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

Abstract

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.

Poor Adherence to the Screening-Based Strategy of Group B Streptococcus Despite Colonization of Pregnant Women in Greece

“…Three additional studies from the USA revealed a wide heterogeneity among states: high adherence levels were recorded in Tennessee (84.7%) and Minnesota (88.4%) [ 16 , 17 ], and mediocre in California (69.05%) [ 18 ]. Moreover, compared to our results, a higher rate of adherence was observed in Australia (76%) [ 19 ].…”

<p>Indications and Clinical Profile of Neonatal Admissions: A Cross-Sectional Descriptive Analysis from a Single Academic Center in Jordan</p>

“…The incidence and epidemiologic trend of sepsis in our cohort is comparable to other reports that showed GBS to remain the leading cause of EOS, and CONS and gram-negative bacteria to be the main causes of LOS. 41 Maternal PROM was reported in 24%. It is not clear if these cases are overestimated since not all cases of suspected PROM were confirmed by PH or microscopic testing.…”

To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

“…The authors concluded that no change was detected in rates of EOGBS over time and there was no difference in rate of EOGBS in babies of screened and unscreened mothers. 16 In New Zealand 2004, an expert multidisciplinary group reviewed the evidence on IAP and the results of a national two-year surveillance study of EOGBS in the period 1998-1999. The group recommended a risk factor-based prevention strategy for prevention of EOGBS in New Zealand.…”

“…The authors concluded that no change was detected in rates of EOGBS over time and there was no difference in rate of EOGBS in babies of screened and unscreened mothers. 16 …”