Toolkit Revision Summary

PREVENTION OF GROUP B STREPTOCOCCUS DISEASE         
Revised August 2008

SUMMARY OF CHANGES

Acknowledgements: First Edition, released 2003
David Wirtschafter, MD, Kaiser Permanente, Southern CA
Richard Powers, MD, Children's Hospital Oakland
Courtney Nisbet, RN, MS, CPQCC

Acknowledgements: Second Edition, released August           2008                                                                                                                                                                                  David Wirtschafter, MD, Kaiser Permanente, Southern CA
Richard Powers, MD, Good Samaritan Hospital, San Jose

 

The original version of the toolkit was released in 2003 and followed the recent CDC Guideline that was extensively modified the previous year.  The CDC Guideline had been updated to reflect improved outcomes with intrapartum prophylaxis based on universal screening when compared to the alternative approach based on prophylaxis only given to mothers with intrapartum risk factors.

The CDC and other investigators have published several reviews of the prevalence of GBS since the universal screening recommendation.   No substantial changes have been made to the CDC Guideline itself.   For this CPQCC toolkit update we surveyed the literature as of May 2008 and have included several studies evaluating the impact of the 2002 guideline and illustrating residual limitations that are obstacles to complete eradication of neonatal GBS early onset disease.

 

Items added to the CPQCC comments and Discussion Sections:

  1. Racial Disparities in prevalence of GBS early onset neonatal disease.  Comparing pre-implementation vs. post-implementation periods (2000-2001 vs 2003 - 2005), the overall incidence of Early Onset Disease from GBS dropped by approximately one third.
  • Incidence in black infants increased in the 2 reporting periods from 0.52 to 0.89 cases per 1,000 live births. 
  • Incidence for white infants decreased from 0.26 to 0.22 cases per 1,000 live births in the same period.

     2.  Potential obstacles to further declines in prevalence of GBS Early Onset Disease.

  • Baseline rate of false negative GBS screening tests when performed at 35-37 weeks gestation.
  • Development of antibiotic resistance to Erythromycin and Clindamycin used for intrapartum antibiotic prophylaxis in mothers with allergies to Penicillin.

     3.  Changes in the microbiololgy of early onset disease due to the increased use of Penicillin and Ampicillin.

  • Several studies have documented an increase in prevalence of Penicillin and Ampicillin resistant organisms since widespread adoption of intrapartum antibiotic prophylaxis.
  • This shift in microbiology of early onset sepsis is predominantly in VLBW infants and has not been reported in populations of term infants, who make up the overwhelming majority of newborns receiving intrapartum prophylaxis.
  • There has been no evidence of any increase in penicillin or ampicillin resistance in Group B Strep itself, the shifting sensitivities are predominantly related to Clindamycin and Erythromycin.

 

 Updates to Bibliography

  1. Early-onset and late-onset neonatal group B streptococcal disease--United States, 1996-2004. MMWR Morb Mortal Wkly Rep 2005;54:1205-8.
  2. Perinatal group B streptococcal disease after universal screening recommendations--United States, 2003-2005. MMWR Morb Mortal Wkly Rep 2007;56:701-5.
  3. Angstetra D, Ferguson J, Giles WB. Institution of universal screening for Group B streptococcus (GBS) from a risk management protocol results in reduction of early-onset GBS disease in a tertiary obstetric unit. Aust N Z J Obstet Gynaecol 2007;47:378-82.
  4. Chen KT, Puopolo KM, Eichenwald EC, Onderdonk AB, Lieberman E. No increase in rates of early-onset neonatal sepsis by antibiotic-resistant group B Streptococcus in the era of intrapartum antibiotic prophylaxis. Am J Obstet Gynecol 2005;192:1167-71.
  5. Hyde TB, Hilger TM, Reingold A, Farley MM, O'Brien KL, Schuchat A. Trends in incidence and antimicrobial resistance of early-onset sepsis: population-based surveillance in San Francisco and Atlanta. Pediatrics 2002;110:690-5. Phares CR, Lynfield R, Farley MM, et al. Epidemiology of Invasive Group B Streptococcal Disease in the United States, 1999-2005. JAMA 2008;299:2056-65.
  6. Phares CR, Lynfield R, Farley MM, et al. Epidemiology of Invasive Group B Streptococcal Disease in the United States, 1999-2005. JAMA 2008;299:2056-65.
  7. Puopolo KM, Madoff LC, Eichenwald EC. Early-onset group B streptococcal disease in the era of maternal screening. Pediatrics 2005;115:1240-6.
  8. Rentz AC, Samore MH, Stoddard GJ, Faix RG, Byington CL. Risk factors associated with ampicillin-resistant infection in newborns in the era of group B streptococcal prophylaxis. Arch Pediatr Adolesc Med 2004;158:556-60.
  9. Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P, Reingold A, Schuchat A. Risk factors for invasive, early-onset Escherichia coli infections in the era of  widespread intrapartum antibiotic use. Pediatrics 2006;118:570-6.
  10. Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002;347:240-7.
  11. Yancey MK, Schuchat A, Brown LK, Ventura VL, Markenson GR. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol 1996;88:811-5.

 

PREVENTION OF GROUP B STREPTOCOCCUS DISEASE, REVISED 8/08 - Newsletter Article

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