Prevention of group B streptococcus early-onset neonatal sepsis: Comparison of the Center for Disease Control and prevention screening-based protocol to a risk-based protocol in infants at greater than 37 weeks' gestation

被引：19
作者：
Gilson G.J. [1 ,3 ]
Christensen F. [1 ]
Romero H. [1 ]
Bekes K. [1 ]
Silva L. [1 ]
Qualls C.R. [2 ]
机构：
[1] Dept. of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Univ. of New Mex. Hlth. Sci. Center, Albuquerque, NM
[2] Dept. of Math. and Biostatistics, Univ. of New Mex. Hlth. Sci. Center, Albuquerque, NM
[3] Dept. of Obstetrics and Gynecology, 4-ACC, University of New Mexico Hospital, Albuquerque, NM 87131
来源：
Journal of Perinatology | 2000年 / 20卷 / 8期
关键词：
D O I：
10.1038/sj.jp.7200463
中图分类号：
学科分类号：
摘要：
OBJECTIVE: To compare the Center for Disease Control consensus guidelines' screening-based strategy to a risk-based strategy as regards the incidence of early-onset group B streptococcus (GBS) infection among term infants. STUDY DESIGN: A cohort of university hospital prenatal clinic mother-infant pairs who were screened for GBS at 35 to 37 weeks' gestation were compared to a matched control group of unscreened mother-infant pairs from the outreach satellite prenatal clinics who delivered at the same institution during the same time period. GBS screening was carried out with rectovaginal cultures plated on selective media. GBS-positive women received antimicrobial prophylaxis in labor whereas women of unknown GBS status were only treated intrapartum if they had a risk factor for GBS infection. Principal outcome variables included incidence of cases of neonatal early-onset GBS sepsis (blood, urine, or cerebrospinal fluid positive for GBS), incidence of cases of strongly suspected GBS sepsis (culture negative), and incidence of neonatal sepsis with non-GBS organisms. RESULTS: There were 3164 screened mother-infant pairs who were compared to 2684 unscreened pairs. The incidence of GBS carriage was 13.3%. A random sample of 420 screened women were compared to a matched sample of 407 women of unknown GBS carrier status for characterization of demographics and risk factors. No cases of documented GBS sepsis occurred in the infants of the screened women, but four cases occurred among the infants of the women who did not undergo screening (incidence 1.5/1000) (p=0.04), only one of whom had a risk factor for GBS infection. Cases of suspected but culture negative sepsis were not more common in the screened population when compared to the unscreened. There was one case of Escherichia coli sepsis in an infant of a mother in the unscreened group. CONCLUSIONS: GBS screening at 35 to 37 weeks, with intrapartum antimicrobial prophylaxis of carriers, decreased the incidence of neonatal early-onset GBS sepsis and appears to have advantages over treatment based on risk factors alone in term infants.
引用
收藏
页码：491 / 495
页数：4
相关论文
共 16 条
  • [1] Mohle-Boetani J., Schuchat A., Plikaytis B.D., Smith D., Broome C.V., Comparison of prevention strategies for neonatal group B streptococcal infection: A population-based economic analysis, J Am Med Assoc, 270, pp. 1442-1448, (1993)
  • [2] Easmon C.S.F., Hastings M.J.G., Deeley J., Bloxham B., Rivers R.P.A., Marwood R., The effect of intrapartum chemoprophylaxis on the vertical transmission of group B streptococci, Br J Obstet Gynaecol, 90, pp. 633-635, (1983)
  • [3] Boyer K.M., Gadzala C.A., Kelly P.D., Burd L.I., Gotoff S.P., Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease: II. Predictive value of prenatal cultures, J Infect Dis, 148, pp. 795-809, (1983)
  • [4] Prevention of perinatal group B streptococcal disease: A public health perspective, MMWR, 45, pp. 1-25, (1996)
  • [5] Adoption of hospital policies for prevention of perinatal group B streptococcal disease - United States, 1997, MMWR, 47, pp. 665-670, (1998)
  • [6] Kennon C., Overturf G., Bessman S., Sierra E., Smith K.J., Brann B., Granulocyte colony-stimulating factor as a marker for bacterial infection in neonates, J Pediatr, 128, pp. 765-769, (1996)
  • [7] Hafner E., Sterniste W., Rosen A., Et al., Group B streptococci during pregnancy: A comparison of two screening and treatment protocols, Am J Obstet Gynecol, 179, pp. 677-681, (1998)
  • [8] Locksmith G.J., Clark P., Duff P., Maternal and neonatal infection rates with three different protocols for prevention of group B streptococcal disease, AmJ Obstet Gynecol, 180, pp. 416-422, (1999)
  • [9] Rouse D.J., Goldenberg R.L., Cliver S.P., Cutter G.R., Mennemeyer S.T., Fargason C.A., Strategies for the prevention of early-onset neonatal group B streptococcal sepsis: A decision analysis, Obstet Gynecol, 83, pp. 483-494, (1994)
  • [10] Hannon-Bert E., Elder S., Weymouth L., Dinsmoor M.J., Changes in microbial flora in early-onset neonatal sepsis, Obstet Gynecol, 93, (1999)
12