Reduction of Group B Streptococcal Disease
Marianna Parker
Sara V. Bates
A Population-based Comparison of Strategies to Prevent Early-Onset Group B Streptococcal Disease in Neonates
Schrag SJ, Zell ER, Lynfield R, et al. New Engl J Med. 2002;347(4):233–239
Background
Perinatal group B streptococcal (GBS) infections remain a leading cause of illness and death among newborns in the United States, affecting about 1:3,000 live births.1 In 1996, both the American Congress of Obstetricians and Gynecologists and American Academy of Pediatrics guidelines recommended 1 of 2 approaches for intrapartum antibiotic prophylaxis: universal screening or risk-based. However, the comparative effectiveness of these 2 strategies had not been well analyzed prior to this study.
Objectives
To evaluate the effectiveness of universal screening compared with the risk-based approach in preventing early-onset GBS disease.
Methods
Retrospective cohort study in 8 geographic areas in the US from 1998 to 1999.
Patients
5,144 neonates randomly sampled from areas with active surveillance for GBS infection, including all cases of early-onset disease (occurring at <7 days old).
Intervention
Comparison of universal screening (all women screened for GBS carriage with rectovaginal culture between 35 and 37 weeks’ gestation with intrapartum antibiotic prophylaxis [IAP] offered to carriers) with the risk-based approach (women presenting in labor with clinical risk factors for GBS transmission [e.g., fever, prolonged rupture of membranes, preterm delivery] offered IAP).
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