Prevention of early-onset

GBS disease CDC, 2010.

Prof. Aboubakr Elnashar Benha university, Egypt

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Incidence

Asymptomatic carriage of GBS:

Common.

10-30% of all pregnant women

Organism

Streptococcus agalactiae:

Gram-positive

Colonize the lower GIT &

Spread to the genitourinary tract Aboubar Elnashar

• Found in pairs or chains

•6 groups:

A, B, C, D, F, and G by

antibodies that recognize

surface antigens

(Streptococcus fluorescent

antibody stain (digitally

colorized).

•The most important:

A, B and D.

•3 types of hemolysis after

growth of streptococci on

blood agar.

Alpha: partial hemolysis

Beta: complete clearing

Gamma: no lysis.

•Group A and group B are beta

hemolytic

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Complications

1.PTL

2.Premature ROM

3.Chorioamnionitis

4.Puerperal sepsis

5.Postpartum osteomylitis & mastitis.

6.Fetal & neonatal infections

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Neonatal sepsis

USA:

GBS is the leading cause of neonatal

bacterial sepsis UK:

GBS is the most frequent cause of

neonatal severe early onset infection

(0.5/1000 births).

There is controversy about its

prevention

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Early onset disease (<7 days of age)

Usually 6 -12 hrs after

birth

80% of GBS disease in

newborn

Respiratory distress,

apnea & shock.

It should be DD from

RDS

Mortality: 25%.

Long term neurological

sequalae

Late onset disease 1 w or more after

birth

Meningitis

Mortality rate:

less than early onset

Neurological

sequalae:

common

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Indications of intrapartum GBS prophylaxis

1. Previous infant with invasive GBS disease

2. GBS bacteriuria during any trimester of the current

pregnancy*

3. Positive GBS vaginal-rectal screening culture in

late gestation† during current pregnancy*

4. Unknown GBS status at the onset of labor (culture

not done, incomplete, or results unknown) and any of

the following:

– Delivery at <37 weeks’ gestation§

– Amniotic membrane rupture ≥18 hours

– Intrapartum temperature ≥100.4°F (≥38.0°C)¶

– Intrapartum NAAT** positive for GBS

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Intrapartum GBS prophylaxis not indicated

1. Colonization with GBS during a previous

pregnancy (unless an indication for GBS prophylaxis

is present for current pregnancy)

2. GBS bacteriuria during previous pregnancy

(unless an indication for GBS prophylaxis is present

for current pregnancy)

3. Negative vaginal and rectal GBS screening culture

in late gestation† during the current pregnancy,

regardless of intrapartum risk factors

4. Cesarean delivery performed before onset of labor

on a woman with intact amniotic membranes,

regardless of GBS colonization status or gestational

age

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Screening strategy • Women with GBS isolated from the urine at any

time during the current pregnancy or who had a

previous infant with invasive GBS disease should

receive intrapartum antibiotic prophylaxis and do not

need third trimester screening for GBS colonization

(AII).

Women with symptomatic or asymptomatic GBS

urinary tract infection detected during pregnancy

should be treated according to current standards of

care for urinary tract infection during pregnancy and

should receive intrapartum antibiotic prophylaxis to

prevent early-onset GBS disease (AIII).

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•All other pregnant women should be screened at

35–37 weeks’ gestation for vaginal and rectal GBS

colonization (AII).

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Algorithm for GBS

prophylaxis in

preterm labor (<37W)

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Algorithm for GBS

prophylaxis in

rupture of

membranes at

<37w

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• Antibiotics given to prolong latency for preterm

premature rupture of membranes with adequate

GBS coverage (specifically 2 g ampicillin

administered intravenously followed by 1 g

administered intravenously every 6 hours for 48

hours) are sufficient for GBS prophylaxis if delivery

occurs while the patient is receiving that antibiotic

regime (CIII).

Oral antibiotics alone are not adequate for GBS

prophylaxis (DII).

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Identification of GBS bacteriuria in pregnant

women

• Routine screening for asymptomatic bacteriuria is

recommended in pregnant women, and laboratories

should screen urine culture specimens for the

presence of GBS in concentrations of 104 colony-

forming units (cfu)/ml or greater.

• Laboratories should identify GBS when present at

≥104 cfu/ml in pure culture or mixed with a second

microorganism.

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Antibiotics

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Thank you Aboubakr Elnashar

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