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Group B Streptococcus (GBS) or Streptococcus agalactiae is the main cause of death from early-onset neonatal sepsis. Because of its fulminant clinical presentation, even with the timely use of antibiotics and clinical support in the intensive care unit, the fatality rate is high and the neonatologist can do little to prevent death. In developed countries, such as the United States, the incidence of GBS infection reduced from 1.7 cases per 1000 live births in the early 1990s to 0.34 cases per 1000 live births after the implementation of antibiotic prophylaxis during labor.1 In Brazil, there is no national recommendation for antibiotic prophylaxis during labor to prevent GBS neonatal infection. The information about GBS incidence derives from two studies published a decade ago and ranged between 0.39 and 1.0 per 1000 live births.2,3 A more recent study that analyzed data from 2007 to 2011 reported a GBS incidence of 0.51 per 1000 live births.4 We describe the cases of GBS infection among infants admitted to a public neonatal intensive care unit (NICU) in Brasilia, during 2012 and 2013. The NICU has 40 beds and it is a regional reference for very low birth weight babies (<1500 g) and neonatal surgery. We identified positive blood cultures for GBS using the microbiology laboratory database. Blood culture obtained from each patient was submitted to an automated continuous monitoring system for bacterial detection (Bactec fluorescent series system® Becton Dickinson Microbiology System). The Streptococcus genus was identified by Gram stain, colony morphology, hemolysis, and the catalase test. Then, an automated panel of Gram-positive identification (MicroScan Walk-Away® Dade Behring Inc.) was used to identify Streptococcus agalactiae species. Patients’ medical records were reviewed using a standardized form to collect data. During 2012 and 2013, 12,585 babies were born in our hospital and eight cases of GBS infection were identified. All positive cultures were collected during the first 48 h of life, representing early-onset sepsis. Therefore, the incidence of GBS infection was 0.63 per 1000 live births. tic prophylaxis

Group B streptococcus neonatal infection in an intensive care unit in Brazil: high fatality and missed opportunities for antibiotic prophylaxis