Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference

Abstract

Group B streptococcus (GBS) remains worldwide a leading cause of severe neonatal disease. Since the end of the 1990s, various strategies for prevention of the early onset neonatal disease have been implemented and have evolved. When a universal antenatal GBS screening-based strategy is used to identify women who are given an intrapartum antimicrobial prophylaxis, a substantial reduction of incidence up to 80% has been reported in the USA as in other countries including European countries. However recommendations are still a matter of debate due to challenges and controversies on how best to identify candidates for prophylaxis and to drawbacks of intrapartum administration of antibiotics. In Europe, some countries recommend either antenatal GBS screening or risk-based strategies, or any combination, and others do not have national or any other kind of guidelines for prevention of GBS perinatal disease. Furthermore, accurate population-based data of incidence of GBS neonatal disease are not available in some countries and hamper good effectiveness evaluation of prevention strategies. To facilitate a consensus towards European guidelines for the management of pregnant women in labor and during pregnancy for the prevention of GBS perinatal disease, a conference was organized in 2013 with a group of experts in neonatology, gynecologyobstetrics and clinical microbiology coming from European representative countries. The group reviewed available data, identified areas where results were suboptimal, where revised procedures and new technologies could improve current practices for prevention of perinatal GBS disease. The key decision issued after the conference is to recommend intrapartum antimicrobial prophylaxis based on a universal intrapartum GBS screening strategy using a rapid real time testing.

Polish Gynecological Society Recommendations for Labor Induction

“…The results of randomized trials also indicate that antibiotic therapy and hospitalization in intermediate and intensive care units are less likely after labor induction [15]. The use of antibiotics is recommended in pregnant in women with positive or unknown group B streptococcus (GBS) colonization [16].…”

Challenges in reducing group B Streptococcus disease in African settings

“…Several risk factors are associated with increased risk of EOD in the newborn, including preterm labour, PROM >18 hours, intrapartum fever >38°C, GBS bacteriuria in the mothers during the current pregnancy and previous sibling with invasive GBS disease 51. Several countries adopt a strategy to implement IAP when some or all of these risks are identified.…”

“…Rapid real-time PCR tests demonstrated sensitivity from 62.5% to 100% and specificity from 84.6% to 100% compared with enriched GBS cultures 51. Di Renzo et al 51 argue that this method could prove superior to risk-based approach or universal screening if undertaken when a woman is in labour as those who are current carriers of GBS are at most risk of passing GBS to their babies will be identified. Direct antigen detection tests are rapid and inexpensive, but not sufficiently sensitive for diagnosis 51.…”

Real-time polymerase chain reaction and culture in the diagnosis of invasive group B streptococcal disease in infants: a retrospective study

“…LOD is not amenable to prevention by IAP. Recent European guidelines (2014) also recommend universal screening, a strategy already adopted by several European countries [4]. Ireland, the UK and the Netherlands presently employ a risk-based approach [3].…”