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Point-of-Care Intrapartum Group B Streptococcus Molecular Screening: Effectiveness and Costs
Najoua El Helali1, Fakher Habibi, Elie Azria
1Service de Microbiologie Clinique, Groupe Hospitalier Paris Saint-Joseph, France-EA4043 Unité Bactéries Pathogènes et Santé, Université Paris-Sud Saclay, Chatenay-Malabry, Service de Néonatologie, Groupe Hospitalier Paris Saint-Joseph, Service de Gynécologie Obstétrique, Groupe Hospitalier Paris Saint-Joseph, France - UMR1153, Obstetrical, neonatal and pediatric epidemiology research team (EPOPé) - DHU Risk in pregnancy - Paris Descartes University, AP-HP Unité de Recherche Clinique en Economie de la Santé d'Ile-de-France, Hôpital de l'Hôtel Dieu, ECEVE, UMR1123, Université Paris Est Créteil, Paris France.
Insights
Point-of-care intrapartum group B streptococcus (GBS) polymerase chain reaction (PCR) screening significantly reduced early-onset GBS disease and antibiotic use in newborns. The costs of PCR screening were offset by decreased treatment expenses.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Infectious Disease Screening
Background:
- Group B Streptococcus (GBS) poses a risk for early-onset neonatal disease.
- Traditional antenatal culture screening has limitations in timely detection.
- Intrapartum screening methods are being explored to improve outcomes.
Purpose of the Study:
- To evaluate the outcomes and costs of implementing around-the-clock point-of-care intrapartum group B streptococcus (GBS) polymerase chain reaction (PCR) screening.
- To compare the effectiveness of intrapartum GBS PCR screening with previous antenatal culture methods.
Main Methods:
- A pre- and post-intervention study design was used at a single institution.
- Intrapartum GBS PCR screening (implemented in 2010) was compared to antenatal culture screening over study periods from 2006-2015.
- Primary outcome was the rate of early-onset neonatal GBS disease; secondary outcomes included length of stay, antibiotic days, and costs.
Main Results:
- Intrapartum GBS PCR screening increased GBS testing rates from 96.2% to 99.9%.
- The rate of proven early-onset GBS disease decreased from 1.01 to 0.21 per 1,000 live births (P=.026).
- Total hospital and antibiotic days for GBS disease declined by 64% and 60%, respectively, with significant cost reduction.
Conclusions:
- Point-of-care intrapartum GBS PCR screening is associated with a significant reduction in early-onset GBS disease and neonatal antibiotic use.
- The increased costs of PCR screening were partially offset by savings in GBS disease treatment.
- Intrapartum GBS PCR screening offers a valuable strategy for improving neonatal safety and optimizing healthcare resource utilization.
Objective:
To assess outcomes and costs associated with around-the-clock point-of-care intrapartum group B streptococcus (GBS) polymerase chain reaction (PCR) screening.
Methods:
Intrapartum PCR screening was implemented in 2010. Intrapartum PCR was compared with antenatal culture screening in an uncontrolled, single institution, preintervention and postintervention study. The study periods included 4 years before and 6 years after the intervention, commencing in 2006 and concluding in 2015. The primary outcome measure was rate of early-onset neonatal GBS disease. Secondary outcomes included length of stay, days of antibiotics, and costs.
Results:
During the 4 years of antenatal culture screening, 11,226 deliveries were recorded compared with 18,835 in the 6 years of intrapartum GBS PCR screening, corresponding to 11,818 and 18,980 live births, respectively. During the antenatal culture period, 3.8% of term deliveries did not undergo GBS testing compared with 0.1% during the intrapartum PCR period (P<.001). Between the two periods, the rate of proven early-onset GBS disease cases decreased from 1.01/1,000 to 0.21/1,000 (P=.026) and probable early-onset GBS disease cases from 2.8/1,000 to 0.73/1,000 (P<.001); the risk ratio for both was 0.25, 95% CI (0.14-0.43). Total days of hospital and antibiotic therapy for early-onset GBS disease declined by 64% and 60%, respectively, with no significant difference for average length of stay or antibiotic duration preintervention and postintervention. The yearly cost of delivery and treatment of newborns with GBS infection was reduced from $41,875±6,823 to $11,945±10,303 (P<.001). The estimated extra cost to avoid one early-onset GBS disease was $5,819.
Conclusion:
Point-of-care intrapartum GBS PCR screening was associated with a significant decrease in the rate of early-onset GBS disease and antibiotic use in newborns. The additional PCR costs were offset in part by the reduction in early-onset GBS disease treatment costs.
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