Is Group B Streptococcus Colonization Associated with Maternal Peripartum Infection in an Era of Routine Prophylaxis?

Abstract

Objective This study aimed to assess whether colonization with group B streptococcus (GBS) is associated with maternal peripartum infection in an era of routine prophylaxis. Study Design This study presented a secondary analysis of women delivering ≥37 weeks who underwent a trial of labor from the U.S. Consortium on Safe Labor (CSL) study. The exposure was maternal GBS colonization and the outcome was a diagnosis of chorioamnionitis, and secondarily, analyses were restricted to deliveries not admitted in labor and measures of postpartum infection (postpartum fever, endometritis, and surgical site infection). Logistic regression with generalized estimating equations was used accounting for within-woman correlations. Models adjusted for maternal age, parity, race, prepregnancy body mass index, pregestational diabetes, insurance status, study site/region, year of delivery, number of vaginal exams from admission to delivery, and time (in hours) from admission to delivery. Results Among 170,804 assessed women, 33,877 (19.8%) were colonized with GBS and 5,172 (3.0%) were diagnosed with chorioamnionitis. While the frequency of GBS colonization did not vary by chorioamnionitis status (3.0% in both groups), in multivariable analyses, GBS colonization was associated with slightly lower odds of chorioamnionitis (adjusted odds ratio [AOR]: 0.89; 95% confidence interval [CI]: 0.83–0.96). In secondary analyses, this association held regardless of spontaneous labor on admission; and the odds of postpartum infectious outcomes were not higher with GBS colonization. Conclusion In contrast to historical data, GBS colonization was associated with lower odds of chorioamnionitis in an era of routine GBS screening and prophylaxis. Key Points

Documented β-Lactam Allergy and Risk for Cesarean Surgical Site Infection

“…One possible explanation is access to care, where those with private insurance may be more inclined to seek care and receive an antibiotic in the first place as well as subsequent care and documentation if they were to develop an allergy. Group B Streptococcus colonization was associated with decreased odds of SSI, consistent with the findings of other authors in the setting of routine prophylaxis [ 37 ]. Women with group B Streptococcus most likely received additional antibiotic therapy, particularly if they labored prior to their cesarean birth.…”

Group B streptococcal infection of the genitourinary tract in pregnant and non‐pregnant patients with diabetes mellitus: An immunocompromised host or something more?

“…With these interventions, recent studies have suggested that GBS colonization are associated with a lower odds of chorioamnionitis. 11 Additionally, obstetric comorbidities are also associated with an increase in antibiotic use during pregnancy, which may in turn decrease rates of neonatal infections. 104 While studies of invasive GBS infection in non-pregnant adults demonstrate increased incidence of infection, many of these studies do not independently investigate the incidence of GBS UTIs.…”

“…10 Following initiation of routine GBS screening and prophylaxis, maternal GBS colonization during pregnancy is now associated with lower odds of chorioamnionitis compared to prior to these interventions. 11 Over the past two decades, the epidemiology of invasive GBS infections in non-pregnant adults has evolved. A recent population-based surveillance study suggests a rising incidence of invasive GBS infection in non-pregnant adults, especially with increasing age.…”

Causes of early postpartum complications that result in visits to the emergency department

“…Furthermore, patients who were positive for Group B Strep status (GBS) were less likely to be admitted upon presentation to the ED. With appropriate screening and peripartum prophylaxis, the incidence of maternal infections is decreased [ 6 ]. Hence the antibiotics used to treat GBS may confer protection against infections.…”