scholarly journals To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

2020 ◽  
Vol 7 ◽  
pp. 204993612094242
Author(s):  
Guduru Gopal Rao ◽  
Priya Khanna
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Low Income ◽  
Streptococcus Agalactiae ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Developed Countries ◽  
Low Income Countries ◽  
Early Onset Sepsis ◽  
Group B

Streptococcus agalactiae, also known as Group B streptococcus (GBS) is the commonest cause of early onset sepsis in newborns in developed high-income countries. Intrapartum antimicrobial (antibiotic) prophylaxis (IAP) is recognized to be highly effective in preventing early onset Group B sepsis (EOGBS) in newborns. The key controversy is about the strategy that should be used to identify mothers who should receive IAP. There are two strategies that are followed in developed countries: screening-based or risk-factor-based identification of women requiring IAP. The debate regarding which of the two approaches is better has intensified in the recent years with concerns about antimicrobial resistance, effect on newborn’s microbiome and other adverse effects. In this review, we have discussed some of the key research papers published in the period 2015–2019 that have addressed the relative merits and disadvantages of screening versus risk-factor-based identification of women requiring IAP. Although screening-based IAP appears to be more efficacious than risk-based IAP, IAP-based prevention has several limitations including ineffectiveness in prevention of late-onset GBS infection in babies, premature and still births, impact of IAP on neonatal microbiota, emergence of antimicrobial resistance and difficulties in implementing IAP-based strategies in middle and low income countries. Alternative strategies, principally maternal immunization against GBS would circumvent use of IAP. However, no licensed vaccines are currently available for use.

Neonatal implications of early-onset group B streptococcal disease

1998 ◽  
Vol 10 (4) ◽  
pp. 181-196
Author(s):  
Nicholas D Embleton
Keyword(s):  
Early Onset ◽  
Group B Streptococcus ◽  
Developed Countries ◽  
The United States ◽  
Epidemiological Studies ◽  
Clinical Aspects ◽  
Streptococcal Disease ◽  
Early Onset Sepsis ◽  
Group B Streptococcal Disease ◽  
Group B

Group B streptococcal disease is the commonest cause of early-onset neonatal sepsis in most developed countries. Recent epidemiological studies and controlled trials have shown that many cases are theoretically preventable and guidelines have been widely adopted in the United States and Australia but are not common place in much of Europe. Infections caused by group B streptococcus may present at any time before, during or after delivery. This article reviews aspects of early-onset sepsis in the newborn infant (clinical presentation in the first 48 hours) as almost all of these cases are maternally acquired. Microbiological, epidemiological, pathophysiological and clinical aspects of the disease are discussed, and the practical implications of adopting preventative programmes are addressed.

scholarly journals The Italian arm of the PREPARE study: an international project to evaluate and license a maternal vaccine against group B streptococcus

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Alberto Berardi ◽  
◽  
Tiziana Cassetti ◽  
Roberta Creti ◽  
Caterina Vocale ◽  
...  
Keyword(s):  
Low Income ◽  
Pregnancy Outcomes ◽  
Group B Streptococcus ◽  
Invasive Disease ◽  
Low Income Countries ◽  
International Project ◽  
Main Body ◽  
Non Profit ◽  
Maternal Vaccination ◽  
Group B

Abstract Background Group B streptococcus (GBS) is a leading cause of sepsis, pneumonia and meningitis in infants, with long term neurodevelopmental sequelae. GBS may be associated with poor pregnancy outcomes, including spontaneous abortion, stillbirth and preterm birth. Intrapartum antibiotic prophylaxis (IAP) is currently the only way to prevent early-onset disease (presenting at 0 to 6 days of life), although it has no impact on the disease presenting over 6 days of life and its implementation is challenging in resource poor countries. A maternal vaccine against GBS could reduce all GBS manifestations as well as improve pregnancy outcomes, even in low-income countries. Main body The term “PREPARE” designates an international project aimed at developing a maternal vaccination platform to test vaccines against neonatal GBS infections by maternal immunization. It is a non-profit, multi-center, interventional and experimental study (promoted by the St George University of London. [UK]) with the aim of developing a maternal vaccination platform, determining pregnancy outcomes, and defining the extent of GBS infections in children and mothers in Africa. PREPARE also aims to estimate the protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa and to conduct two trials on candidate GBS vaccines. PREPARE consists of 6 work packages. In four European countries (Italy, UK, Netherlands, France) the recruitment of cases and controls will start in 2020 and will end in 2022. The Italian PREPARE network includes 41 centers. The Italian network aims to collect: GBS isolates from infants with invasive disease, maternal and neonatal sera (cases); cord sera and GBS strains from colonized mothers whose infants do not develop GBS infection (controls). Short conclusion PREPARE will contribute information on protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa. The vaccine that will be tested by the PREPARE study could be an effective strategy to prevent GBS disease.

The Use of Blood Counts and Blood Cultures to Screen Neonates Born to Partially Treated Group B Streptococcus-carrier Mothers for Early-onset Sepsis

2011 ◽  
Vol 30 (10) ◽  
pp. 840-843 ◽  
Author(s):  
Saar Hashavya ◽  
Shmuel Benenson ◽  
Zivanit Ergaz-Shaltiel ◽  
Benjamin Bar-Oz ◽  
Diana Averbuch ◽  
...  
Keyword(s):  
Early Onset ◽  
Group B Streptococcus ◽  
Treated Group ◽  
Blood Cultures ◽  
Early Onset Sepsis ◽  
Group B

scholarly journals Late Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Kam Lun Hon ◽  
King Hang Chan ◽  
Pak Long Ko ◽  
King Woon So ◽  
Alexander K. C. Leung
Keyword(s):  
Streptococcus Agalactiae ◽  
Early Onset ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Cost Effective ◽  
Rapid Onset ◽  
Current Treatment ◽  
Effective Solution ◽  
Birth Canal ◽  
Group B

We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.

Group B streptococcus infection in pregnancy: an update

1999 ◽  
Vol 11 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Geralyn C O'Reilly ◽  
Jane E Hitti ◽  
Thomas J Benedetti
Keyword(s):  
Cost Effectiveness ◽  
Streptococcus Agalactiae ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Group B ◽  
The Cost ◽  
In Pregnancy

Group B streptococcus (GBS), or Streptococcus agalactiae, has been a continuing focus of debate in the paediatric and obstetric worlds. The organism has emerged as the leading cause of early-onset neonatal sepsis. With an average of 20% of mothers being carriers for the organism (range from 15–40%), the following questions remain to be answered:1 How best to screen for GBS and which protocol to use?2 How best to counsel patients who are GBS carriers?3 What is the cost effectiveness of the screening protocols?

Early-onset neonatal infections in Australia and New Zealand, 2002–2012

2018 ◽  
Vol 104 (3) ◽  
pp. F248-F252 ◽  
Author(s):  
Tarun Singh ◽  
Elizabeth H Barnes ◽  
David Isaacs
Keyword(s):  
New Zealand ◽  
Incidence Rate ◽  
Early Onset ◽  
Group B Streptococcus ◽  
E Coli ◽  
Live Births ◽  
Early Onset Sepsis ◽  
Group B ◽  
Almost All ◽  
Over Time

BackgroundThe epidemiology of early-onset neonatal sepsis (EONS) varies over time, and requires regular surveillance.ObjectiveTo analyse data on EONS in Australia and New Zealand.MethodsRetrospective analysis of data collected longitudinally from multiple neonatal units from 2002 to 2012.ResultsOf 386 423 live births, 454 infants had EONS. The incidence rate of EONS was 1.20 per 1000 live births in 2002 and 0.83 in 2012, decreasing by 4% per year (95% CI 1% to 7%, p=0.007). Group B streptococcus (GBS) (37%) and Escherichia coli (25%) were the most prevalent organisms. The early-onset GBS (EOGBS) incidence rate was 0.43/1000 live births, with no evidence of change over time (p=0.3). Of EOGBS-infected babies, 62% were born at term compared with 8% with early-onset E. coli sepsis, p<0.0001. The mortality of E. coli early-onset sepsis (EOS) (25%) was higher than GBS (11%), but this difference in mortality was no longer significant after adjusting for gestation and birth weight. Mortality from EOS fell significantly over the study period (17% per year, 95% CI 10 to 24, p<0.0001).ConclusionsGBS was the most common cause of early sepsis, but the incidence was lower than prior to the introduction of intrapartum antibiotic prophylaxis, and remained steady over time. The mortality of early-onset E. coli sepsis was significantly higher than GBS sepsis, but this may have been because almost all babies with E. coli were born preterm, rather than a difference in virulence.

Management of well appearing infants born to afebrile mothers with inadequate GBS prophylaxis: A retrospective comparison of the three approaches recommended by the COFN

2021 ◽  
pp. 1-6
Author(s):  
T. Beck ◽  
A.J. Sloane ◽  
D.L. Carola ◽  
D. McElwee ◽  
C. Edwards ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Risk Factor ◽  
Clinical Condition ◽  
Early Onset ◽  
Vital Signs ◽  
Newborn Care ◽  
Kaiser Permanente ◽  
Multivariate Risk ◽  
Early Onset Sepsis ◽  
Group B

BACKGROUND: There are three different approaches set forth by the Committee on the Fetus and Newborn (COFN) for managing asymptomatic neonates born to mothers with inadequate intrapartum antibiotic prophylaxis (IAP) for early-onset Group B Strep (GBS) infection. The first approach is that of categorical risk factor assessments, and recommends that asymptomatic infants born to afebrile mothers with inadequate IAP for GBS be monitored with clinical observation for 36–48 hours. The second approach recommends serial physical examinations and vital signs for 36–48 hours to closely monitor changes in clinical condition for all patients. The Kaiser Permanente EOS risk calculator (SRC) is an example of the third approach, a multivariate risk assessment, and it takes into consideration several perinatal risk factors. This multivariate risk assessment then provides recommendations for reassessment and management based on presume risk of the infant developing or having Early Onset Sepsis (EOS). The aim of our study was to compare these three recently published recommendations from the COFN for the management of asymptomatic neonates born to afebrile mothers with inadequate IAP for GBS. STUDY DESIGN: This is a retrospective study of asymptomatic neonates with gestational age ≥35 weeks born to afebrile mothers with indicated inadequate IAP for GBS between April 2017 and July 2020. Management recommendations of the SRC were compared to the recommendations of categorical risk assessment and risk assessment based on clinical condition. RESULTS: A total of 7,396 infants were born during the study period, 394 (5.3%. to mothers with inadequate IAP. Recommendations for these infants according to both the categorical risk factor guideline and the clinical condition guideline include extended, close observation. However, the SRC recommended routine newborn care for 99.7%.f these infants. None of the infants developed EOS. CONCLUSION: The SRC recommend routine neonatal care without enhanced and prolonged observation for nearly all asymptomatic infants born to afebrile mothers with inadequate IAP. As none of the infants in this cohort had EOS, further studies in a larger cohort are needed to establish the safety of SRC in neonates born to mothers with inadequate IAP.

scholarly journals Group B Streptococci Colonization in Pregnant Guatemalan Women: Prevalence, Risk Factors, and Vaginal Microbiome

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Anne-Marie Rick ◽  
Angie Aguilar ◽  
Rosita Cortes ◽  
Remei Gordillo ◽  
Mario Melgar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Low Income ◽  
Group B Streptococcus ◽  
Cross Sectional Study ◽  
Low Income Countries ◽  
Vaginal Microbiome ◽  
Group B Streptococci ◽  
Cross Sectional ◽  
Group B

Abstract Background Infection causes 1 of every 5 neonatal deaths globally. Group B Streptococcus (GBS) is the most significant pathogen, although little is known about its epidemiology and risk in low-income countries. Methods A cross-sectional study in 2015 at a public hospital in Guatemala City enrolled women ≥35 weeks’ gestation. Vaginal and rectal swabs were processed using Lim broth and GBS CHROMagar then agglutination testing. Risk factors were assessed using multivariate analysis. Vaginal microbiota were profiled by 16S ribosomal ribonucleic acid sequencing in a subset of 94 women. Results Of 896 pregnant women, 155 (17.3%; 95% confidence interval [CI], 14.9–19.9) were GBS colonized. Colonization was associated with history of previous infant with poor outcome (odds ratio [OR], 1.94; 95% CI, 1.15–3.27) and increasing maternal age (OR, 1.05; 95% CI, 1.02–1.09). Multiparity was protective (OR, .39; 95% CI, .21–.72). Four (6%) GBS-exposed infants had early-onset neonatal sepsis. Vaginal microbiome composition was associated with previous antibiotic exposure (P = .003) and previous low birth weight infant (P = .03), but not GBS colonization (P = .72). Several individual taxa differed in abundance between colonized and noncolonized women. Conclusions Group B Streptococcus is prevalent in pregnant women from Guatemala with different risk factors than previously described. Although the vaginal microbiome was not altered significantly in GBS-colonized women, use of antibiotics had an effect on its composition.

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