Beyond Screening

Eisenberg, Esther; Gautam, Shiva; Khalil, Marwa M; Shaktour, Bashar; Schaffner, William; Griffin, Marie R.

doi:10.1097/01.inf.0000164765.12808.26

Cited by 13 publications

(6 citation statements)

References 16 publications

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“…Risk of bias is higher in these studies because participants in the two arms are not contemporaneous, so other differences between these periods may contribute. The few observational studies that compare screening with concurrent controls often retrospectively compare women who have a culture result to all other women8990; this may be biased due to the risk of misclassification and because people who accept screening are systematically different from those who do not 8091. Finally, as most studies only assess early onset GBS infection confirmed on culture, changes in disease incidence may actually reflect a decreased likelihood of culturing GBS in the laboratory, owing to the presence of antibiotics in neonates’ blood 92.…”

Section: Uncertain Evidence On Screening Effectivenessmentioning

confidence: 99%

Universal antenatal screening for group B streptococcus may cause more harm than good

Seedat

Geppert

Stinton

et al. 2019

BMJ

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Section: Uncertain Evidence On Screening Effectivenessmentioning

confidence: 99%

Universal antenatal screening for group B streptococcus may cause more harm than good

Seedat

Geppert

Stinton

et al. 2019

BMJ

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“…5 This striking and encouraging increase in screening rates was coupled with the elimination of previously reported racial and regional differences in screening. Screening for GBS was associated significantly with the use of other recommended prenatal screening tests and greater prenatal care utilization.…”

Section: Discussionmentioning

confidence: 86%

“…However, the study population was similar to that reported previously, allowing comparisons over time. 3,5 …”

Section: Discussionmentioning

confidence: 99%

“…Three maternal-age strata (younger than 20 years, 20–34 years, and 35 years or older) were created to compare results with previous data. 5 All women were included in the primary analysis of screening, but only those with an indication for GBS chemoprophylaxis were included in analyses of optimal chemoprophylaxis. Routine GBS chemoprophylaxis is not recommended for women undergoing a planned cesarean delivery in the absence of membrane rupture or labor.…”

Section: Methodsmentioning

confidence: 99%

“…5 Only 43% of these women underwent prenatal GBS screening in 1998–1999, and several cases of early-onset GBS disease occurred in neonates born to women with an indication for GBS chemoprophylaxis but who failed to receive optimal intrapartum chemoprophylaxis. The objective of the current study was to estimate adherence to the revised 2002 perinatal GBS prevention guidelines in Tennessee.…”

mentioning

confidence: 99%

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Adherence to Perinatal Group B Streptococcal Prevention Guidelines

Goins

Talbot

Schaffner

et al. 2010

Obstetrics &Amp; Gynecology

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OBJECTIVE To estimate compliance with the 2002 revised perinatal group B streptococci (GBS) prevention guidelines in Tennessee, which recommend universal GBS screening of pregnant women at 35–37 weeks of gestation and, when indicated, administration of intrapartum chemoprophylaxis. METHODS Active Bacterial Core surveillance conducts active, population-based surveillance for invasive GBS disease in 11 Tennessee counties. A retrospective case–cohort study was conducted using a stratified random sample of all live births in surveillance hospitals during 2003–2004, including all early-onset GBS cases. Factors associated with GBS screening and lack of optimal GBS chemoprophylaxis were analyzed using logistic regression. RESULTS Screening was performed for 84.7% of pregnant women, but 26.3% of prenatal tests with documented test dates were performed before 35 weeks of gestation. Among women with an indication for GBS prophylaxis, 61.2% received optimal chemoprophylaxis, defined as initiation of a recommended antibiotic 4 hours or more before delivery. When the analysis was restricted to women who were admitted 4 hours or more before delivery, 70.9% received optimal chemoprophylaxis. Women not receiving optimal chemoprophylaxis were more likely to have penicillin allergy (11.7% compared with 2.5%, adjusted odds ratio [OR] 8.58, 95% confidence interval [CI] 1.57–47.04) or preterm delivery (45.5% compared with 13.2%, adjusted OR 5.52, 95% CI 2.29–13.30) and were less likely to have received the recommended prenatal serologic testing for other infectious diseases (77.9% compared with 91.1%, adjusted OR 0.30, 95% CI 0.09–0.98). Forty cases of early-onset GBS were identified (0.36 per 1,000 live births); 25% of these neonates were born to women who received screening at 35 weeks of gestation or later and, when indicated, optimal chemoprophylaxis. CONCLUSION Universal prenatal GBS screening was implemented widely in Tennessee, although the timing of screening and administration of chemoprophylaxis often were not optimal. A substantial burden of early-onset GBS disease occurs despite optimal prenatal screening and chemoprophylaxis, suggesting that alternative strategies, such as vaccination, are needed. LEVEL OF EVIDENCE II

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