Impact of different prevention strategies on neonatal group B streptococcal disease

Am J Perinatol. 2002 Aug;19(6):341-8. doi: 10.1055/s-2002-34464.

Abstract

The objective of this paper is to evaluate the effect of different prevention strategies on the rate of early-onset neonatal group B streptococcus (GBS) disease and mortality. We compared the neonatal mortality and morbidity rates associated with early-onset GBS disease in three periods characterized by different prevention strategies, including no screening for GBS during pregnancy and no standardized chemoprophylaxis (1/1987 to 12/1990), antibiotic prophylaxis only with risk factors for GBS (1/1991 to 12/1994), and universal screening for GBS with rectovaginal cultures and chemoprophylaxis for women with positive results or risk factors (1/1995 to 12/1999). Statistical analysis included Fisher's exact test and Chi-square, with a two-tailed p <0.05 considered significant. The yearly prevalence of positive GBS cultures was similar throughout the screening period (mean 18%, range 16 to 19%). Compared with the no prophylaxis group (rate = 4/8,573), introduction of universal screening (rate = 0/13,754, p = 0.02) but not of prophylaxis for risk factors alone (rate = 1/10,303, p = 0.18) significantly decreased the occurrence of GBS-specific neonatal mortality. Universal screening decreased, though not significantly, the GBS-specific neonatal morbidity rates compared with a policy based on risk factors alone (0.4/1000 vs. 0.8/1000, p = 0.29). Our study had a power to detect a 0.7/1000 difference in the rate of specific morbidity between the two chemoprophylaxis policies (alpha = 0.05, beta= 0.80). Intrapartum prophylaxis for GBS, using universal screening or risk factors, is associated with a significant reduction in the specific neonatal mortality rate compared with no prophylaxis. Universal screening for GBS leads to a decrease in specific GBS morbidity compared with screening using risk factors alone.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Antibiotic Prophylaxis
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Bacteremia / prevention & control*
  • Chi-Square Distribution
  • Europe / epidemiology
  • Female
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Mass Screening
  • Odds Ratio
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy
  • Pregnancy Complications, Infectious / epidemiology
  • Pregnancy Complications, Infectious / prevention & control*
  • Prenatal Care
  • Primary Prevention*
  • Risk Factors
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / prevention & control*
  • Streptococcus agalactiae*