Committee on Infectious Diseases and Committee on Fetus and Newborn
Here are the recommendations at the end of the article:
Recommendations
1. Obstetric care practitioners should adopt a strategy for the prevention of
early-onset GBS disease in neonates. Patientsshould be informed regarding the
available strategies for itsprevention. Individual patient requests regarding
GBS culturesshould be honored. Insurance coverage for obstetric care
shouldinclude payment for GBS cultures and at least 48 hours of
nurseryobservation for at-risk newborns.
2. Regardless of thepreventive strategy used, women should be managed as
follows:
Women found to have symptomatic or asymptomatic GBS bacteriuriaduring
pregnancy should be treated at the time of diagnosis. Becausesuch women usually
have heavy GBS colonization, they also shouldreceive intrapartum
chemoprophylaxis.
Intrapartumchemoprophylaxis should be administered to women who have
previouslygiven birth to an infant with invasive GBS disease; prenatal
culturescreening is not necessary.
3. Until additional data becomeavailable to define the most effective
prevention strategy, eitherone of the following strategies is appropriate.
Prevention Strategy for Early-onset GBS Disease Using Prenatal Culture Screening
at 35 to 37 Weeks of Gestation
All pregnant women at 35 to 37 weeks of gestation should be routinely screened
for anogenital GBS colonization. All womenidentified as GBS carriers by culture
should be offered intrapartumchemoprophylaxis even if a risk factor is not
present.
If the results of GBS cultures are not known at the onset of labor or rupture of
membranes, intrapartum antimicrobial prophylaxisshould be administered if one of
the following is present: gestationof <37 weeks, the membranes have been
ruptured 18 hours or longer,or a temperature of 38°C (100.4°F) or greater.
Culture techniques that maximize the likelihood of GBS recovery should be used.
The optimal method for GBS screening is collectionof a single swab or two
separate swabs of the distal vagina andanorectum followed by inoculation into
selective broth medium,overnight incubation, and then subculture onto solid
blood agarmedium.
Oral antimicrobial agents should not be used to treat women who are found to
have GBS colonization during prenatal screening.Such treatment is not effective
in eliminating carriage or preventingneonatal disease.
Prevention Strategy for Early-onset GBS Disease Using Risk Factors Without
Prenatal Culture Screening
A prevention strategy based on the presence of intrapartum risk factors without
culture screening (eg, gestation of <37 weeks,duration of membrane rupture 18
hours, or temperature 38°C)is an acceptable alternative.4 For intrapartum
chemoprophylaxis,intravenous penicillin G (5 million U initially and then
2.5 millionU every 4 hours) should be given until delivery. Intravenous
ampicillin(2 g initially and then 1 g every 4 hours until delivery) is
anacceptable alternative, but penicillin G is preferred, becauseit has a narrow
spectrum and is therefore less likely to selectfor antibiotic-resistant
organisms. Intravenous clindamycin orerythromycin may be used for women allergic
to penicillin.
5 Routine use of prophylactic antimicrobial agents for infants born to mothers
who have received intrapartum chemoprophylaxisis not recommended. However,
therapeutic use of these agentsis appropriate for infants with clinically
suspected sepsis. Theduration of therapy in symptomatic infants varies depending
onthe results of blood culture, cerebrospinal fluid findings (ifdetermined), and
clinical course. If the laboratory evaluationand clinical course are
inconsistent with a diagnosis of invasiveinfection, the duration of empiric
therapy should be as shortas 48 to 72 hours.
6 Guidelines regarding management of asymptomatic infants born to women given
intrapartum chemoprophylaxis are empiric. Thesuggested approach given here is
not an exclusive course of management.Other treatment modalities that take into
account individual circumstancesand individual physician or institutional
preferences may be appropriate.
For asymptomatic infants whose mothers have received intrapartumprophylaxis,
those with gestations of <35 weeks should have alimited diagnostic evaluation
(CBC [and differential] and bloodculture) and be observed without antimicrobial
therapy in thehospital for at least 48 hours (ie, does not allow for early
discharge).If during hospital observation signs of systemic infection develop,a
complete diagnostic evaluation should be performed, and antimicrobialtherapy
should be initiated.
In asymptomatic infants witha gestational age of 35 weeks or longer, the
duration of intrapartumprophylaxis before delivery determines subsequent
management.If two or more doses of maternal prophylaxis were given
beforedelivery, no laboratory evaluation or antimicrobial therapy isrecommended.
These infants should be observed in the hospitalfor at least 48 hours (ie, does
not allow for early discharge).If only one dose of maternal prophylaxis was
given before delivery,infants should have a limited evaluation and at least
48 hoursof observation before hospital discharge. 7 Investigations designed to
evaluate and compare these and other strategies are needed urgently to assess
outcomes, includingthe incidence of neonatal GBS disease, occurrence of adverse
reactionsto antimicrobial prophylaxis, and the emergence of perinatal
infectionsattributable to penicillin-resistant organisms. Characterizationof
prevention failures also is important.
http://pediatrics.aappublications.org/cgi/content/full/99/3/489?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=GBS&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
