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Preventing Early‐Onset Group B Streptococcus neonatal infection and reducing antibiotic exposure using a rapid PCR test in term prelabour rupture of membranes
Author(s) -
Wang Mandy,
Keighley Caitlin,
Watts Matthew,
Plymoth Martin,
McGee Therese M.
Publication year - 2020
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13159
Subject(s) - medicine , rupture of membranes , group b , population , risk factor , antibiotics , neonatal infection , antibiotic prophylaxis , chorioamnionitis , retrospective cohort study , cohort , streptococcus , pediatrics , obstetrics , pregnancy , gestation , surgery , microbiology and biotechnology , genetics , bacteria , biology , environmental health
Background How best to target intrapartum antibiotic prophylaxis (IAP) to minimise both Early‐Onset Group B Streptococcus (EOGBS) neonatal infection and maternal/fetal antibiotic exposure is uncertain, with both routine‐screening and risk‐factor approaches available. Aims This retrospective cohort study was undertaken to examine the outcomes of a hybrid risk‐and‐screen approach to EOGBS prevention using GBS polymerase chain reaction (PCR). The target population was women with term prelabour rupture of membranes (TermPROM) having the risk factor of prolonged rupture of membranes (ROM) ≥18 h. Materials and Methods Non‐labouring TermPROM women had rapid GBS PCR testing at presentation. GBS screen‐positive women proceeded to induction of labour and received IAP. GBS screen‐negative women were allowed home to await spontaneous labour and not given IAP regardless of duration of ROM, unless other risk factors developed. For all other women, the risk‐factor approach was followed. Results From 2009 to 2018, there were 20 cases of culture‐positive EOGBS, a rate of 0.36/1000 live births (95% CI 0.22–0.56/1000), comparable to other recent reports. Over 2010–2018 when laboratory data were available, 1120 TermPROM women with ROM ≥18 h avoided antibiotics because they were GBS PCR‐negative (2.3% of all births, 3.6% of vaginal births) while 338 TermPROM women with ROM <18 h received targeted antibiotics for being GBS‐positive. No cases of EOGBS occurred in TermPROM women, those with ROM ≥18 h, or due to protocol‐compliance failure. Conclusions A hybrid approach involving risk‐factor‐based IAP and intrapartum GBS PCR screening of non‐labouring TermPROM women delivers acceptably low rates of EOGBS while minimising and better targeting antibiotic exposure.