Group B Streptococcus real‐time PCR may potentially reduce intrapartum maternal antibiotic treatment

Abstract

Background Protocols for preventing early‐onset group B streptococcal (GBS) neonatal infection may result in unnecessary antibiotics administration. Real‐time polymerase chain reaction (PCR) can provide a result within 30–60 min and has been found to be specific and sensitive for defining intrapartum GBS status. Objective To evaluate whether implementation of GBS fast real‐time PCR to all women who require GBS prophylaxis may reduce the use of maternal prophylactic antibiotics. Methods This prospective cohort study included women admitted to a single delivery ward who required prophylactic antibiotics either due to a positive antepartum GBS culture screening performed at 35–37 weeks or due to an unknown GBS status with an intrapartum risk factor. All the women were tested by a double vaginal swab (real‐time PCR and culture) as soon as it became apparent, they required antibiotic prophylaxis and prior to its administration. Results Between May 2019 and August 2020, 303 women met eligibility criteria and were enrolled, but four were excluded from the analysis due to failed culture or PCR tests. Of 299 women included in the study, 208 (69.5%) and 180 (60.2%) women, showed no evidence of GBS on intrapartum culture or PCR, respectively. Of 89 GBS antepartum carriers, 43 (48.3%) and 32 (35.9%) had negative intrapartum culture and PCR results, respectively. Of the 210 women with risk factors, 165 (78.5%) were culture negative and 148 (70.4%) had a negative PCR. Using intrapartum culture as the gold standard, intrapartum GBS real‐time PCR was found to have a sensitivity of 97.8% (95% confidence interval [CI] 92.3, 99.7) and a specificity of 85.6% (95% CI 80.1, 90.1). Conclusions Compared with antepartum universal culture screening or intrapartum risk‐factor assessment, the need for maternal antibiotic treatment may be substantially reduced by implementation of intrapartum GBS real‐time PCR, without compromising the sensitivity of GBS detection.

Beyond COVID‐19: Equitable epidemiology for studying the impact of maternal infections on neonatal mortality and morbidity

“…While this life-saving therapy remarkably improved the quality of life of people living with HIV, it means that many newborns are exposed to ART in utero, and the potential risks and benefits of this maternal treatment on birth outcomes and longer-term offspring health are still unclear. Three articles [4][5][6] in this special issue of Paediatric and Perinatal Epidemiology illustrate the importance of prospective studies from LMICs on infection during pregnancy, and on the impact of new strategies to improve birth outcomes and neonatal health.…”

“…Despite global advocacy to highlight the GBS burden, research gaps remain and implementation of preventive strategies in LMICs is urgently needed. In another article in this special issue, by evaluating whether diagnosis of maternal GBS colonisation could be done by real‐time polymerase chain reaction (PCR) at the time of delivery, Kugelman and colleagues 6 concluded that PCR had good sensitivity and specificity compared to culture to detect GBS. They suggested that the need for maternal prophylactic antibiotics could be substantially reduced by using this strategy compared with antepartum universal culture screening or intrapartum risk‐factor assessment.…”

Importance of considering infection during pregnancy: An underappreciated and preventable perinatal concern

“…However, such preventive measures must be applied efficiently and effectively. Kugelman and colleagues 12 evaluated the potential use of real‐time PCR in place of universal screening at 37 weeks of pregnancy to reduce the use of prophylactic antibiotics against GBS disease. The authors show that in many cases, universal screening results in unnecessary antibiotic use for the prevention of GBS—important for tailoring our screening measures.…”