Adherence to Perinatal Group B Streptococcal Prevention Guidelines

Goins, William P. MD, MPH; Talbot, Thomas R. MD, MPH; Schaffner, William MD; Edwards, Kathryn M. MD; Craig, Allen S. MD; Schrag, Stephanie J. DPhil; Van Dyke, Melissa K. PhD; Griffin, Marie R. MD, MPH

Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181dd916f
Original Research
Abstract

OBJECTIVE: To estimate compliance with the 2002 revised perinatal group B streptococci (GBS) prevention guidelines in Tennessee, which recommend universal GBS screening of pregnant women at 35–37 weeks of gestation and, when indicated, administration of intrapartum chemoprophylaxis.

METHODS: Active Bacterial Core surveillance conducts active, population-based surveillance for invasive GBS disease in 11 Tennessee counties. A retrospective case–cohort study was conducted using a stratified random sample of all live births in surveillance hospitals during 2003–2004, including all early-onset GBS cases. Factors associated with GBS screening and lack of optimal GBS chemoprophylaxis were analyzed using logistic regression.

RESULTS: Screening was performed for 84.7% of pregnant women, but 26.3% of prenatal tests with documented test dates were performed before 35 weeks of gestation. Among women with an indication for GBS prophylaxis, 61.2% received optimal chemoprophylaxis, defined as initiation of a recommended antibiotic 4 hours or more before delivery. When the analysis was restricted to women who were admitted 4 hours or more before delivery, 70.9% received optimal chemoprophylaxis. Women not receiving optimal chemoprophylaxis were more likely to have penicillin allergy (11.7% compared with 2.5%, adjusted odds ratio [OR] 8.58, 95% confidence interval [CI] 1.57–47.04) or preterm delivery (45.5% compared with 13.2%, adjusted OR 5.52, 95% CI 2.29–13.30) and were less likely to have received the recommended prenatal serologic testing for other infectious diseases (77.9% compared with 91.1%, adjusted OR 0.30, 95% CI 0.09–0.98). Forty cases of early-onset GBS were identified (0.36 per 1,000 live births); 25% of these neonates were born to women who received screening at 35 weeks of gestation or later and, when indicated, optimal chemoprophylaxis.

CONCLUSION: Universal prenatal GBS screening was implemented widely in Tennessee, although the timing of screening and administration of chemoprophylaxis often were not optimal. A substantial burden of early-onset GBS disease occurs despite optimal prenatal screening and chemoprophylaxis, suggesting that alternative strategies, such as vaccination, are needed.

LEVEL OF EVIDENCE: II

In Brief

A substantial burden of early-onset group B streptococcal disease occurs despite optimal prenatal screening and chemoprophylaxis.

Author Information

From the Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas; the Department of Medicine, Divisions of Infectious Diseases and General Internal Medicine and Public Health, and the Departments of Preventive Medicine and Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee; the Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, Tennessee; and the Respiratory Diseases Branch, Division of Bacterial and Mycotic Disease, Centers for Disease Control and Prevention, Atlanta, Georgia.

Dr. Craig's current affiliation is Malaria Branch, Division of Parasitic Diseases, National Center for Zoonotic, Vector-Borne and Enteric Disease, Centers for Disease Control and Prevention, Atlanta, Georgia.

Supported by the Agency for Healthcare Research and Quality T32 HS 013833, the Vanderbilt-Sanofi Pasteur Healthcare Vaccinology and Epidemiology Training Program, Centers for Disease Control and Prevention Emerging Infections Program cooperative agreement U50/CCU416123-9, and the Max it Out Foundation.

The authors thank Paige Lewis, MSPH, Christina R. Phares, PhD, and Emily Weston, MPH, Centers for Disease Control and Prevention, Atlanta, Georgia, and Brenda Barnes, RN, CCRP, Jane Conners, RN, Amanda Faulk, RN, and Melinda Eady, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, for their assistance with abstraction and data management.

Corresponding author: William Goins, MD, MPH, 1709 Dryden Road, Suite 6.15, BCM 620, Houston, TX 77030; e-mail: goins@bcm.edu.

Financial Disclosure Dr. Talbot received money for a consultancy through Joint Commission Resources and received donated vaccine from Sanofi-Pasteur for a CDC-funded research study. The other authors did not disclose any potential conflicts of interest.

© 2010 by The American College of Obstetricians and Gynecologists.