Risk-based screening combined with a PCR-based test for group B streptococci diminishes the use of antibiotics in laboring women. (August 2017)

• Record Type: Journal Article
• Authors: Khalil, Mohammed R.; Uldbjerg, Niels; Thorsen, Poul B.; Henriksen, Birgitte; Møller, Jens K.
• Is Part Of: European journal of obstetrics, gynecology, and reproductive biology. Volume 215(2017)
• Page Start: 188
• Page End: 192
• Publication Date: 2017-08
• Subjects: ACOG American College of Obstetricians and Gynecologists -- CDC Centers for Disease Control and Prevention, USA -- EO Early-onset -- EOGBS Early onset of neonatal group B streptococcal disease -- GBS Group B streptococci -- IAP Intrapartum antibiotic prophylaxis -- NPV Negative predictive value -- PCR Polymerase chain reaction -- PPV Positive predictive value -- RCOG Royal College of Obstetricians and Gynecologists, Great Britain -- PTD Preterm delivery -- ROM Rupture of membranes; GBS -- Early-onset neonatal infection -- Polymerase chain reaction -- Risk based approach -- Intrapartum antibiotic prophylaxis; Obstetrics -- Periodicals; Gynecology -- Periodicals; Reproductive health -- Periodicals; Gynecology -- Periodicals; Obstetrics -- Periodicals; Reproduction -- Periodicals; Obstétrique -- Périodiques; Gynécologie -- Périodiques; Reproduction -- Périodiques; Verloskunde; Gynaecologie; Voortplanting (biologie); Gynecology; Obstetrics; Reproduction; Electronic journals; Periodicals; Electronic journals; 618.05
• DOI: 10.1016/j.ejogrb.2017.06.019
• Languages: English
• ISSNs: 0301-2115

Abstract

Abstract: Objective: To assess the performance of a polymerase chain reaction – group B streptococci test (PCR-GBS test) – in deciding antibiotic prophylaxis in term laboring women. Study design: In this observational study, we enrolled 902 unselected Danish term pregnant women. During labor, midwives obtained vaginal swabs that were used for both GBS cultures (reference standard) and for the PCR-GBS test. Furthermore, we recorded the presence of risk factors for EOGBS (Early Onset Group B Streptococcal disease): (1) Bacteriuria during current pregnancy, (2) Prior infant with EOGBS (3) Temperature above 38.0 °C during labor, and (4) Rupture of membranes ≥18 h. Results: The prevalence of GBS carriers was 12% (104 of 902), the sensitivity of the PCR-GBS test 83% (86 of 104), and the specificity 97% (774 of 798). Among the 108 with one or more EOGBS-risk factors, GBS was present in 23% (25 of 108), the sensitivity 92% (23 of 25), and the specificity 89% (74 of 83). Conclusion: In programs that aim to treat all laboring women with vaginal GBS-colonization (12% in the present study) with penicillin, the PCR-GBS will perform well (sensitivity 83% and specificity 97%). In programs aiming to treat only GBS-carriers among those with risk factors of EOGBS, a reduction of penicillin usage by two-thirds from 12% to 4% may be possible.