Early-onset group B streptococcal infection after a combined maternal and neonatal group B streptococcal chemoprophylaxis strategy.

Abstract

OBJECTIVE:

In January 1995, a combined maternal and neonatal protocol for prevention of early-onset group B streptococcal (GBS) infection was implemented that consisted of a risk factor-based approach for maternal intrapartum chemoprophylaxis using ampicillin combined with a single intramuscular dose of penicillin given to all newborns within 1 hour of delivery. The objective of this study was to review the cases of early-onset GBS infections that occurred from 1995 to 1999 to identify factors associated with their continued occurrence despite implementation of a GBS chemoprophylaxis protocol.

METHODS:

Infants <or=72 hours of age with early-onset GBS infection born at Parkland Memorial Hospital in Dallas from January 1995 to December 1999 were identified through a prospective laboratory-based surveillance system. Maternal and infant medical records were reviewed for clinical and demographic data.

RESULTS:

There were 32 cases (0.47/1000 live births) of early-onset GBS infection for the 5-year period. This represented a 76% reduction compared with the rate from 1986 to 1994 (1.95/1000), when there was no protocol for GBS chemoprophylaxis. Thirteen cases (41%) did not have any identifiable maternal risk factor. Of the 19 cases (59%) with risk factors, maternal intrapartum fever was the most frequent (15 [79%]), followed by prematurity (6 [32%]) and prolonged rupture of membranes (6 [32%]). Among the 19 mothers with risk factors, 15 (79%) mothers received intrapartum chemoprophylaxis, and 12 (80%) of the 15 mothers had intrapartum fever. Only 33% of mothers with risk factors received >or=2 doses of intrapartum chemoprophylaxis, and among those with intrapartum fever, 25% received >or=2 doses. None of the 32 infants with early-onset GBS infection received the combination of intrapartum ampicillin and postnatal penicillin.

CONCLUSIONS:

A combined obstetric and neonatal chemoprophylaxis protocol significantly reduced early-onset GBS infection. Maternal intrapartum fever was the most frequent risk factor associated with failure of chemoprophylaxis.

• Authors: Sithembiso Velaphi, Jane D Siegel, George D Wendel Jr, Nancy Cushion, Walid M Eid, Pablo J Sánchez
• Journal: Pediatrics (Pediatrics) Vol. 111 Issue 3 Pg. 541-7 (Mar 2003) ISSN: 1098-4275 [Electronic] United States
• PMID: 12612234 (Publication Type: Journal Article)

Chemical References

• Penicillins
• Ampicillin

Topics

• Ampicillin (administration & dosage)
• Antibiotic Prophylaxis (adverse effects, methods)
• Female
• Fever (diagnosis, epidemiology, prevention & control)
• Humans
• Infant, Newborn
• Infectious Disease Transmission, Vertical (prevention & control)
• Penicillins (administration & dosage)
• Pregnancy
• Pregnancy Complications, Infectious (diagnosis, epidemiology, prevention & control)
• Sepsis (diagnosis, epidemiology, prevention & control)
• Severity of Illness Index
• Streptococcal Infections (diagnosis, epidemiology, prevention & control)
• Streptococcus agalactiae
• Surveys and Questionnaires
• Treatment Failure