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Performance of a group B streptococcal prophylaxis protocol combining high-risk treatment and low-risk screening
D P Reisner1, M J Haas, R W Zingheim
1Center for Perinatal Studies, Swedish Medical Center, Seattle, WA 98104, USA.
Insights
A new protocol for group B streptococcus (GBS) significantly reduced neonatal sepsis cases in a community hospital. This approach combined targeted antibiotic treatment for high-risk mothers with rapid GBS screening for low-risk mothers during labor.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Disease Prevention
Background:
- Group B Streptococcus (GBS) poses a significant risk for neonatal sepsis.
- Effective screening and treatment protocols are crucial for preventing intrapartum GBS transmission.
- Previous approaches lacked comprehensive strategies for both high- and low-risk pregnancies.
Purpose of the Study:
- To evaluate the effectiveness of a novel GBS protocol in a large community hospital.
- To assess the impact of combining high-risk patient treatment with low-risk patient rapid screening.
- To reduce the incidence of neonatal GBS sepsis.
Main Methods:
- Prospective cohort study (1994-1996) in a level III community hospital.
- High-risk criteria included preterm labor, prolonged rupture of membranes, known GBS carriage, maternal fever, growth restriction, multiple gestation, or previous infected neonate.
- Low-risk patients underwent rapid optical immunoassay screening for GBS antigen during labor.
Main Results:
- Neonatal GBS sepsis incidence decreased from 9 cases in 8188 deliveries (pre-protocol) to 2 cases in 9932 deliveries (during protocol) (P =.0287).
- The rapid immunoassay showed 81% sensitivity, with 93% of screened patients receiving results and treatment within 2.5 hours.
- No increase in other bacterial sepsis, maternal anaphylaxis, or antibiotic resistance was observed.
Conclusions:
- The implemented protocol effectively reduced neonatal GBS sepsis rates.
- Combining targeted treatment for high-risk and rapid screening for low-risk patients is a successful strategy.
- This protocol offers a safe and effective method for GBS prevention in community hospitals.
Objective:
This study was undertaken to evaluate a group B streptococcal protocol in a large community hospital that combined treatment of high-risk patients with rapid screening of low-risk patients.
Study Design:
In a prospective cohort study from 1994 through 1996 laboring patients in a level III community hospital were considered to be at high risk for neonatal group B streptococcal transmission if they were at <37 weeks' gestation, if they had rupture of membranes >12 hours, if they were known carriers of group B streptococci, if they had a temperature > or =100 degrees F, if the gestation was complicated by fetal growth restriction or was a multiple gestation, or if they had a previous neonate infected with group B streptococci. High-risk patients were treated intravenously with antibiotics during labor. Low-risk patients were screened for group B streptococcal antigen by means of a rapid optical immunoassay. Patients with positive screening results were treated. Neonatal morbidity and mortality were evaluated.
Results:
Two of 9932 infants delivered had group B streptococcal sepsis diagnosed. In the 2 previous years without a protocol 9 cases of neonatal group B streptococcal sepsis had been diagnosed in 8188 deliveries (P =.0287 by Fisher exact test). The 2 cases of group B streptococcal sepsis during the protocol were as follows: 1 infant born to a high-risk mother with delay in treatment and 1 infant born to a low-risk mother with negative results of both culture and rapid screen during labor. During the previous period 7 infected infants had been born to high-risk mothers and 2 had been born to low-risk mothers. The maternal group B streptococcal carriage rate during the study was 18%. Group B streptococcal rapid optical immunoassay sensitivity was 81%. Elapsed time from screening to treatment was < or =2(1/2) hours for 93% of patients. No maternal anaphylaxis, no increase in bacterial neonatal sepsis caused by organisms other than group B streptococci, and no protocol-related group B streptococcal antibiotic resistance were noted.
Conclusion:
Successful implementation and maintenance of a protocol combining treatment of high-risk patients with rapid screening of low-risk patients during labor reduced neonatal group B streptococcal sepsis.