Intrapartum chemoprophylaxis of early-onset group B streptococcal disease

Matorras, Roberto; García-Perea, Adela; Omeñaca, F; Diez-Enciso, M.; Madero, Rosário; Usandizaga, J. A.

doi:10.1016/0028-2243(91)90045-m

Cited by 88 publications

(52 citation statements)

References 15 publications

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“…In one study, blood cultures were obtained routinely from infants who received postpartum penicillin prophylaxis, but not from infants reported as historical control subjects, 90 creating the potential for overascertainment in the penicillin-treated group. The potential for ascertainment errors in prospective studies in which blood cultures were obtained only if the infant was judged to be clinically ill 47,53,79,81,83 , at the discretion of the attending neonatologist, 49 or according to unspecified criteria 23,51,52,63,70,80,82,91,92 depends on the duration of observation and the proportion of infants for whom complete outcome data were available. All but two of these studies were prospective trials with apparently complete data on early-onset neonatal bacteremia; the other two studies were hospital-based studies that included data for the entire birth cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Among 157 women with positive latex agglutination tests who could not be randomized because delivery occurred before screening test results were available, only 1 woman had an infant with GBS bacteremia; therefore, the relatively high attack rate in the group randomized to no treatment may have been anomalous. Matorrás et al 79 observed no invasive GBS disease in 60 infants born to GBScolonized women assigned randomly to treatment with intrapartum intravenous ampicillin and 3 cases in 65 infants whose mothers were randomized to no treatment (95% CI for OR 0 -.90, but P ϭ .06 by G test). Pylipow et al 83 documented GBS bacteremia in 5 of 54 infants whose mothers were GBS colonized, had at least one intrapartum risk factor (fever or amnionitis, preterm labor, or rupture of membranes for Ͼ6 hours), and did not receive intrapartum antibiotics.…”

Section: Intrapartum Prophylaxismentioning

confidence: 99%

“…83 Differences between attack rates in treatment and nontreatment groups are statistically significant only in the last of these studies, 83 which was not a randomized trial. Studies in which treatment was randomized 79,81,82 did demonstrate a significant reduction in EOGBS (OR: .11; 95% CI: .02-.62). Studies of intrapartum prophylaxis have been criticized because of nonrandom assignment of penicillin-allergic subjects to the control group 81 (although no biological mechanism by which maternal penicillin allergy could increase the risk of neonatal infection is apparent 84 ), failure to provide comparison data on the study groups or to describe fully the randomization procedure, 79,82 omission of statistical methods, 82 and multiple outcome analyses.…”

Section: Intrapartum Prophylaxismentioning

confidence: 99%

“…Studies in which treatment was randomized 79,81,82 did demonstrate a significant reduction in EOGBS (OR: .11; 95% CI: .02-.62). Studies of intrapartum prophylaxis have been criticized because of nonrandom assignment of penicillin-allergic subjects to the control group 81 (although no biological mechanism by which maternal penicillin allergy could increase the risk of neonatal infection is apparent 84 ), failure to provide comparison data on the study groups or to describe fully the randomization procedure, 79,82 omission of statistical methods, 82 and multiple outcome analyses. 82 Although there are many potential sources of error, including bias and selective publication as well as those noted above, these studies provide reasonable evidence that intrapartum antibiotic prophylaxis reduces the risk of EOGBS sepsis by 80%.…”

Section: Intrapartum Prophylaxismentioning

confidence: 99%

“…Of the reports, 9 were excluded: 4 had no control subjects 71,72 or only historical controls, 73,74 2 used clinical 75 or unspecified 76 criteria to diagnose sepsis, 1 did not report the number of recipients of prophylaxis, 77 and 2 were duplicate reports. 78,79 The 5 remaining studies 79 -83 are summarized in Table 4. In the study by Allardice et al, 80 28 women who were prospectively identified as GBS carriers by vaginal culture at 28 to 34 weeks gestation were confirmed to have GBS colonization at delivery and were given intrapartum ampicillin prophylaxis; none delivered infants with invasive GBS disease.…”

Section: Intrapartum Prophylaxismentioning

confidence: 99%

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Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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ABSTRACT. Objective. To identify interventions that reduce the attack rate for early-onset group B streptococcal (GBS) sepsis in neonates.Study Design. Literature review and reanalysis of published data.Results. The rate of early-onset GBS sepsis in highrisk neonates can be reduced by administration of antibiotics. Treatment during pregnancy (antepartum prophylaxis) fails to reduce maternal GBS colonization at delivery. With the administration of intravenous ampicillin, the risk of early-onset infection in infants born to women with preterm premature rupture of membranes is reduced by 56% and the risk of GBS infection is reduced by 36%; addition of gentamicin may increase the efficacy of ampicillin. Treatment of women with chorioamnionitis with ampicillin and gentamicin during labor reduces the likelihood of neonatal sepsis by 82% and reduces the likelihood of GBS infection by 86%. Universal administration of penicillin to neonates shortly after birth (postpartum prophylaxis) reduces the early-onset GBS attack rate by 68% but is associated with a 40% increase in overall mortality and therefore is contraindicated. Intrapartum prophylaxis, alone or combined with postnatal prophylaxis for the infants, reduces the early-onset GBS attack rate by 80% or 95%, respectively.Conclusions. Women with chorioamnionitis or preterm premature rupture of membranes and their infants should be treated with intravenous ampicillin and gentamicin. Intrapartum antimicrobial prophylaxis may be appropriate for other women whose infants are at increased but less extreme risk, and supplemental postpartum prophylaxis may be indicated for some of their infants. Selection of appropriate candidates and prophylaxis strategies requires careful consideration of costs and benefits for each patient. Pediatrics 1999;103(6). URL: http://www.pediatrics.org/cgi/content/full/103/6/e78; group B streptococcus, neonatal sepsis, early-onset sepsis, prevention, prophylaxis.ABBREVIATIONS. EOGBS, early-onset neonatal group B streptococcus infection; AAP, American Academy of Pediatrics; ACOG, American College of Obstetricians and Gynecologists; CDC, Centers for Disease Control and Prevention; GBS, group B streptococcus. P revention of early-onset neonatal group B streptococcal (EOGBS) sepsis requires the identification of infants who are at high risk and the use of effective preventive intervention. The American Academy of Pediatrics (AAP), 1,2 American College of Obstetricians and Gynecologists (ACOG), 3,4 and Centers for Disease Control and Prevention (CDC) 5 agree that this intervention should be intrapartum antibiotic treatment. The commentaries that accompany those recommendations and several recent cost-benefit or efficacy analyses implicitly 1-7 or explicitly 8 -11 assume that intrapartum antimicrobial prophylaxis is 100% effective, but reports of at least 50 cases of EOGBS disease in infants whose mothers received intrapartum prophylaxis [12][13][14][15] demonstrate that this cannot be correct. The decision analysis cited by the CDC recommendations 1...

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Section: Discussionmentioning

confidence: 99%

Section: Intrapartum Prophylaxismentioning

confidence: 99%

Section: Intrapartum Prophylaxismentioning

confidence: 99%

Section: Intrapartum Prophylaxismentioning

confidence: 99%

Section: Intrapartum Prophylaxismentioning

confidence: 99%

See 3 more Smart Citations

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

1999

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Compliance with a risk-factor-based guideline for the prevention of neonatal group B streptococcal sepsis

Fleming

McDuffie

Russell

et al. 1997

Infect. Dis. Obstet. Gynecol.

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Objective: The purpose of this study was to determine the compliance rate with a maternal riskfactor-based guideline for the prevention of neonatal group B streptococcal (GBS) sepsis.Methods: In August 1994, a risk-factor-based guideline for selective intrapartum prophylaxis against neonatal GBS was adopted by a group model health maintenance organization. This guideline identified the following maternal risk factors for neonatal GBS sepsis: preterm delivery, rupture of membranes for >18 h, fever/chorioamnionitis, and history of a previous GBS-affected child. Patients with one or more risk factors were to receive intrapartum antibiotic prophylaxis consisting of either ampicillin, erythromycin, or clindamycin. We conducted a retrospective chart review to record risk factors and use of antibiotics. We hypothesized that >90% of patients with risk factors would receive intrapartum chemoprophylaxis.Results: A total of 805 maternal charts were reviewed. Of these, 105 (13%) were candidates for intrapartum prophylaxis. We found an overall compliance rate of 65%. Compliance rates by risk factor were preterm delivery (51%), prolonged rupture of membranes (73%), fever/chorioamnionitis (87%), and previous affected child (100%).Conclusions: Our results show unexpectedly low compliance rates with a risk-factor-based guideline for the prevention of neonatal GBS sepsis. Only 65% of women with any risk factor for neonatal GBS sepsis received intrapartum antibiotic prophylaxis appropriately. Educational efforts to improve compliance with a risk-factor-based guideline should specifically address mothers delivering at 34-36 weeks gestation and mothers with prolonged rupture of membranes. Infect. Dis.

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Randomized, placebo-controlled trial of transplacental antibiotic prophylaxis of neonatal group B streptococcal colonization and bacteremia in rabbits

Lembet

McDuffie

Gibbs

1997

Infect. Dis. Obstet. Gynecol.

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Objective We evaluated the effect of maternal administration of ampicillin/sulbactam on colonization and bacteremia in newborn rabbits after intracervical inoculation of mothers with group B streptococci (GBS). Methods New Zealand white rabbits on day 30 of a 31‐day gestation were inoculated intracervically with 104–105 colony forming units (cfu) GBS. Two hours after inoculation mothers received ampicillin/sulbactam (50 mg/kg) or saline (control) intramuscularly as a single dose, in a randomized double‐blinded manner. We induced labor 4 h later with intramuscular oxytocin. At delivery, cultures for GBS were taken from neonatal oropharynx. Thereafter, cultures were taken from neonatal oropharynx and anorectum daily and from neonatal heart at death or after 96 h. Sample size analysis showed a need for 17 pups in each group. Results In the control group, induction failed in one animal that was excluded from analysis. At birth, 0 of 39 pups of treated does had positive oropharyngeal cultures compared to 26 of 27 (96%) pups of saline‐treated does (P < 0.0001). Pups treated with antibiotic in utero were also significantly less likely to have positive oropharyngeal cultures at 24, 48, and 72 h after birth compared to controls (24 h, 0% vs. 100%, P < 0.0001; 48 h, 8% vs. 100%,P < 0.0001; 72 h, 16% vs. 100%, P < 0.0001). Treated pups were significantly less likely to have positive anorectal cultures at 24, 48, and 72 h after birth compared to control animals (24 h, 0% vs. 100%, P < 0.0001; 48 h, 0% vs. 95%, P < 0.0001; 72 h, 0% vs. 92%, P < 0.0001). Treated pups were significantly less likely to have positive heart cultures at 72 h after birth compared to controls (11% vs. 92%, P < 0.0002). Cumulative neonatal survival was higher in treated pups compared to controls at 72 and 96 h after birth (72 h, 32% vs. 0%, P = 0.0003; 96 h, 26% vs. 0%, P = 0.015). Conclusions Single dose transplacental prophylaxis given 4 h before delivery resulted in decreased neonatal GBS colonization and bacteremia and improved neonatal survival in rabbits. Infect. Dis. Obstet. Gynecol. 5:355–358, 1997. © 1998 Wiley‐Liss, Inc.

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Intrapartum chemoprophylaxis of early-onset group B streptococcal disease

Cited by 88 publications

References 15 publications

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Antimicrobial Prevention of Early-onset Group B Streptococcal Sepsis: Estimates of Risk Reduction Based on a Critical Literature Review

Compliance with a risk-factor-based guideline for the prevention of neonatal group B streptococcal sepsis

Randomized, placebo-controlled trial of transplacental antibiotic prophylaxis of neonatal group B streptococcal colonization and bacteremia in rabbits

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