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Neonatal Group B Streptococcal Disease: How Infection Control Teams Can Contribute to Prevention Efforts

Published online by Cambridge University Press:  02 January 2015

Larry J. Strausbaugh
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert W. Pinner
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Stephanie J. Schrag*
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Cynthia G. Whitney
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Anne Schuchat
Affiliation:
Respiratory Diseases Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Respiratory Diseases Branch, MS-C23, Centers for Disease Control and Prevention, Clifton Rd, Atlanta, GA30333

Abstract

Group B streptococcal (GBS) disease is a leading cause of morbidity and mortality among newborns. Many cases of newborn GBS disease can be prevented by the administration of intrapartum antibiotic prophylaxis. Current consensus guidelines for prevention of perinatal GBS disease have led to substantial declines in the incidence of GBS disease occurring in newborns <7 days of age (early-onset disease). Despite declines in the incidence of early-onset disease, approximately 20% of pregnant women are colonized with GBS at the time of labor and thus have the risk of transmitting the bacteria to their newborns. Consequently, continued and improved implementation of prevention efforts is essential. Infection control teams can contribute uniquely to prevention of perinatal GBS disease by serving as hospital champions of GBS disease prevention. In particular, teams can coordinate with administration and staff to encourage establishment and effective implementation of GBS prevention policies; facilitate improved laboratory processing of prenatal GBS screening specimens; monitor any adverse consequences of increased use of intrapartum antibiotics within the hospital; and investigate GBS cases that occur to determine whether they could have been prevented. By spearheading efforts to improve implementation of perinatal GBS disease prevention at the hospital level, hospital epidemiologists and infection control practitioners can play an important role in reducing the burden of early-onset GBS disease.

Type
Emerging Infectious Diseases
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2000

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References

1. Baker, CJ, Barrett, FF, Gordon, RC, Yow, MD. Suppurative meningitis due to streptococci of Lancefield group B: a study of 33 infants. J Pediatr 1973;82:724729.CrossRefGoogle Scholar
2. Barton, LL, Feigin, RD, Lins, R. Group B beta hemolytic streptococcal meningitis in infants. J Pediatr 1973;82:719723.CrossRefGoogle Scholar
3. Franciosi, RA, Knostman, JD, Zimmerman, RA. Group B streptococcal neonatal and infant infections. J Pediatr 1973;82:707718.CrossRefGoogle Scholar
4. McCracken, GH. Group B streptococci: the new challenge in neonatal infections. J Pediatr 1973;82:703706.CrossRefGoogle Scholar
5. Regan, JA, Klebanoff, MA, Nugent, RP. The epidemiology of group B streptococcal colonization in pregnancy. Vaginal Infections and Prematurity Study Group. Obstet Gynecol 1996;77:604610.Google Scholar
6. McDonald, H, Vigneswaran, R, O'Loughlin, JA. Group B streptococcal colonization and preterm labor. Aust N Z J Obstet Gynecol 1989;29:291293.CrossRefGoogle Scholar
7. Boyer, KM, Gotoff, SP. Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. N Engl J Med 1986;314:16651669.CrossRefGoogle Scholar
8. Mohle-Boetani, JC, Schuchat, A, Plikaytis, BD, Smith, JD, Broome, CV. Comparison of prevention strategies for neonatal group B streptococcal infection: a population-based economic approach. JAMA 1993;270:14421448.CrossRefGoogle Scholar
9. Rouse, DJ, Goldenberg, RL, Cliver, SP, Cutter, GR, Mennemeyer, ST, Fargason, CA. Strategies for the prevention of early-onset neonatal group B streptococcal sepsis: a decision analysis. Obstet Gynecol 1994;83:483494.CrossRefGoogle Scholar
10. Yancey, MK, Duff, P. An analysis of the cost-effectiveness of selected protocols for the prevention of neonatal group B streptococcal infection. Obstet Gynecol 1994;83:367371.Google ScholarPubMed
11. Mohle-Boetani, JC, Lieu, TA, Ray, GT, Escobar, G. Preventing neonatal group B streptococcal disease: cost-effectiveness in a health maintenance organization and the impact of delayed hospital discharge for newborns who received intrapartum antibiotics. Pediatrics 1999;103:703710.CrossRefGoogle Scholar
12. Revised guidelines for prevention of early-onset group B streptococcal (GBS) disease. American Academy of Pediatrics Committee on Infectious Diseases and Committee on Fetus and Newborn. Pediatrics 1997;99:489496.CrossRefGoogle Scholar
13. Committee on Obstetric Practice American College of Obstetricians and Gynecologists. Prevention ofEarlyOnset Group B Streptococcal Disease in Newborns. Washington, DC: American College of Obstetricians and Gynecologists; 1996.Google Scholar
14. Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45(RR-7):124.Google Scholar
15. Schuchat, A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev 1998;11:497513.CrossRefGoogle Scholar
16. Schrag, SJ, Zywicki, S, Farley, MM, Reingold, AL, Harrison, LH, Leftkowitz, LB, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000;342:1520.CrossRefGoogle Scholar
17. Anthony, BF, Okada, DM. The emergence of group B streptococci in infections of the newborn infant. Annu Rev Med 1977;28:355369.CrossRefGoogle Scholar
18. Schuchat, A, Oxtoby, M, Cochi, S, Sikes, RK, Hightower, A Plikaytis, B, et al. Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta. J Infect Dis 1990;162:672677.CrossRefGoogle Scholar
19. Wald, ER, Bergman, I, Taylor, HG, Chiponis, D, Porter, C, Kubek, K, et al. Long-term outcome of group B streptococcal meningitis. Pediatrics 1986;77:217221.CrossRefGoogle ScholarPubMed
20. Edwards, MS, Rench, MA, Haffar, AA, Murphy, MA, Desmond, MM, Baker, CJ. Long-term sequelae of group B streptococcal meningitis in infants. J Pediatr 1985;106:717722.CrossRefGoogle Scholar
21. Dillon, HC, Gray, E, Pass, MA, Gray, BM. Anorectal and vaginal carriage of group B streptococci during pregnancy. J Infect Dis 1982;145:794799.CrossRefGoogle Scholar
22. Yow, MD, Leeds, LJ, Thompson, PK, Mason, EO Jr, Clark, DJ, Beachler, CW. The natural history of group B streptococcal colonization in the pregnant woman and her offspring, I: colonization studies. Am J Obstet Gynecol 1980;137:3438.CrossRefGoogle Scholar
23. Baker, CJ, Edwards, MS. Group B streptococcal infections. In: Remington, J, Klein, O, eds. Infectious Diseases of the Fetus and Newborn Infant. 4th ed. Philadelphia, PA: WB Saunders; 1995:9801054.Google Scholar
24. Boyer, KM, Gadzala, CA, Burd, LI, Fisher, DE, Paton, JB, Gotoff, SP. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease, I: epidemiologic rationale. J Infect Dis 1983;148:795801.CrossRefGoogle Scholar
25. Zangwill, KM, Schuchat, A, Wenger, JD. Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR 1992;41:2532.Google Scholar
26. Regan, JA, Klebanoff, MA, Nugent, RP. The epidemiology of group B streptococcal colonization in pregnancy. Vaginal Infections and Prematurity Study Group. Obstet Gynecol 1991;77:604610.Google Scholar
27. Dillon, HC, Khare, S, Gray, BM. Group B streptococcal carriage and disease: a 6-year prospective study. J Pediatr 1987;110:3136.CrossRefGoogle Scholar
28. Schuchat, A. Group B streptococcus. Lancet 1999;353:5156.CrossRefGoogle ScholarPubMed
29. Robbins, JB, Schneerson, R, Vann, WF, Bryla, DA, Fattom, A. Prevention of systemic infections caused by group B streptococcus and Staphylococcus aureus by multivalent polysaccharide-protein conjugate vaccines. Ann NY Acad Sci 1995;754:6882.CrossRefGoogle ScholarPubMed
30. Baker, CJ, Paoletti, LC, Wessels, MR, Guttormsen, HK, Rench, MA, Hickman, ME, et al. Safety and immunogenicity of capsular polysaccharide-tetanus toxoid conjugate vaccines for group B streptococcal types Ia and Ib. J Infect Dis 1999;179:142150.CrossRefGoogle Scholar
31. Centers for Disease Control and Prevention. Adoption of hospital policies for prevention of perinatal group B streptococcal disease—United States, 1997. MMWR 1998;47:665670.Google Scholar
32. Lieu, TA, Mohle-Boetani, JC, Ray, T, Ackerson, LM, Walton, DL. Neonatal group B streptococcal infection in a managed care population. Obstet Gynecol 1998;92:2127.CrossRefGoogle Scholar
33. Davis, RL, Hasselquist, MB, Zerr, DM, Schuchat, A. Introduction of the new CDC group B streptococcal prevention guideline at a large West Coast health maintenance organization. Presented at the Pediatric Academic Societies Conference; May 1999; San Francisco, CA. Abstract 105.Google Scholar
34. Factor, SH, Whitney, CG, Zywicki, SS, Schuchat, A. Effects of hospital policies based on 1996 group B streptococcal consensus guidelines. The Active Bacterial Core Surveillance Team. Obstet Gynecol 2000;95:377382.Google Scholar
35. Towers, CV, Suriano, K, Asrat, T. The capture rate of at-risk term newborns for early-onset group B streptococcal sepsis determined by a risk factor approach. Am J Obstet Gynecol 1999;181:12431249.CrossRefGoogle Scholar
36. Rosenstein, NE, Schuchat, A. Opportunities for prevention of perinatal group B streptococcal disease: a multistate surveillance analysis. Obstet Gynecol 1997;90:901906.CrossRefGoogle Scholar
37. Yancey, MK, Schuchat, A, Brown, LK, Ventura, VL, Markenson, GR. The accuracy of late antenatal screening cultures in predicting genital group B streptococcal colonization at delivery. Obstet Gynecol 1996;88:811815.CrossRefGoogle Scholar
38. Philipson, EH, Palermino, DA, Robinson, A. Enhanced antenatal detection of group B streptococcus colonization. Obstet Gynecol 1995;85:437439.CrossRefGoogle ScholarPubMed
39. Badri, MS, Zawaneh, S, Cruz, AC, Mantilla, G, Baer, H, Spellacy, WN, et al. Rectal colonization with group B streptococcus: relation to vaginal colonization of pregnant women. J Infect Dis 1977;135:308312.CrossRefGoogle ScholarPubMed
40. Sayahtaheri Altaie, S, Dryja, D. Detection of group B streptococcus: comparison of solid and liquid culture media with and without selective antibiotics. Diagn Microbiol Infect Dis 1994;18:141144.CrossRefGoogle Scholar
41. Centers for Disease Control and Prevention. Laboratory practices for prenatal group B streptococcal screening and reporting—Connecticut, Georgia and Minnesota, 1997-1998. MMWR 1999;48:426428.Google Scholar
42. Heim, K, Alge, A, Marth, C. Anaphylactic reaction to ampicillin and severe complication in the fetus. Lancet 1991;337:859860.CrossRefGoogle ScholarPubMed
43. McDuffie, RS, McGregor, JA, Gibbs, RS. Adverse perinatal outcome and resistant Enterobacteriaceae after antibiotic usage for premature rupture of the membranes and group B streptococcal carriage. Obstet Gynecol 1993;82:487489.Google Scholar
44. Amstey, MS, Gibbs, RS. Is penicillin G a better choice than ampicillin for prophylaxis of neonatal group B streptococcal infections? Obstet Gynecol 1994;84:10581059.Google ScholarPubMed
45. Fernandez, M, Hickman, ME, Baker, CJ. Antimicrobial susceptibilities of group B streptococci isolated between 1992 and 1996 from patients with bacteremia or meningitis. Antimicrob Agents Chemother 1998;42:15171519.CrossRefGoogle ScholarPubMed
46. Pearlman, MD, Pierson, CL, Faix, RG. Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin. Obstet Gynecol 1998;92:258261.Google Scholar
47. National Committee for Clinical Laboratory Standards. Approved Standard M7-A4: Standard Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: NCCLS; 1997.Google Scholar
48. Towers, CV, Carr, MH, Padilla, G, Asrat, T. Potential consequences of widespread antepartal use of ampicillin. Am J Obstet Gynecol 1998;179:879883.CrossRefGoogle ScholarPubMed
49. Joseph, TA, Pyati, SP, Jacobs, N. Neonatal early-onset Escherichia coli disease: the effect of intrapartum ampicillin. Arch Pediatr Adolesc Med 1998;152:3540.CrossRefGoogle ScholarPubMed
50. Isaacs, D, Royle, JA. Intrapartum antibiotics and early onset neonatal sepsis caused by group B streptococcus and by other organisms in Australia. Pediatr Infect Dis J 1999;18:524528.CrossRefGoogle ScholarPubMed
51. Adams, WG, Kinney, JS, Schuchat, A, Collier, CL, Papasian, CJ, Kilbride, HW, et al. Outbreak of early-onset group B streptococcal sepsis. Pediatr Infect Dis J 1993;12:565570.CrossRefGoogle ScholarPubMed
52. Takayanagi, T, Tanaka, H, Yoshinaga, M, Aoki, M, Teshima, H, Fukuda, M, et al. An outbreak of group B streptococcus in a neonatal nursery and subsequent trial for prophylaxis of nosocomial transmission. Acta Paediatr Jpn 1994;36:8890.CrossRefGoogle Scholar
53. Noya, FJD, Rench, MA, Metzger, TG, Colman, G, Naidoo, J, Baker, CJ. Unusual occurrence of an epidemic of type lb/c group B streptococcal sepsis in a neonatal intensive care unit. J Infect Dis 1987;155:11351144.CrossRefGoogle Scholar
54. Schuchat, A, Zywicki, SS, Dinsmoor, MJ, Mercer, B, Romaguera, J, O'Sullivan, MJ, et al. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Pediatrics 2000;105(1 Pt 1):2126.CrossRefGoogle ScholarPubMed
55. Queenan, JT. GBS prevention: national guidelines at last. Contemp Obstet Gynecol 1996;41:811.Google Scholar
56. Kramarow, E, Letzner, H, Rooks, R, Weeks, J. Health and Aging Chartbook: Health, United States, 1999. Hyattsville, MD: National Center for Health Statistics; 1999.Google Scholar
57. Towers, CV, Rumney, PJ, Minkiewicz, SF, Asrat, T. Incidence of intrapartum maternal risk factors for identifying neonates at risk for early-onset group B streptococcal sepsis: a prospective study. Am J Obstet Gynecol 1999;181:11971202.CrossRefGoogle Scholar