The Role for Intra-Partum Antibiotics in Previously GBS-Colonised Pregnancies, Not So Straightforward After All: A Case Study

Background: Group B Streptococcus (GBS) is the most frequent pathogen involved in early-onset infection in newborninfants. The incidence of early-onset GBS disease (EOGBS) is estimated at 0.4 and 0.57 per 1000 births in the UnitedStates of America and the United Kingdom respectively. It is clear that administration of intrapartum antibiotics (IAP)significantly reduces risk of EOGBS (RR 0.17, 95% CI 0.04 to 0.74; number needed to treat to benefit 25, 95% CI 14 to 100),hence institutes such as the Royal College of Obstetrics and Gynecology (RCOG), and American College of Obstetricsand Gynecology (ACOG), have released clinical practice guidelines (CPGs) with the aim to improve the standard of carein GBS screening and IAP for the prevention of EOGBS in neonates. CPGs guide clinicians in their management basedon a consensus of care drawn from clinical evidence and offer a standard of care for them to fall back on to guard againstmedical malpractice litigation. However, deviation from the intended clinical context or the failure to recognize the limitsof such guidelines could compromise patient safety.Aim: The aim of this case study is to highlight the role and limitations of clinical practice guidelines in medical practice,through a case of an early onset GBS infection in a neonate that was a result of selectively applying the RCOG and ACOGguidelines outside their intended context.Conclusion: The case illustrates the importance of applying guidelines correctly within the appropriate clinical contextbut serves also as a reminder for clinicians to understand the limitations of them when accounting for other co-conditionspatients often present with in daily medical practice.