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Changes in early-onset group B beta hemolytic streptococcus disease with changing recommendations for prophylaxis
Imelda P Uy1, Carl T D'Angio, Marilyn Menegus
1Department of Pediatrics, Division of Neonatology, Golisano Children's Hospital at Strong, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
Insights
The incidence of early-onset group B streptococcal infection decreased significantly following guideline implementation. However, intrapartum antibiotic prophylaxis alone did not fully account for this decline in infection rates.
Area of Science:
- Neonatal infections
- Public health
- Epidemiology
Background:
- Group B Streptococcus (GBS) remains a significant cause of neonatal infections.
- Early-onset GBS (EOGBS) infection poses a serious risk to newborns.
- Guidelines for prevention have evolved over time.
Purpose of the Study:
- To assess the incidence of EOGBS infections.
- To examine the relationship between EOGBS incidence and intrapartum antibiotic prophylaxis (IAP).
- To analyze trends in EOGBS infection following different prevention guidelines.
Main Methods:
- Retrospective population survey of infants with GBS (<7 days old).
- Nested case-control study of non-GBS infants.
- Analysis of GBS incidence and maternal antibiotic use across distinct time periods (pre-guidelines, AAP/ACOG, CDC).
Main Results:
- EOGBS incidence decreased from 1.5/1000 to 0.67/1000 after AAP/ACOG guidelines (p=0.004).
- Further decline to 0.28/1000 after CDC guidelines (p=0.38).
- IAP use increased from 33% to 59% after CDC guidelines (p=0.02).
Conclusions:
- The decline in EOGBS incidence was observed following guideline implementation.
- Intrapartum antibiotic prophylaxis did not fully explain the reduction in EOGBS infections.
- Further research may be needed to understand all contributing factors to the decreased incidence.
Objective:
To determine the incidence of early-onset group B beta hemolytic streptococcal (EOGBS) infection and the association between changes in the incidence and intrapartum antibiotic prophylaxis (IAP).
Study Design:
A retrospective population survey of infants with GBS at < 7 days of age with a nested case-control study of non-GBS infants over the same time period, January 1985 to December 1998. The incidence of GBS and maternal antibiotic treatment during labor was analyzed as a function of time period: prior to publication of guidelines for prevention of EOGBS (1985-1992), following AAP/ACOG guidelines (1993-1995), and following CDC consensus guidelines (1996-1998).
Results:
Fifty-six cases of EOGBS infection occurred among 53,088 live births. The incidence declined from 1.5/1000 before any guidelines to 0.67/1000 after AAP/ACOG guidelines (p = 0.004), and continued to decline after the CDC consensus statement (0.28/1000) (p = 0.38). IAP remained stable (33% of at risk mothers) until after introduction of the CDC consensus guidelines (59%, p = 0.02).
Conclusion:
IAP did not fully explain the decline in EOGBS incidence in our center.