Should Australia follow the US decision to base prophylaxis on results of maternal screening?
Ever since group B streptococcus (GBS) emerged as the commonest cause of perinatal sepsis in the late 1970s, there has been controversy about prevention strategies. A few hospitals in Australia were among the first in the world to introduce routine antenatal screening for GBS carriage and intrapartum antibiotic prophylaxis for carriers.1 This approach was later vindicated by randomised controlled trials in selected carriers2 and the demonstration of lower rates of sepsis after intrapartum prophylaxis compared with historical rates.3 However, problems remain. Group B streptococcus is a normal vaginal commensal in healthy women, but colonisation is often intermittent, and rates of colonisation can vary from 18% to 27%, depending on the detection method.4 Moreover, vaginal carriage is a very crude predictor of perinatal sepsis, with fewer than 1% of the infants of carriers affected (1–2/1000 overall) without intervention.1,5
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead, NSW.
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- 2. Boyer KM, Gadzala CA, Kelly PD, Gotoff SP. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. III. Interruption of mother-to-infant transmission. J Infect Dis 1983; 148: 810-816.
- 3. Jeffery HE, Moses LM. Eight-year outcome of universal screening and intrapartum antibiotics for maternal group B streptococcal carriers. Pediatrics 1998; 101: E2.
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- 6. Prevention of perinatal group B streptococcal disease: a public health perspective. Centers for Disease Control and Prevention. MMWR Recomm Rep 1996; 45 (RR-7): 1-24.
- 7. Oddie S, Embleton ND. Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. BMJ 2002; 325: 308-312.
- 8. Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000; 342: 15-20.
- 9. Smaill F. Intrapartum antibiotics for Group B streptococcal colonisation. Cochrane Database Syst Rev 2000; 2: CD000115.
- 10. Stoll BJ, Hansen N, Fanaroff AA, et al. Changes in pathogens causing sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347: 240-247.
- 11. Towers CV, Briggs GG. Antepartum use of antibiotics and early-onset neonatal sepsis: the next 4 years. Am J Obstet Gynecol 2002; 187: 495-500.
- 12. Prevention of perinatal group B streptococcal diseases. Centers for Disease Control and Prevention. MMWR Recomm Rep 2002; 51(RR-11): 1-22.
- 13. Schrag SJ, Zell ER, Lynfield R, et al. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med 2002; 347: 233-239.
- 14. Gilbert GL, Isaacs D, Burgess MA, et al. Prevention of neonatal group B streptococcal sepsis: is routine antenatal screening appropriate. Aust N Z J Obstet Gynaecol 1995; 35: 120-126.