophylaxis and prevention, various methods are proposed such as the screening for expectant mothers, the use of antibiotics during pregnancy and childbirth, and the development of maternal immunization to prevent infections as well. Conclusions: The colonization by Group B Streptococcus in pregnant women and the risk that this entails to the newborn and his/her mother requires constant updating in techniques for screening, prevention and management of it. Numerous advances in these fields of study have been carried out in recent years, ...

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

Cited by 11 publications

References 35 publications

Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016

Group B streptococcal screening, intrapartum antibiotic prophylaxis, and neonatal early-onset infection rates in an Australian local health district: 2006-2016

Maternal group B Streptococcus and the infant gut microbiota

Prevención de la infección por Streptococcus del grupo B en gestantes

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