Materiały źródłowe

• #1 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns

  Key components of screening and prophylaxis for Group B streptococcal (GBS) early-onset neonatal disease include: […] Targeted intravenous intrapartum antibiotic prophylaxis has demonstrated efficacy for prevention of GBS early-onset disease (EOD) in neonates born to women with positive antepartum GBS cultures and women who have other risk factors for intrapartum GBS colonization. […] Regardless of planned mode of birth, all pregnant women should undergo antepartum screening for GBS at 36 0/737 6/7 weeks of gestation, unless intrapartum antibiotic prophylaxis for GBS is indicated because of GBS bacteriuria during the pregnancy or because of a history of a previous GBS-infected newborn. […] All women whose vaginalrectal cultures at 36 0/737 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes.

• #2 Group B Streptococcus and Pregnancy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482443/

  Universal third-trimester screening and intrapartum antibiotic prophylaxis have significantly reduced neonatal group B streptococcus infections, although these measures may have unintended consequences for mothers and infants. […] Effective prevention of neonatal group B streptococcus disease depends on proper screening, timely antibiotic administration, and coordination with pediatric care clinicians. […] The American College of Obstetricians and Gynecologists (ACOG) recommends universal GBS screening at 36 to 37 6/7 weeks of gestation, with positive cases receiving appropriate intrapartum antibiotics. […] Effective prevention of neonatal GBS disease depends on proper screening, timely antibiotic administration, and coordination with pediatric care clinicians. […] IAP is recommended to prevent neonatal GBS-EOD in women with identified GBS colonization or with risk factors for GBS colonization.

• #3 Group B Streptococcus (GBS) Infections Guidelines: GBS Prophylaxis in Preterm Labor

  https://emedicine.medscape.com/article/229091-guidelines

  The American College of Obstetricians and Gynecologists has updated guidelines on the prevention of early-onset GBS infection in newborns, which have replaced the third set of GBS prevention guidelines from the Centers for Disease Control and Prevention published in 2010. […] In summary, the recommendations are to perform a universal GBS screening between weeks 36 0/7 and 37 6/7 of gestation, regardless of the planned mode of delivery. This provides a 5-week window for valid cultures, which increases the accuracy of predicting GBS colonization status at the time of delivery. […] Screening is best done with vaginal-rectal cultures. For patients with positive cultures, it is best to offer early intrapartum intravenous antibiotics because 2 hours of antibiotic administration has been shown to be effective in decreasing the frequency of neonatal sepsis by decreasing the GBS vaginal colonies.

• #4 Group B strep disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/group-b-strep/symptoms-causes/syc-20351729

  If you’re pregnant, get a group B strep screening test during your third trimester. If you have this type of bacteria in your body, medicines called antibiotics given to you during labor can protect your baby. […] If you’re pregnant, the American College of Obstetricians and Gynecologists recommends a group B strep screening test during weeks 36 to 37 of pregnancy. Talk to your health care professional about when to get screened if you live outside of the U.S. […] During the screening test, a member of your health care team takes swab samples from your vagina and rectum. Then the samples are sent to a lab for testing. […] A „positive” test result means that you carry group B strep. It doesn’t mean that you’re ill or that your unborn baby will be affected. But you do have a higher risk of passing the bacteria to your baby.

• #5 Group B strep disease – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/group-b-strep/symptoms-causes/syc-20351729

  Medicine can prevent group B bacteria from spreading to your baby during labor or delivery. An antibiotic through a needle in a vein, also called an IV, is given to you when labor begins. The antibiotic is usually penicillin or a related medicine. […] If you’re allergic to penicillin or related medicines, you might receive another antibiotic such as clindamycin or vancomycin instead. But it’s not clear how well these other antibiotics work. […] Taking antibiotics by mouth ahead of time won’t help lower the risk of passing the bacteria to your baby. That’s because the bacteria can return before labor begins. […] Antibiotic treatment during labor also is recommended if you: Have a urinary tract infection. Delivered a previous baby with group B strep disease. Get a fever during labor. Haven’t delivered your baby within 18 hours of your water breaking. Go into labor before 37 weeks and haven’t been tested for group B strep. […] Although it’s not available yet, researchers are working on a group B strep vaccine. It could help prevent group B strep infections in the future.

• #6 Group B Streptococcus and Pregnancy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482443/

  Indications for intrapartum GBS prophylaxis include: GBS colonization identified by antenatal culture, GBS bacteriuria detected during pregnancy, history of a previous infant with GBS disease, unknown GBS status and preterm labor or preterm premature rupture of membranes (37 0/7 weeks). […] ACOG recommends penicillin as the first-line antibiotic for GBS prophylaxis due to its narrow antimicrobial activity, which decreases the risk of resulting antibiotic resistance. […] IAP should be given at least 4 hours before delivery to be most effective, although a time interval from administration to delivery of 2 hours has been found to have some effectiveness. […] For women with penicillin allergies, the choice of IAP antibiotic depends on the allergy history and, if available, clindamycin susceptibility results from GBS cultures.

• #7 Group B Streptococcus (GBS) Infections Guidelines: GBS Prophylaxis in Preterm Labor

  https://emedicine.medscape.com/article/229091-guidelines

  For prevention of early-onset GBS infection, penicillin G remains the agent of choice. For women with penicillin allergy in whom the risk for anaphylaxis is considered to be low and/or in whom the severity of a reaction is uncertain, first-generation cephalosporins can be used. For women with penicillin allergy in whom the risk for anaphylaxis is high, penicillin allergy testing should be performed, if available, and cultures should include testing for susceptibility to clindamycin. Intravenous vancomycin remains the agent of choice for patients with high-risk penicillin allergy and also for those with GBS isolates not susceptible to clindamycin. […] The following scenarios are indications for intrapartum prophylaxis: Maternal history of delivery of a neonate with invasive GBS disease, Positive GBS cultures obtained at 36 0/7 weeks of gestation or later during pregnancy, GBS bacteriuria during any trimester of current pregnancy, Unknown GBS status at onset of labor and any of the following: Delivery before 37 0/7 weeks of gestation, Amniotic rupture of membranes 18 hours or more before delivery, Maternal fever (38 C) during labor, Positive result of nucleic amplification testing for GBS, Negative result of nucleic amplification testing for GBS but patient has 1 of the first 3 risk factors listed. […] Intrapartum antibiotics are not required for GBS carriers who are having a planned cesarean delivery with intact membranes and no labor.

• #8

  https://journals.lww.com/greenjournal/fulltext/2020/02000/prevention_of_group_b_streptococcal_early_onset.43.aspx

  Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 12% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginalrectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginalrectal cultures at 36 0/737 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes.

• #9 Group B Strep and Pregnancy | ACOG

  https://www.acog.org/womens-health/faqs/group-b-strep-and-pregnancy

  In some cases, your doctor may recommend antibiotics during labor without testing for GBS. Antibiotics may be given without testing if you had a previous child who had GBS disease […] your GBS status is not known when you go into labor and you have a fever […] your GBS status is not known and you go into labor before 37 weeks […] your GBS status is not known and it has been 18 hours or more since your water broke.

• #10 Group B Streptococcus (GBS) in Pregnant Women and Infants: Commonly Asked Questions – MN Dept. of Health

  https://www.health.state.mn.us/diseases/strep/gbs/gbswomen.html

  What can be done to help prevent GBS disease in my baby? In August 2002, the U.S. Centers for Disease Control and Prevention (CDC) updated recommendations on the prevention of the type of GBS infection that occurs in babies shortly after birth. These guidelines advise health care providers to use a screening-based approach to decide which woman may benefit from getting an antibiotic (like penicillin) through the vein during delivery. Providers use a screening test to see if their patients carry GBS. This test is done by swabbing the vagina and rectum between the 35th and 37th week of pregnancy. Women who have a positive screening test for GBS, can benefit from receiving antibiotics during labor. Women who have had a previous baby that had a GBS infection or women who during the current pregnancy have a urinary tract infection with GBS, have an increased risk of having a baby with GBS infection and can benefit from receiving antibiotic during labor. These women do not need to be screened during pregnancy. There are risks that are associated with an increased chance of a woman having a baby with GBS that occur around the time of labor and delivery. These include:

• #11 Prevention of Perinatal Group B Streptococcal Disease

  https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm

  Intrapartum antibiotic prophylaxis to prevent early-onset GBS disease is not recommended as a routine practice for cesarean deliveries performed before labor onset on women with intact amniotic membranes, regardless of the GBS colonization status of the woman or the gestational age of the pregnancy. […] The following are key components of the screening strategy: Women with GBS isolated from the urine at any time during the current pregnancy or who had a previous infant with invasive GBS disease should receive intrapartum antibiotic prophylaxis and do not need third trimester screening for GBS colonization. […] All other pregnant women should be screened at 35–37 weeks’ gestation for vaginal and rectal GBS colonization. […] In the absence of GBS urinary tract infection, antimicrobial agents should not be used before the intrapartum period to eradicate GBS genitorectal colonization, because such treatment is not effective in eliminating carriage or preventing neonatal disease and can cause adverse consequences. […] Monitoring for the latter will require long-term surveillance of a large population of term and preterm births.

• #12 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns

  If the prenatal GBS culture result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for women who have risk factors for GBS EOD. […] If a woman presents in labor at term with unknown GBS colonization status and does not have risk factors that are an indication for intrapartum antibiotic prophylaxis but reports a known history of GBS colonization in a previous pregnancy, the risk of GBS EOD in the neonate is likely to be increased. […] Intravenous penicillin remains the agent of choice for intrapartum prophylaxis, with intravenous ampicillin as an acceptable alternative. […] For women who are at high risk of anaphylaxis after exposure to penicillin, the laboratory requisitions for ordering antepartum GBS screening cultures (whether on paper or online in electronic medical records) should indicate clearly the presence of penicillin allergy.

• #13

  https://journals.lww.com/greenjournal/fulltext/2020/02000/prevention_of_group_b_streptococcal_early_onset.43.aspx

  If the prenatal GBS culture result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for women who have risk factors for GBS EOD. […] Intravenous penicillin remains the agent of choice for intrapartum prophylaxis, with intravenous ampicillin as an acceptable alternative. […] For women who are at high risk of anaphylaxis after exposure to penicillin, the laboratory requisitions for ordering antepartum GBS screening cultures (whether on paper or online in electronic medical records) should indicate clearly the presence of penicillin allergy. […] Intravenous vancomycin remains the only pharmacokinetically and microbiologically validated option for intrapartum antibiotic prophylaxis in women who report a high-risk penicillin allergy and whose GBS isolate is not susceptible to clindamycin. […] Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth.

• #14 Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0701/p59.html

  The new algorithm for secondary prevention of early-onset group B streptococcal disease in newborns should be applied to all infants, not only those at high risk of infection. […] The previous CDC guideline recommended that any amount of group B streptococcal bacteriuria be considered a positive culture. […] The new guideline reflects findings that only concentrations exceeding 104 colony-forming units per mL are associated with early-onset neonatal disease. […] The new guideline offers separate, more detailed algorithms for each of these situations, including recommendations for antibiotic regimens to prolong latency while also providing adequate coverage against GBS. […] Penicillin is the recommended antibiotic for intrapartum chemoprophylaxis of group B streptococcal disease; ampicillin is an acceptable alternative.

• #15

  https://journals.lww.com/mfm/fulltext/2020/04000/prevention_of_perinatal_group_b_streptococcus.8.aspx

  The recommended time for universal culture-based screening for GBS is ranges from 36 0/7 to 37 6/7 weeks of gestation. The GBS cultures have a high degree of accuracy in predicting GBS colonization status at birth if cultures are collected within 5 weeks of birth. The predictive ability of prenatal cultures for GBS decreases significantly when the culture-to-birth interval is longer than 5 weeks. […] IAP is hypothesized to prevent GBS EOD in three ways: (1) by temporarily decreasing the maternal vaginal GBS colonization burden; (2) by preventing surface and mucus membrane colonization of the fetus or newborn; (3) by reaching levels above the minimum inhibitory concentration of the antibiotic for killing GBS in the newborn bloodstream. […] Penicillin remains the main agent of choice for IAP, and ampicillin is an acceptable alternative. The definition of adequate IAP has been clarified to be at least 4 hours of penicillin, ampicillin, or cefazolin. Ampicillin IAP decreases maternal vaginal colonization and prevents neonatal surface colonization in 97% of cases if IAP is administered at least 2 hours before delivery.

• #16 Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0701/p59.html

  The new guideline clarifies that women who are allergic to penicillin are at risk of anaphylaxis if they have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administration of penicillin or a cephalosporin. […] Clindamycin is the drug of choice if the GBS isolate is susceptible to clindamycin and erythromycin, and if there is no inducible clindamycin resistance. […] The new guideline defines inadequate intrapartum chemoprophylaxis as failure to receive at least four hours of intravenous penicillin, ampicillin, or cefazolin before delivery.

• #17 Prevention of Group B Streptococcal Early-Onset Disease in Newborns | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns

  Intravenous vancomycin remains the only pharmacokinetically and microbiologically validated option for intrapartum antibiotic prophylaxis in women who report a high-risk penicillin allergy and whose GBS isolate is not susceptible to clindamycin. […] Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth.

• #18 Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05697-0

  To evaluate the choice of antibiotic used for intrapartum Group B Streptococcus (GBS) prophylaxis in pregnant individuals with reported penicillin allergies compared to those without reported penicillin allergies and investigate whether there are associated differences in neonatal outcomes. […] Pregnant individuals who report a penicillin allergy were more likely to receive alternative antibiotics for GBS prophylaxis compared to those without a penicillin allergy. This was associated with an increased frequency of postnatal blood draws among neonates of mothers with a reported penicillin allergy. […] Administration of alternative intrapartum antibiotic prophylaxis with vancomycin or clindamycin is common in individuals with self-reported penicillin allergy, and maternal alternative antibiotic administration may impact neonatal care, particularly via increased lab draws.

• #19 Antibiotic choice for Group B Streptococcus prophylaxis in mothers with reported penicillin allergy and associated newborn outcomes | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05697-0

  Despite the CDCs recommendation to treat penicillin allergic pregnant individuals with cefazolin for GBS prophylaxis, the majority (73.7%) of patients with a documented penicillin allergy in our cohort were treated with clindamycin or vancomycin, both considered alternative treatment for GBS prophylaxis. […] Our study also showed that the use of clindamycin and vancomycin for GBS prophylaxis had consequences for the newborn during the study period. Neonates of mothers who received clindamycin or vancomycin had an increased rate of blood draws (specifically, CBC and blood culture) compared to neonates of mothers who received penicillin or cefazolin. […] Most individuals with documented penicillin allergy should be able to safely receive penicillin or cefazolin, unless specifically deemed to be at high risk for anaphylaxis. Determining why medical providers disproportionately choose vancomycin or clindamycin over cefazolin will be important going forward to improve adherence to current best-practice GBS prophylaxis guidelines. […] There is a clear need for implementing healthcare provider education regarding antibiotic selection in penicillin allergic patients and the role of penicillin testing in pregnancy to improve appropriate and targeted antibiotic choice and impact on newborn infants born to GBS positive mothers.

• #20 Group B Streptococcus and Pregnancy – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK482443/

  In patients with preterm labor or preterm premature rupture of membranes, the following recommendations for GBS prophylaxis have been established by ACOG: IAP should be started during the initial management of preterm labor and continued if labor progresses. […] Universal screening for GBS colonization combined with IAP has significantly reduced the incidence of GBS-EOD by approximately 80%, with prophylaxis efficacy estimated between 86% and 89%.

• #21 CDC Updates Guidelines for the Prevention of Perinatal GBS Disease | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0501/p1106.html

  The recommended antibiotic for intrapartum GBS prophylaxis is penicillin, although ampicillin is an acceptable alternative. […] GBS prophylaxis should be given at hospital admission in patients with threatened preterm delivery if their colonization status is unknown or if they had a positive screen within the preceding five weeks. […] Antibiotics may be given to patients with PPROM to prolong latency; this dosage (i.e., 2 g of intravenous ampicillin, followed by 1 g every six hours for 48 hours) should also cover GBS prophylaxis if delivery occurs while the patient is receiving that antibiotic regimen. […] A full diagnostic evaluation should be performed on any newborn with signs of sepsis. Treatment should include antimicrobial agents that are active against GBS and other organisms that might cause neonatal sepsis.

• #22 Group B Streptococcus (GBS) in pregnancy and newborn babies | RCOG

  https://www.rcog.org.uk/for-the-public/browse-our-patient-information/group-b-streptococcus-gbs-in-pregnancy-and-newborn-babies/

  If your waters break after 37 weeks of your pregnancy and you are known to carry GBS, you will be offered induction of labour straight away. This is to reduce the time that your baby is exposed to GBS before birth. You should also be offered antibiotics through a drip. […] Even if you are not known to carry GBS, if you develop any signs of infection in labour, you will be offered antibiotics through a drip that will treat a wide range of infections including GBS. […] If your labour starts before 37 weeks of your pregnancy, your healthcare professional will recommend that you have antibiotics through a drip even if you are not known to carry GBS. […] If you are found to carry GBS in your vagina or rectum, treating you with antibiotics before your labour begins does not reduce the chance of your baby developing GBS infection. You do not need antibiotic treatment until labour starts, when you will be offered antibiotics through a drip to reduce the chance of your baby being infected.

• #23 Updated Guidance on GBS Screening and Prophylaxis – The ObG Project

  https://www.obgproject.com/2023/02/06/cdc-algorithm-intrapartum-antibiotic-prophylaxis-gbs/

  with GBS bacteriuria in the current pregnancy […] with a GBS-positive screening result in the current pregnancy […] with unknown GBS status and […] Birth <37w0d [...] Have an intrapartum temperature of ≥100.4°F (38.0°C) [...] Have rupture of membranes for ≥18 hours [...] Consider in women with positive GBS colonization in previous pregnancy and present at ≥37w0d in labor with unknown culture status in current pregnancy. [...] Note: (1) Penicillin remains the preferred agent with ampicillin an acceptable alternative; (2) Clinicians do not need to test women who had a previous baby who developed GBS disease – These women should receive antibiotics. [...] ACOG notes that there are different standards internationally: For example, RCOG recommends GBS culture 3 to 5 weeks prior to anticipated delivery date for high risk pregnancy, otherwise at 35-37 weeks gestation for uncomplicated pregnancies.

• #24 Group B streptococcal infection – Wikipedia

  https://en.wikipedia.org/wiki/Group_B_streptococcal_infection

  Two ways are used to select female candidates to IAP: the culture-based screening approach and the risk-based approach. The culture-based screening approach identifies candidates using lower vaginal and rectal cultures obtained between 35 and 37 weeks of gestation, and IAP is administered to all GBS colonized women. The risk-based strategy identifies candidates to receive IAP by the aforementioned risk factors known to increase the probability of GBS-EOD without considering if the mother is or is not a GBS carrier. […] IAP is not required for women undergoing planned cesarean section in the absence of labour and with intact membranes, irrespective of the known GBS carriage status. […] Routine screening of pregnant women is performed in most developed countries such as the United States, France, Spain, Belgium and Canada, and data have shown falling incidences of GBS-EOD following the introduction of screening-based measures to prevent GBS-EOD.

• #25 Family Health Service – Prevention of Neonatal Group B Streptococcus Infection

  https://www.fhs.gov.hk/english/health_info/woman/478.html

  Prevention of Neonatal Group B Streptococcus Infection […] For GBS carriers, taking antibiotics before labour starts is not an effective way to get rid of the bacteria. As they naturally live in the intestine, the bacteria can come back after the antibiotic treatment. The most effective way to prevent baby’s infection is to give the antibiotic during labour. […] If you are test positive for GBS, we recommend giving you intravenous injection of antibiotics during delivery which can greatly reduce the chance of your baby becoming sick. […] In certain conditions, the baby would have a higher risk of infection. These include: Previous baby affected by GBS infection, Mother has urinary tract infection due to GBS during pregnancy, GBS colonisation before 35 weeks. Under these conditions, we recommend injection of antibiotic during labour and screening is not necessary. […] In case your GBS status is unknown and if any of the following condition is present, we recommend you to have antibiotic during labour. The conditions include: Gestation less than 37 weeks, Maternal fever with temperature equal to or higher than 38C, Water broken for more than 18 hours. […] Although antibiotic treatment during labour helps to prevent early-onset GBS infection, it is not 100% and does not always prevent late-onset GBS infection. Babies may pick up GBS from people they come in contact with or through other means.

• #26 Group B streptococcal infection – Wikipedia

  https://en.wikipedia.org/wiki/Group_B_streptococcal_infection

  It has been reported that IAP does not prevent all cases of GBS-EOD; its efficacy is estimated at 80%. The risk-based prevention strategy does not prevent about 33% of cases with no risk factors. Up to 90% of cases of GBS-EOD would be preventable if IAP were offered to all GBS carriers identified by universal screening late in pregnancy, plus to the mothers in higher risk situations.

• #27 Evidence on Group B Strep in Pregnancy

  https://evidencebasedbirth.com/groupbstrep/

  The “other risk factor approach.” Do not screen for GBS. Instead, treat laboring people with antibiotics if they have one or more of these other risk factors: GBS in the urine at any point in pregnancy. Previously gave birth to an infant with early GBS disease. Preterm labor. Fever during labor. Water has been broken for more than 18 hours. […] Later in this article, we will discuss which approach is most supported by evidence—the universal screening approach, or the other risk factor approach. […] The universal screening approach worked better than the other risk factor approach at preventing early GBS disease. Overall, there were 0.5 infants born with GBS per every 1,000 births. […] The findings from this landmark study convinced the CDC to revise their guidelines in 2002 and only recommend the universal screening approach.

• #28 Group B strep: What to know in adults and babies

  https://www.medicalnewstoday.com/articles/326233

  If a pregnant woman carries group B strep, the bacteria can sometimes pass to a baby during delivery, which can present problems. Therefore, preventing group B strep infection is important for a healthy delivery. […] During pregnancy, the only proven way to reduce the risk of passing GBS to a newborn is by giving the mother intravenous (IV) antibiotics during labor. Oral antibiotics will not help. Taking antibiotics before labor will not provide any benefit, as these bacteria grow back very fast. […] Doctors will want to take steps to prevent a woman from passing GBS to her newborn child. Giving a high risk pregnant woman an IV of antibiotics during labor can usually prevent early onset GBS in newborns. […] According to the CDC, a woman who is a GBS carrier and receives antibiotics during labor has only a 1 in 4,000 chance of delivering a baby who develops GBS disease. Without the antibiotics, the risk increases to 1 in 200. […] Taking antibiotics during labor can significantly reduce the risk of a pregnant woman passing GBS to her newborn.

• #29 Evidence on Group B Strep in Pregnancy

  https://evidencebasedbirth.com/groupbstrep/

  In 2019, when researchers published another analysis of early GBS disease in the U.S. and the effects of universal screening as prevention, they found that GBS disease continued to drop further (to 0.23 per 1,000 live births). […] In summary, although these studies had limitations (not uncommon for research published before 1996), there is also some valid information that we can use. […] Although it would be best if we had modern, larger, randomized, controlled trials on antibiotics for Group B Strep, such trials will not be available given that antibiotics are already in routine use, and it could be considered unethical to withhold antibiotics. […] Regardless of which strategy is used (universal screening vs. other risk factor approach), about one-third of people in high-resource countries are given IV antibiotics during birth. These antibiotics have the temporary side effect of negatively impacting the infant microbiome.

• #30 Group B Streptococcus (GBS) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/group-b-streptococcus-gbs

  Pregnant woman can get tested for GBS prior to giving birth, making GBS preventable. […] Prevention methods include antibiotics for the mother during labor. […] Yes. The Centers for Disease Control and Prevention recommends that all pregnant women be tested for GBS in her vagina and rectum when she is 35 to 37 weeks pregnant. […] If you are a carrier, you should be given antibiotics through the vein (IV) at the time of labor or when their water breaks. […] Research is ongoing to develop vaccines to prevent GBS disease. In the future, women who are vaccinated against GBS may make antibodies that cross the placenta and protect the baby during birth and early infancy. […] If you have a positive GBS culture during pregnancy, the Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG) recommends treatment with intravenous (IV) antibiotics during labor to reduce the risk of transmission of the infection to the baby.

• #31

  https://www.who.int/news/item/02-11-2021-urgent-need-for-vaccine-to-prevent-deadly-group-b-streptococcus

  The report calls urgently for the development of maternal vaccines against GBS to reduce this toll, emphasizing they could be highly cost-effective with significant health benefits in all regions of the world. […] Currently antibiotic prophylaxis administered to a woman during labour is the main means of preventing GBS disease in newborn infants, if the bacterium is detected during pregnancy. However, even in regions with high prophylactic coverage, there remain significant health risks, since this intervention is unlikely to prevent most GBS associated stillbirths, preterm births, or GBS disease that occurs later after birth. […] Importantly the largest burden of GBS is in low- and middle-income countries, where screening and intrapartum antibiotic administration are most challenging to implement, and a vaccine is therefore most urgently needed.

• #32

  https://www.who.int/news/item/02-11-2021-urgent-need-for-vaccine-to-prevent-deadly-group-b-streptococcus

  The report calls for researchers, vaccine developers and funders to accelerate development of an effective GBS vaccine that could be administered to pregnant women during routine pregnancy checkups. […] Estimates suggest that if GBS vaccination reached over 70% of pregnant women, then over 50,000 GBS-related deaths could be averted annually – as well as over 170,000 preterm births.

• #33 Group B Streptococcus neonatal infections, the ongoing history | Enfermedades Infecciosas y Microbiología Clínica

  https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-group-b-streptococcus-neonatal-infections-S0213005X2200012X

  The ACOG guideline also states that asymptomatic GBS bacteriuria in pregnant women with colony counts of less than 10^5 cfu/mL does not require antibiotic therapy, but GBS bacteriuria at levels ≥10^5 cfu/mL always warrants antibiotic treatment and follow-up until delivery. […] Despite the success of measures recommended in guidelines in preventing EOD, IAP is not effective in preventing LOD, and also GBS cause stillbirths and preterm births. In contrast, an effective GBS vaccine could prevent invasive GBS disease in all groups, including mother, fetus and infants. […] Maternal vaccination will be the most effective approach for preventing GBS infection in NBs. Developing such a vaccine is deemed a high priority by the World Health Organization. Vaccines based on capsular polysaccharides and protein vaccines have shown promising preliminary results and are now at various advanced phases of development.

• #34 GBS Information for Health Care Professionals – MN Dept. of Health

  https://www.health.state.mn.us/diseases/strep/gbs/gbshcp.html

  In a busy medical practice, it can be challenging to implement the latest evidence-based guidelines consistently. CDC: Prevent Group B Strep App for Obstetric Providers simplifies implementation of the latest guidelines for prevention of GBS disease. […] Consistent with the 2010 Guidelines for the Prevention of Perinatal GBS Disease, Prevent GBS was developed with and endorsed by the American College of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP), American College of Nurse-Midwives (ACNM), and American Academy of Family Physicians (AAFP). […] The app provides specific guidance based on the scenario entered. Concerned about choosing the best prophylaxis option? The app provides easy access to the appropriate antibiotic regimens for obstetric patients requiring intrapartum prophylaxisall from a mobile device or computer. […] Please help us optimize implementation of evidence-based guidelines to prevent early-onset GBS disease by promoting the Prevent GBS app to your members and colleagues.

• #35 Clinical Guidelines for Group B Strep Disease | Group B Strep | CDC

  https://www.cdc.gov/group-b-strep/hcp/clinical-guidance/index.html

  Professional associations have issued prevention and management recommendations for GBS disease in newborns. […] Current guidelines related to the prevention and management of GBS in newborns include: […] Use the „Prevent Group B Strep” app to achieve better implementation of obstetric guidelines. […] These organizations remain committed to working together to protect newborns from GBS disease.

• #36

  https://journals.lww.com/greenjournal/fulltext/2020/02000/prevention_of_group_b_streptococcal_early_onset.43.aspx

  Targeted intravenous intrapartum antibiotic prophylaxis has demonstrated efficacy for prevention of GBS early-onset disease (EOD) in neonates born to women with positive antepartum GBS cultures and women who have other risk factors for intrapartum GBS colonization. Neither antepartum nor intrapartum oral or intramuscular regimens have been shown to be comparably effective in reducing GBS EOD. […] Regardless of planned mode of birth, all pregnant women should undergo antepartum screening for GBS at 36 0/737 6/7 weeks of gestation, unless intrapartum antibiotic prophylaxis for GBS is indicated because of GBS bacteriuria during the pregnancy or because of a history of a previous GBS-infected newborn. […] All women whose vaginalrectal cultures at 36 0/737 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes.

• #37 Prevention of Perinatal Group B Streptococcal Disease

  https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm

  Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. […] Universal screening at 35–37 weeks’ gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns. […] Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. […] In the absence of a licensed GBS vaccine, universal screening and intrapartum antibiotic prophylaxis continue to be the cornerstones of early-onset GBS disease prevention. […] The use of intravenous intrapartum antibiotic prophylaxis to prevent early-onset GBS disease in the infant was first studied in the 1980s.

• #38 Group B Streptococcus neonatal infections, the ongoing history | Enfermedades Infecciosas y Microbiología Clínica

  https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-group-b-streptococcus-neonatal-infections-S0213005X2200012X

  Widespread application of CDC guidelines resulted in a reduction in the incidence of EOD in the United States (US) of more than 85%, from 1.8 NBs per 1000 live births in the 1990s to 0.23 per 1000 live births in 2015. […] In 2018, the management for updating the GBS prophylaxis guidelines was transferred in the US from the CDC to the American College of Obstetricians and Gynecologists (ACOG), the American Society of Microbiology (ASM) and the American Academy of Pediatrics (AAP) who issued updated recommendations. […] It is again stated in new ACOG guidelines that the critical point of preventing EOD continues to be universal screening and appropriate IAP. The main change from the CDC guidelines is that now it is recommended to perform universal GBS screening between weeks 36 and 37 of gestation, instead of at weeks 35-37, as it was advocated in the 2010 CDC guidelines.

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