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Committee Opinion No. 797: Prevention of Group B Streptococcal Early-Onset Disease in Newborns: Correction

doi: 10.1097/AOG.0000000000003824
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In “Committee Opinion No. 797: Prevention of Group B Streptococcal Early-Onset Disease in Newborns” from the American College of Obstetricians and Gynecologists,1 the number of colony forming units (CFU) was expressed incorrectly, resulting in errors on page e57 and in Box 3.

In the second and third paragraphs under “Bacteriuria” and in Box 3, “105 CFU/mL” and “104 CFU/mL” should have appeared as “105 CFU/mL” and “104 CFU/mL,” respectively.

The full, corrected paragraphs are as follows:

Indications for treatment of GBS bacteriuria prenatally depend on the quantification of the GBS bacterial colony count and the presence or absence of urinary symptoms. Treatment is recommended for women who are symptomatic. Treatment of asymptomatic bacteriuria, which is defined as 105 colony forming units (CFU)/mL or more (65) has been shown to reduce the risks of pyelonephritis, birth weight less than 2,500 grams, and preterm birth (less than 37 weeks of gestation) (65, 66). In asymptomatic women, treatment of GBS bacteriuria, as with bacteriuria due to other organisms, is recommended only if test results indicate a level of 105 CFU/mL or higher (65, 66).

Although laboratories may report concentrations of GBS in urine at 104 CFU/mL or lower, no correlation has been found between concentrations of GBS bacteriuria of less than 105 CFU/mL and preterm birth (67–69). In addition, there is no evidence that prenatal treatment of asymptomatic women with GBS bacteriuria less than 105 CFU/mL provides better maternal or neonatal outcomes. Antibiotics do not completely eliminate GBS from the genitourinary and gastrointestinal tract, and even among women who receive treatment for GBS bacteriuria during pregnancy, recolonization after a course of antibiotics is typical (33). However, it is to be reinforced that any GBS colony count, even one less than 105 CFU/mL which would not require antepartum treatment in an asymptomatic woman, still indicates a higher level of anogenital colonization and is established as an indication for antibiotic prophylaxis in the intrapartum period (70).

The corrected version of Box 3 is reprinted on page 978.

Box 3.

Antepartum Group B Streptococcus Bacteriuria and Intrapartum Prophylaxis: Key Points

  • Group B streptococcus (GBS) bacteriuria at any concentration identified at any time in pregnancy represents heavy maternal vaginal–rectal colonization and indicates the need for intrapartum antibiotic prophylaxis (see Table 1) without the need for a subsequent GBS screening vaginal–rectal culture at 36 0/7–37 6/7 weeks of gestation.
  • Group B streptococcus bacteriuria at levels of 105 CFU/mL or greater, either asymptomatic or symptomatic, warrants acute treatment and indicates the need for intrapartum antibiotic prophylaxis at the time of birth (see Table 1).
  • Identification of asymptomatic bacteriuria with GBS during pregnancy at a level less than 105 CFU/mL does not require maternal antibiotic therapy during the antepartum period but is an indication for intrapartum antibiotic prophylaxis at the time of birth (see Table 1).
  • A urine culture sent for laboratory evaluation during pregnancy for any indication should be marked as being that of a pregnant woman.
  • In women who have a reported penicillin allergy, the laboratory requisition that accompanies an antepartum urine culture should be specifically marked for the laboratory to be aware of the penicillin allergy, to ensure that any GBS isolate identified will be appropriately tested for clindamycin susceptibility.
  • Clindamycin susceptibility results reported on an antepartum GBS-positive urine culture are ONLY for the purpose of guiding the choice of antibiotic for intrapartum antibiotic prophylaxis during labor.
    • ○ If antepartum treatment of a urinary tract infection or bacteriuria is indicated, clindamycin is not recommended as a treatment agent, even in women allergic to penicillin. It is concentrated poorly in urine, metabolized primarily by the liver, and is intended to treat bloodstream and soft tissue, not urinary, infections.

REFERENCE

1. Prevention of group B streptococcal early-onset disease in newborns. ACOG Committee Opinion No. 797. American College of Obstetricians and Gynecologists. Obstet Gynecol 2020;135:e51–72.
© 2020 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.