Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Abstract

Background Early‐onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening‐based protocol), whereas others employ risk‐based protocols. Objectives To compare the effectiveness of screening‐based versus risk‐based protocols in preventing EOGBS disease. Search strategy Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture‐based, risk‐based. Selection criteria Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk‐based protocols with each other or with controls. Data collection and analysis Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel‐Haenszel analyses with random effects. Main results Seventeen eligible studies were included. In this meta‐analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk‐based protocols (ten studies, RR 0.43, 95% CI 0.32–0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11–0.84). Meta‐analysis could not demonstrate a significant effect of risk‐based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61–1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). Conclusions Screening‐based protocols were associated with lower incidences of EOGBS disease compared with risk‐based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. Tweetable abstract Meta‐analysis: general screening is associated with lower rates of early‐onset group B strep. neonatal sepsis compared with risk‐based protocols.

Authors’ reply re: Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset Group B streptococcal disease: a systematic review and meta‐analysis

“…However, 50% of neonates with early‐onset sepsis with GBS did not have risk factors. To the contrary, we confirm in our meta‐analysis and systematic review that universal screening lowered the incidence of early‐onset GBS sepsis in newborns, whereas risk‐based approaches did not 2 . This might indicate that although screening is imperfect, risk factors might be worse in predicting early‐onset GBS outcomes.…”

“…We read the letter from Drs Seedat and Marshall, commenting on our article, with great interest 1,2 . Their clarifications on the UK National Screening Committee (UK NSC) position are very clear.…”

Authors' reply re: Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

“…We extracted data from studies in the review, which showed missed cases to be 41% of early-onset GBS (EOGBS) cases in the risk-based group compared with 24% in the screening group (weighted mean). 2 When it comes to preterm birth, innovative methods are needed without doubt, as EOGBS sepsis in this group of infants results in a much higher casefatality rate compared with term infants. 3 Besides, few data are available on the role of GBS infection as the cause of preterm birth.…”

“…reliability, validity and responsiveness, should be assessed and considered adequate. 2 The authors' citation supporting a 'valid' questionnaire 3 only addresses internal consistency, construct validity and sensitivity to change, with test-retest reliability and minimally important difference (responsiveness in a clinically meaningful way) of the questionnaire unaddressed in peer review literature. For this reason, the POPss was not included as a recommended questionnaire for assessment of prolapse in the 6th International Consultation on Incontinence 4 and should be described as a non-validated questionnaire and primary outcome.…”

“…colonisation status, only 63.4% received IAP. 2 Accordingly, rapid, highly sensitive, real-time, intrapartum PCR identification for detection of GBS may be of value.…”