A study of the management of group B streptococcal colonisation in pregnant women: Benefits and risks of preventative modalities
- Publication Type:
- Thesis
- Issue Date:
- 2020
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๐๐ฎ๐ฐ๐ธ๐ด๐ฟ๐ผ๐๐ป๐ฑ
In high-income countries ~ 30% of women and their babies are exposed to intrapartum antibiotic prophylaxis (IAP), for the prevention of neonatal early-onset group B streptococcal infection (EOGBS). This intervention aims to lower the risk of EOGBS but IAP is not without its own risks. Emerging evidence of the potential impact of antibiotics on the maternal/babyโs microbiome is concerning. Evidence of the effectiveness of IAP and its application was needed to establish if current management was the optimum strategy for the reduction of EOGBS.
๐ฃ๐๐ฟ๐ฝ๐ผ๐๐ฒ
To establish the impact of the normally commensal bacteria, group B streptococcus (GBS), on rates of neonatal early-onset sepsis (EOS) in one large health district; to describe local management of maternal GBS colonisation; and assess cliniciansโ adherence to GBS guidelines.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐
An integrative literature review was undertaken to examine the effectiveness and implications of IAP. Subsequently, two retrospective observational studies explored temporal trends in EOS, GBS management, and EOGBS, in one large health service over 11 years, using logistic regression and covariates for potential modifiers. A third study analysed a subset of women using ordered logistic regression. A 5% margin of error and a 95% confidence interval was used throughout.
๐ฅ๐ฒ๐๐๐น๐๐
This research found management of GBS risk was sub-optimal. Clinical trials reported high effectiveness, but they had major methodological flaws. Observational studies showed poor adherence to GBS management. Whilst scant consideration was given to short-term risks; long-term consequences were not addressed.
In this work, group B streptococcus was the most common cause of EOS in term babies. All cause EOS reduced significantly over time; EOGBS reduced but this did not reach statistical significance. Analysis of blood culture utilisation revealed intensity of surveillance did not change. Eighteen babies were diagnosed with EOGBS (0.19/1000 live births), ten of these were term. Seven were born to mothers screened negative for GBS. No evidence of difference in rates of EOGBS between screened and unscreened pregnancies was found. Prophylaxis in accord with local guidelines was received by one third of eligible women. Most missed opportunities for IAP were unavoidable, and mainly due to lack of time between admission for labour and birth. Despite this, rates of EOGBS were extremely low at 0.19/1000 live births.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป
Evidence for screening and IAP is poor. Current management has serious limitations, and risks may outweigh benefit. Overall, management of GBS risk warrants urgent reconsideration. Research is needed to understand factors, other than IAP, that may be contributing to protection from EOGBS.
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