Objective To identify and to establish the prevalence of ORs factors associated with increased risk for early-onset group B streptococcal (EOGBS) infection in neonates. streptococcal (EOGBS) infection in neonates. Study design Literature review and reanalysis of published data. Results Risk factors for EOGBS infection include group B streptococcal (GBS)-positive vaginal culture at delivery (OR: 204), GBS-positive rectovaginal culture at 28 (OR: 9.64) or 36 weeks gestation (OR: 26. 7), vaginal Strep B OIA test positive at delivery (OR: 15.4), birth weight 18 hours (OR: 7.28), intrapartum fever >37.5 degrees C (OR: 4.05), intrapartum fever, PROM, or prematurity (OR: 9.74), intrapartum fever or PROM at term (OR: 11.5), chorioamnionitis (OR: 6.43). Chorioamnionitis is reported in most (88%) cases in which neonatal infection occurred despite intrapartum maternal antibiotic therapy. ORs could not be estimated for maternal GBS bacteriuria during pregnancy, with preterm premature rupture of membranes, or with a sibling or twin with invasive GBS disease, but these findings seem to be associated with a very high risk. Multiple gestation is not an independent risk factor for GBS infection. Conclusions h Mothers with GBS bacteriuria during pregnancy, with another child with GBS disease, or with chorioamnionitis should receive empirical intrapartum antibiotic treatment. Their infants should have complete diagnostic evaluations and receive empirical treatment until infection is excluded by observation and negative cultures because of their particularly high risk for EOGBS infection. Either screening with cultures at 28 weeks gestation or identification of clinical risk factors, ie, PROM, intrapartum fever, or prematurity, may identify parturients whose infants include 65% of those with EOGBS infection. Intrapartum screening using the Strep B OIA rapid test identifies more at-risk infants (75%) than any other method. These risk identifiers may permit judicious selection of patients for prophylactic interventions.

https://pediatrics.aappublications.org/content/pediatrics/103/6/e77.full.pdf

Risk Factors for Early-onset Group B Streptococcal Sepsis: Estimation of Odds Ratios by Critical Literature Review

1. Tara M. Randis, MD, MS*
2. Jacqueline A. Baker, MD†
3. Adam J. Ratner, MD, MPH*,‡


 

1. Departments of *Pediatrics and

2. ‡Microbiology, New York University School of Medicine, New York, NY

3. †Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, NY

* Abbreviations:
 CDC: : Centers for Disease Control and Prevention
 CFR: : case fatality rate
 CSF: : cerebrospinal fluid
 EO: : early-onset
 GBS: : group B Streptococcus HIV: : human immunodeficiency virus
 IAP: : intrapartum antibiotic prophylaxis
 LO: : late-onset
 PCR: : polymerase chain reaction

Despite recommendations for universal screening and intrapartum antibiotic prophylaxis strategies for pregnant women, group B Streptococcus remains a major cause of neonatal disease.

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### Organism

Streptococcus agalactiae , or group B Streptococcus (GBS), was first recognized as a distinct entity in the 1930s by Rebecca Lancefield, who used immunologic typing of carbohydrate antigens as a means to classify streptococci. (1) Early studies by her group and others indicated that GBS was an uncommon cause of human disease and was more frequently isolated as an etiologic agent of bovine mastitis. Sporadic case reports from that time demonstrated the potential for GBS to cause invasive infections, especially in peripartum women, although such infections were believed to be infrequent. However, over the period of the 1950s to the early 1970s, GBS became the major cause of neonatal sepsis in the United States and worldwide.

### Colonization and Pathogenesis

GBS asymptomatically colonizes the lower gastrointestinal and female genital tracts. Colonization rates …

Group B Streptococcal Infections

Prospective studies of group B streptococcal infections in infants

Early-onset group B streptococcal sepsis: A current assessment

Humans exist in an environment replete with microorganisms, but only a few become resident on the skin surface. The skin possesses protective mechanisms to limit colonization, and the survival of organisms on the surface lies in part in the ability of the organisms to resist these mechanisms. Microbial colonization on the skin adds to the skin's defense against potentially pathogenic organisms. Although microbes normally live in synergy with their hosts, occasionally colonization can result in clinical infection. Common infections consist of superficial infections of the stratum corneum or appendageal structures that can respond dramatically to therapy but commonly relapse. In rare circumstances, these infections can be quite severe, particularly in immunocompromised patients or in hospitalized patients with indwelling foreign devices. These infections are often resistant to conventional antibiotics and can result in infection with other opportunistic pathogens.

Microbiology of the skin: Resident flora, ecology, infection

Group B streptococci are an important cause of infant septicemia and meningitis. A prospective study of group B streptococcal colonization in a 300-bed community hospital disclosed rates of 29% of 297 third-trimester women, 37% of 242 newborn infants, and 45% of 22 hospital personnel. Colonized parturients were more frequently black and anemic on admission for delivery. Infant colonization was statistically associated with a positive maternal genital culture, low birthweight, and prematurity. Nosocomial transmission of group B streptococci was strongly suggested by observations that 41% of colonized infants were born to culture-negative women and such infants became colonized later in their hospital stay than did colonized infants born to colonized women. Furthermore, hospital personnel working in the labor-delivery and nursery areas had a significantly higher prevalence of the organism than did personnel from other areas. Clearly, more information is needed about the epidemiology of group B streptococcal disease before appropriate and rational control measures can be recommended.

Nancy Allen

Papers

Nosocomial Transmission of Group B Streptococci