Intrapartum antibiotics for known maternal Group B streptococcal colonization

Ohlsson, Arne; Shah, Vibhuti

doi:10.1002/14651858.cd007467.pub2

Cited by 99 publications

(36 citation statements)

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“…(iii) Changing the estimated effect of intravenous antibiotic therapy on EOGBS disease and infant death, given maternal colonisation, from an odds ratio of 0.17-0.028 causes a favourable change in the ICER for the strategy of screening based on culture at 35-37 weeks of gestation, from £633,000 as estimated in the base case, to £441,000 per EOGBS death avoided. Using the Ohlsson and Shah 35 odds ratio of 0.17, which had a wider confidence interval than the Smail odds ratio, did not change the base-case result. (iv) A change in the PCR rapidtest 'accuracy' estimate from that based on vaginal swab only to that based on rectal and vaginal swabs combined had no impact.…”

Section: Discussionmentioning

confidence: 92%

Cost‐effectiveness of rapid tests and other existing strategies for screening and management of early‐onset group B streptococcus during labour

Kaambwa

Bryan

Gray³

et al. 2010

BJOG

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Objective To determine the cost-effectiveness of alternative screening and prevention strategies, including rapid intrapartum testing, for prevention of early-onset neonatal group B streptococcus (GBS) infection in the UK. Design A decision model was developed to investigate the costeffectiveness of screening and prevention strategies for GBS. A strategy of doing nothing was also considered. Deterministic and probabilistic sensitivity analyses were carried out.Setting Two large UK based obstetric units.Participants Test accuracy data were obtained from a primary study of rapid tests at the onset of labour and risk factors from 1400 women.Main outcome measures Incremental health sector costs per case of early-onset GBS death avoided.Results Compared with a strategy of do nothing, the incremental cost-effectiveness ratio was £32,000 per Early-Onset GBS Disease avoided and £427,000 per Early-Onset GBS Death avoided for the strategy of providing routine intrapartum antibiotic prophylaxis to all women without prior screening; Based on their current sensitivity, specificity and cost, screening using rapid tests was dominated by other more cost-effective strategies.Conclusions The most cost-effective strategy was shown to be the provision of routine intrapartum antibiotic prophylaxis to all women without prior screening but, given broader concerns relating to antibiotic use, this is unlikely to be acceptable. In its absence, intrapartum antibiotic prophylaxis directed by screening with enriched culture becomes cost-effective. The current strategy of risk-factor-based screening is not cost-effective compared with screening based on culture.Keywords Cost-effectiveness, group B streptococcus, labour, rapid tests.Please cite this paper as: Kaambwa B, Bryan S, Gray J, Milner P, Daniels J, Khan K, Roberts T. Cost-effectiveness of rapid tests and other existing strategies for screening and management of early-onset group B streptococcus during labour.

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Section: Discussionmentioning

confidence: 92%

Cost‐effectiveness of rapid tests and other existing strategies for screening and management of early‐onset group B streptococcus during labour

Kaambwa

Bryan

Gray³

et al. 2010

BJOG

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“…Based on evidence from a Cochrane meta-analysis [6], we assumed that IAP with penicillin would prevent 83% of the true positive identified cases from giving birth to a child infected with GBS. We assumed that 0.022% of the mothers who received IAP would develop an anaphylactic reaction [7], with an attendant case fatality rate (CFR) of 10% [8].…”

Section: Methodsmentioning

confidence: 99%

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

Ginsberg

Eidelman

Shinwell

et al. 2013

Isr J Health Policy Res

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BackgroundIn Israel, an average of 37 children are born each year with sepsis and another four with meningitis as a result of Group B Streptococcal (GBS) disease. Israel currently only screens mothers with defined risk factors (around 15% of all pregnancies) in order to identify candidates for Intrapartum Antiobiotic Prophyhlaxis (IAP) of GBS. This paper presents a cost-utility analysis of implementing an alternative strategy, which would expand the current protocol to one aiming to screen all pregnant women at 35–37 weeks gestation based on taking a vaginal culture for GBS.MethodsA spreadsheet model was built incorporating technical, epidemiological, health service costs, demographic and economic data based primarily on Israeli sources.ResultsThe intervention of universal screening (compared with the current scenario) would increase screening costs from 580,000 NIS to 3,278,000 million NIS. In addition, the intervention would also increase penicillin costs from 39,000 NIS to 221,000 NIS. Current culture screening of approximately 15% of mothers-to-be with high risk factors resulted in 42 GBS births in 2008-9 (0.253/1000 births). Expanding culture screening to 85% of mothers-to-be, will decrease the number of GBS births to 17.3 (0.104/1000 births). The initial 2.9 million NIS incremental intervention costs are offset by decreased treatment costs of 1.9 million NIS and work productivity gains of 811,000 NIS as a result of a decrease in neurological sequelae from GBS caused meningitis. Thus the resultant net cost of the intervention is only around 134,000 NIS. Culture based screening will reduce the burden of disease by 12.6 discounted Quality Adjusted Life Years (QALYS), giving a very cost effective baseline incremental cost per QALY (cf. risk factor screening) of 10,641 NIS per QALY. The data was very sensitive to rates of anaphylactic shock and changes in the percentage of meningitis cases that had associated long term-sequelae.ConclusionIt is recommended that Israel adopt universal culture-based GBS screening.

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“…Gram-positive bacterium associated with transient colonization of mucosal membranes throughout the body, including the vagina, gastrointestinal tract, and urethra (1). GBS rarely causes disease in healthy individuals but can cause serious illness in immunocompromised patients, elderly individuals, and newborn infants (2).…”

Section: S Treptococcus Agalactiae (Group B Streptococcus [Gbs]) Is Amentioning

confidence: 99%

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

et al. 2015

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dNeonatal infection with Streptococcus agalactiae (group B Streptococcus [GBS]) is a leading cause of sepsis and meningitis in newborns. Recent guidelines have recommended universal screening of all pregnant women to identify those colonized with GBS and administration of peripartum prophylaxis to those identified as carriers to reduce the risk of early-onset GBS disease in neonates. Enriched culture methods are the current standard for prenatal GBS screening; however, the implementation of more sensitive molecular diagnostic tests may be able to further reduce the risk of early-onset GBS infection. We report a clinical evaluation of the Xpert GBS LB assay, a molecular diagnostic test for the identification of GBS from broth-enriched vaginal/rectal specimens obtained during routine prenatal screening. A total of 826 specimens were collected from women undergoing prenatal screening (35 to 37 weeks' gestation) and tested at one of three clinical centers. Each swab specimen was tested directly prior to enrichment using the Xpert GBS assay. Following 18 to 24 h of broth enrichment, each specimen was tested using the Xpert GBS LB assay and the FDA-cleared Smart GBS assay as a molecular diagnostic comparator. Results obtained using all three molecular tests were compared to those for broth-enriched culture as the gold standard. The sensitivity and specificity of the Xpert GBS LB assay were 99.0% and 92.4%, respectively, compared to those for the gold standard culture. The Smart GBS molecular test demonstrated sensitivity and specificity of 96.8% and 95.5%, respectively. The sensitivities of the two broth-enriched molecular methods were superior to those for direct testing of specimens using the Xpert GBS assay, which demonstrated sensitivity and specificity of 85.7% and 96.2%, respectively. S treptococcus agalactiae (group B Streptococcus [GBS]) is aGram-positive bacterium associated with transient colonization of mucosal membranes throughout the body, including the vagina, gastrointestinal tract, and urethra (1). GBS rarely causes disease in healthy individuals but can cause serious illness in immunocompromised patients, elderly individuals, and newborn infants (2). Of particular concern is neonatal infection caused by vertical transmission during labor and birthing. Transmission from an asymptomatically colonized mother to the neonate can result in early-onset invasive GBS disease, which is a leading cause of sepsis and meningitis in newborns in the United States (3). Early-onset GBS disease in newborns can result in death or longterm disabilities such as mental retardation and hearing or vision loss (4). Because these infections are acquired through direct contact of the neonate with GBS in the mother's urogenital tract during delivery, it has become a universal practice to screen pregnant women for vaginal/rectal colonization with GBS at 35 to 37 weeks' gestation (5). The identification of GBS during routine screening results in administration of intrapartum prophylaxis to mitigate transmission of bacteria and red...

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Intrapartum antibiotics for known maternal Group B streptococcal colonization

Cited by 99 publications

References 67 publications

Cost‐effectiveness of rapid tests and other existing strategies for screening and management of early‐onset group B streptococcus during labour

Cost‐effectiveness of rapid tests and other existing strategies for screening and management of early‐onset group B streptococcus during labour

Should Israel screen all mothers-to-be to prevent early-onset of neonatal group B streptococcal disease? A cost-utility analysis

Multicenter Clinical Evaluation of the Xpert GBS LB Assay for Detection of Group B Streptococcus in Prenatal Screening Specimens

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