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Prevention of neonatal group B streptococcal sepsis: is routine antenatal screening appropriate
G L Gilbert1, D Isaacs, M A Burgess
1Department of Clinical Microbiology, Westmead Hospital, NSW.
Insights
Preventing early-onset neonatal group B streptococcal (GBS) sepsis is crucial. Strategy C, offering risk-factor-based antibiotic prophylaxis, is recommended for its effectiveness, low cost, and avoidance of unnecessary antibiotic use in GBS prevention.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Medicine
- Infectious Disease Prevention
Background:
- Neonatal early-onset group B streptococcal (GBS) sepsis remains a significant concern.
- Current prevention strategies vary, impacting resource allocation and clinical outcomes.
Purpose of the Study:
- To evaluate four distinct strategies for preventing early-onset neonatal GBS sepsis.
- To compare the effectiveness, cost-benefit, and safety profiles of each strategy.
Main Methods:
- Comparative analysis of four proposed prevention strategies (A, B, C, D).
- Evaluation of outcomes including prophylaxis rates, anaphylaxis risk, sepsis cases prevented, and costs.
- Review of published studies on GBS sepsis, screening, prophylaxis, and cost-effectiveness.
Main Results:
- All evaluated strategies demonstrated potential to significantly reduce neonatal GBS sepsis cases.
- Strategy C (risk-factor-based prophylaxis) is identified as simple, effective, inexpensive, and minimizes unnecessary antibiotic exposure.
- Strategy A (universal antenatal screening and prophylaxis) could prevent more cases but incurs higher costs and requires rigorous implementation.
Conclusions:
- Implementing a strategy for neonatal GBS sepsis prevention should be standard obstetric practice.
- Strategy C is particularly recommended for community or private antenatal care settings due to its balance of efficacy and resource efficiency.
- Further evaluation of Strategy A's cost-effectiveness is warranted if implementation and monitoring protocols are robust.
Abstract:
Four strategies for prevention of early onset neonatal group B streptococcal (GBS) sepsis were considered: A: routine antenatal screening for GBS vaginal carriage at 26-28 weeks' gestation and intrapartum antibiotic prophylaxis for all carriers; B: screening as above and prophylaxis only for carriers with risk factors for sepsis; C: prophylaxis for all women with risk factors; D: as for C plus screening at 37 weeks' gestation and prophylaxis for carriers. The outcomes considered for each option were: the proportion of women given prophylaxis; the risk of anaphylaxis; cases of neonatal GBS sepsis and deaths prevented; costs of screening, prophylaxis and of acute care of remaining cases. Published local and overseas studies of neonatal GBS sepsis, effectiveness of antenatal screening and prophylaxis and estimated costs were evaluated. Any of the proposed strategies can prevent a significant proportion of cases of neonatal GBS sepsis and a strategy for prevention of neonatal group B streptococcal sepsis should be part of routine obstetric practice. Strategy C is simple, effective, inexpensive and avoids unnecessary antibiotic use; it is recommended particularly when antenatal care is provided mainly in community or private practice. Strategy A (using vaginal and rectal swabs for screening) could prevent more cases, but at greater cost which could be justified only if protocols can be properly implemented and monitored.