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 Breaking
news
Update
on Group B Streptococcal Screening
by
Michael E. Speer, MD
Since
1993, the incidence of early onset group B streptococcal
(GBS) disease in the neonate has progressively fallen [see
Figure]. Evidence now validates prenatal GBS screening over
the risk-based approach previously recommended. In the mid-1990s,
Connecticut began a screening-based program. There the incidence
of early-onset GBS disease declined from 0.6 cases/1,000 live
births (1996) to 0.2 cases/ 1,000 live births (1999).
Although
the culture-based methodology is superior, concerns exist regarding
potential adverse or unintended effects of GBS prevention efforts.
These include allergic or anaphylactic reactions to agents used
for intrapartum antibiotic prophylaxis, emergence of GBS strains
resistant to standard therapies, and increasing incidence of serious
neonatal infections caused by pathogens other than GBS, including
antimicrobial-resistant strains. Fortunately, none of these concerns
has proven true related to penicillin prophylaxis. However, increasing
resistance of GBS to erythromycin and clindamycin (up to 25% and
15%, respectively) has been documented. Thus, use of those antibiotics
is not recommended in patients allergic to penicillin unless the
bacterium has been proven to be sensitive. In cases of elective
cesarean section without labor or ruptured fetal membranes, intrapartum
prophylaxis of the mother is not recommended regardless of culture
status. All of the GBS recommendations, are on the CDC web site:
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5111a1.htm#fig2
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Figure
- Incidence of early- and late-onset invasive group B streptococcal
disease; selected Active Bacterial Core surveillance areas,
1989-2000, and activities for prevention of group B streptococcal
disease.
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*ACOG=American
College of Obstetricians and Gynecologists; AAP=American
Academy of Pediatrics
Source:
Prevention of Perinatal Group B Streptococcal Disease. MMWR
2002; 51(RR11): 1-22 as adapted from CDC. Early-onset
group B streptococcal disease, United States 1998-1999.
MMWR 2000;49:793-6; and Schrag SJ, Zywici S, Farley MM,
et al. Group B streptococcal disease in the era of intrapartum
antibiotic prophylaxis. N Engl J Med 2000;342:15-20.
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