Universal Antenatal Screening for Group B Streptococcus in Emilia-romagna

Abstract

Background Group B streptococcus (GBS) is a leading cause of severe infections in newborns. Intrapartum antibiotic chemoprophylaxis (IAP) reduces the rate of early-onset disease. The aim of this study is to determine the degree of clinicians' compliance with the suggested protocol for GBS prevention in Emilia-Romagna (Italy). Methods Characteristics of each delivery were prospectively recorded in the period between October 2005 to December 2005. Standardized pro-forma were used to collect data. Results Among 5118 babies, 7.2% (369) were preterm and 92.3% were born at term (4749). Antenatal screening was performed in 86.6% of women who delivered at term, of which 18.1% were GBS culture-positive. Information regarding culture site was available in 93.2% of women screened and recto-vaginal cultures were documented in 42.7%. IAP was administered to 28.7% of 3937 women at term who had either spontaneous delivery or emergency caesarean section. In this cohort, 15.9% were diagnosed GBS culture-positive, of which 92.6% received IAP. Prophylaxis was also administered to 8.4% (331) of women for no apparent reason. Compared with tertiary level hospitals, women delivering in primary/secondary hospitals were more likely to be both GBS screened (P , 0.0001; OR 3.04; CI 2.33 -3.97) and to receive prophylaxis !4 hours before delivery (P ¼ 0.0025; OR 1.57; CI 1.17 -2.12). Conclusions GBS screening was performed in .85% of women and . 90% of culture-positive women received prophylaxis. However, there is a need to educate clinicians about protocol adherence, as most cultures were suboptimal and cases of unnecessary IAP were administered. The screening was more effective in hospitals with fewer deliveries.

Appropriateness of Intrapartum Antibiotic Prophylaxis to Prevent Neonatal Group B Streptococcus Disease

“…The percentage of GBS screened women was higher than the 85% reported from other national and international studies [12,15], and this increase in the adoption of screening has been probably coupled with the use of other recommended prenatal screening tests and with the greater prenatal care utilization [9]. GBS colonization was 9.8% in our population; which is lower than that reported in many previous studies in the literature [9,11,12,16,17], although it is well known that GBS maternal colonization varies from place to place. Moreover, other factors may have contributed to this variation, including socio-economic factors, variable clinical practices, methods in sample collection and processing techniques, as well as ethnic and genetic factors that may play a role in rates of GBS infection [18].…”

“…Among women with an indication for GBS prophylaxis, Goins et al [9] and De Luca et al [11] reported optimal IAP in 61.2% and 50% of deliveries, respectively. Berardi et al [12] in a prospective cohort study showed that adequate IAP was administered in 52% of GBS culture-positive women and in 62.2% of the women with unknown GBS status and risk factors.…”

“…Few previous studies have analyzed IAP appropriateness and its overall adherence to recommended guidelines, ranging from 50% to 71% [9–12]. …”

Group B streptococcus antimicrobial resistance in neonates born to group B streptococcus‐colonized mothers: Single‐center survey

“…After this time, the screen rates increased to 66% and 70% in 2012 and 2013, respectively. The screen rate was still below the surveillance rate (85%) in the USA during 2003–2004, and the 86.6% reported in Italy in 2005 . The isolation rate of GBS from pregnant women was 18–22%, compatible with a previous report from Taiwan …”

Factors associated with choice of approach for Group B streptococcus screening

“…Screening for women requiring IAP has been done using one of two approaches: culture-based universal screening which should be done between weeks 35 and 37 of pregnancy and risk-based approach in which women receive IAP based on the presence of risk factors [1, 4]. Universal Screening policy is practiced in the United States and Canada [1–3, 5] and it is also recommended with some modifications in many European countries and in Japan [6], (http://www.groupbstrepinternational.org/what-is-group-b-strep/early-onset-gbs-disease/), [2]. A risk-based approach is recommended in Denmark, Israel, the Netherlands, New Zealand and the United Kingdom [1, 2].…”