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==Overview== | ==Overview== | ||
Maternal intrapartum GBS colonization is the primary risk factor for early-onset disease in infants. | |||
==Risk Factors== | ==Risk Factors== | ||
====GBS in Pregnancy==== | |||
===GBS in Neonates=== | |||
Risk factors for GBS infection in neonates include:<ref name="pmid3931544">{{cite journal| author=Boyer KM, Gotoff SP| title=Strategies for chemoprophylaxis of GBS early-onset infections. | journal=Antibiot Chemother (1971) | year= 1985 | volume= 35 | issue= | pages= 267-80 | pmid=3931544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3931544 }} </ref><ref name="pmid12900477">{{cite journal| author=Adair CE, Kowalsky L, Quon H, Ma D, Stoffman J, McGeer A et al.| title=Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study. | journal=CMAJ | year= 2003 | volume= 169 | issue= 3 | pages= 198-203 | pmid=12900477 | doi= | pmc=PMC167120 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12900477 }} </ref> | |||
* Maternal colonization | |||
* Gestational age <37 completed weeks | |||
* Longer duration of membrane rupture | |||
* Intra-amniotic infection | |||
* Young maternal age | |||
* Black race | |||
* Low maternal levels of GBS-specific anticapsular antibody | |||
* Previous delivery of an infant with invasive GBS disease | |||
* Obstetric procedures | |||
** Internal fetal monitoring devices | |||
** More than five or six digital vaginal examinations after onset of labor | |||
** Rupture of membranes | |||
Maternal intrapartum GBS colonization is the primary risk factor for early-onset disease in infants. A classic prospective cohort study conducted during the 1980s revealed that pregnant women with GBS colonization were >25 times more likely than pregnant women with negative prenatal cultures to deliver infants with early-onset GBS disease.<ref name="pmid3931544">{{cite journal| author=Boyer KM, Gotoff SP| title=Strategies for chemoprophylaxis of GBS early-onset infections. | journal=Antibiot Chemother (1971) | year= 1985 | volume= 35 | issue= | pages= 267-80 | pmid=3931544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3931544 }} </ref> | |||
Heavy colonization, defined as culture of GBS from direct plating rather than from selective broth only, is associated with higher risk for early-onset disease.<ref name="pmid8623869">{{cite journal| author=Regan JA, Klebanoff MA, Nugent RP, Eschenbach DA, Blackwelder WC, Lou Y et al.| title=Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group. | journal=Am J Obstet Gynecol | year= 1996 | volume= 174 | issue= 4 | pages= 1354-60 | pmid=8623869 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8623869 }} </ref><ref name="pmid8559521">{{cite journal| author=Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH| title=Risk factors for neonatal sepsis. | journal=Obstet Gynecol | year= 1996 | volume= 87 | issue= 2 | pages= 188-94 | pmid=8559521 | doi=10.1016/0029-7844(95)00402-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8559521 }} </ref> | |||
GBS identified in clean-catch urine specimens during any trimester is considered a surrogate for heavy maternal colonization and also is associated with a higher risk for early-onset GBS disease.<ref name="pmid388649">{{cite journal| author=Liston TE, Harris RE, Foshee S, Null DM| title=Relationship of neonatal pneumonia to maternal urinary and neonatal isolates of group B streptococci. | journal=South Med J | year= 1979 | volume= 72 | issue= 11 | pages= 1410-2 | pmid=388649 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=388649 }} </ref><ref name="pmid19457879">{{cite journal| author=Heath PT, Balfour GF, Tighe H, Verlander NQ, Lamagni TL, Efstratiou A et al.| title=Group B streptococcal disease in infants: a case control study. | journal=Arch Dis Child | year= 2009 | volume= 94 | issue= 9 | pages= 674-80 | pmid=19457879 | doi=10.1136/adc.2008.148874 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19457879 }} </ref> | |||
In a 1985 report of predictors of early-onset disease, women with gestation <37 weeks, membrane rupture of >12 hours, or intrapartum temperature >99.5ºF (>37.5ºC) had 6.5 times the risk for having an infant with early-onset GBS disease compared with women who had none of these risk factors.<ref name="pmid3931544">{{cite journal| author=Boyer KM, Gotoff SP| title=Strategies for chemoprophylaxis of GBS early-onset infections. | journal=Antibiot Chemother (1971) | year= 1985 | volume= 35 | issue= | pages= 267-80 | pmid=3931544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3931544 }} </ref> Of note, women who had one of these risk factors but who had negative prenatal screening cultures were at relatively low risk for early-onset GBS disease (incidence: 0.9 cases per 1,000 births) compared with women who were colonized prenatally but had none of the risk factors (incidence: 5.1 cases per 1,000 births).<ref name="pmid3931544">{{cite journal| author=Boyer KM, Gotoff SP| title=Strategies for chemoprophylaxis of GBS early-onset infections. | journal=Antibiot Chemother (1971) | year= 1985 | volume= 35 | issue= | pages= 267-80 | pmid=3931544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3931544 }} </ref> | |||
Some observational studies have reported an association between early-onset GBS disease and certain obstetric procedures, such as the use of internal fetal monitoring devices<ref name="pmid12900477">{{cite journal| author=Adair CE, Kowalsky L, Quon H, Ma D, Stoffman J, McGeer A et al.| title=Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study. | journal=CMAJ | year= 2003 | volume= 169 | issue= 3 | pages= 198-203 | pmid=12900477 | doi= | pmc=PMC167120 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12900477 }} </ref><ref name="pmid8345997">{{cite journal| author=Adams WG, Kinney JS, Schuchat A, Collier CL, Papasian CJ, Kilbride HW et al.| title=Outbreak of early onset group B streptococcal sepsis. | journal=Pediatr Infect Dis J | year= 1993 | volume= 12 | issue= 7 | pages= 565-70 | pmid=8345997 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8345997 }} </ref> and more than five or six digital vaginal examinations after onset of labor or rupture of membranes.<ref name="pmid8345997">{{cite journal| author=Adams WG, Kinney JS, Schuchat A, Collier CL, Papasian CJ, Kilbride HW et al.| title=Outbreak of early onset group B streptococcal sepsis. | journal=Pediatr Infect Dis J | year= 1993 | volume= 12 | issue= 7 | pages= 565-70 | pmid=8345997 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8345997 }} </ref> However, lack of randomization in observational studies can result in confounding, because certain procedures might be used more frequently in high-risk settings.<ref name="pmid15516403">{{cite journal| author=Gibbs RS, Schrag S, Schuchat A| title=Perinatal infections due to group B streptococci. | journal=Obstet Gynecol | year= 2004 | volume= 104 | issue= 5 Pt 1 | pages= 1062-76 | pmid=15516403 | doi=10.1097/01.AOG.0000144128.03913.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15516403 }} </ref> Although concern has been raised about performing other obstetric procedures (e.g., membrane stripping and mechanical and/or pharmacologic cervical ripening) on GBS-colonized women, available data are not sufficient to determine whether these procedures are associated with an increased risk for early-onset disease.<ref name="pmid11405964">{{cite journal| author=Boulvain M, Stan C, Irion O| title=Membrane sweeping for induction of labour. | journal=Cochrane Database Syst Rev | year= 2001 | volume= | issue= 2 | pages= CD000451 | pmid=11405964 | doi=10.1002/14651858.CD000451 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11405964 }} </ref><ref name="pmid18674661">{{cite journal| author=Heinemann J, Gillen G, Sanchez-Ramos L, Kaunitz AM| title=Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review. | journal=Am J Obstet Gynecol | year= 2008 | volume= 199 | issue= 2 | pages= 177-87; discussion 187-8 | pmid=18674661 | doi=10.1016/j.ajog.2008.05.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18674661 }} </ref> | |||
==References== | ==References== | ||
Revision as of 19:15, 19 August 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Overview
Maternal intrapartum GBS colonization is the primary risk factor for early-onset disease in infants.
Risk Factors
GBS in Pregnancy
GBS in Neonates
Risk factors for GBS infection in neonates include:[1][2]
- Maternal colonization
- Gestational age <37 completed weeks
- Longer duration of membrane rupture
- Intra-amniotic infection
- Young maternal age
- Black race
- Low maternal levels of GBS-specific anticapsular antibody
- Previous delivery of an infant with invasive GBS disease
- Obstetric procedures
- Internal fetal monitoring devices
- More than five or six digital vaginal examinations after onset of labor
- Rupture of membranes
Maternal intrapartum GBS colonization is the primary risk factor for early-onset disease in infants. A classic prospective cohort study conducted during the 1980s revealed that pregnant women with GBS colonization were >25 times more likely than pregnant women with negative prenatal cultures to deliver infants with early-onset GBS disease.[1]
Heavy colonization, defined as culture of GBS from direct plating rather than from selective broth only, is associated with higher risk for early-onset disease.[3][4]
GBS identified in clean-catch urine specimens during any trimester is considered a surrogate for heavy maternal colonization and also is associated with a higher risk for early-onset GBS disease.[5][6]
In a 1985 report of predictors of early-onset disease, women with gestation <37 weeks, membrane rupture of >12 hours, or intrapartum temperature >99.5ºF (>37.5ºC) had 6.5 times the risk for having an infant with early-onset GBS disease compared with women who had none of these risk factors.[1] Of note, women who had one of these risk factors but who had negative prenatal screening cultures were at relatively low risk for early-onset GBS disease (incidence: 0.9 cases per 1,000 births) compared with women who were colonized prenatally but had none of the risk factors (incidence: 5.1 cases per 1,000 births).[1]
Some observational studies have reported an association between early-onset GBS disease and certain obstetric procedures, such as the use of internal fetal monitoring devices[2][7] and more than five or six digital vaginal examinations after onset of labor or rupture of membranes.[7] However, lack of randomization in observational studies can result in confounding, because certain procedures might be used more frequently in high-risk settings.[8] Although concern has been raised about performing other obstetric procedures (e.g., membrane stripping and mechanical and/or pharmacologic cervical ripening) on GBS-colonized women, available data are not sufficient to determine whether these procedures are associated with an increased risk for early-onset disease.[9][10]
References
- ↑ 1.0 1.1 1.2 1.3 Boyer KM, Gotoff SP (1985). "Strategies for chemoprophylaxis of GBS early-onset infections". Antibiot Chemother (1971). 35: 267–80. PMID 3931544.
- ↑ 2.0 2.1 Adair CE, Kowalsky L, Quon H, Ma D, Stoffman J, McGeer A; et al. (2003). "Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study". CMAJ. 169 (3): 198–203. PMC 167120. PMID 12900477.
- ↑ Regan JA, Klebanoff MA, Nugent RP, Eschenbach DA, Blackwelder WC, Lou Y; et al. (1996). "Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group". Am J Obstet Gynecol. 174 (4): 1354–60. PMID 8623869.
- ↑ Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH (1996). "Risk factors for neonatal sepsis". Obstet Gynecol. 87 (2): 188–94. doi:10.1016/0029-7844(95)00402-5. PMID 8559521.
- ↑ Liston TE, Harris RE, Foshee S, Null DM (1979). "Relationship of neonatal pneumonia to maternal urinary and neonatal isolates of group B streptococci". South Med J. 72 (11): 1410–2. PMID 388649.
- ↑ Heath PT, Balfour GF, Tighe H, Verlander NQ, Lamagni TL, Efstratiou A; et al. (2009). "Group B streptococcal disease in infants: a case control study". Arch Dis Child. 94 (9): 674–80. doi:10.1136/adc.2008.148874. PMID 19457879.
- ↑ 7.0 7.1 Adams WG, Kinney JS, Schuchat A, Collier CL, Papasian CJ, Kilbride HW; et al. (1993). "Outbreak of early onset group B streptococcal sepsis". Pediatr Infect Dis J. 12 (7): 565–70. PMID 8345997.
- ↑ Gibbs RS, Schrag S, Schuchat A (2004). "Perinatal infections due to group B streptococci". Obstet Gynecol. 104 (5 Pt 1): 1062–76. doi:10.1097/01.AOG.0000144128.03913.c2. PMID 15516403.
- ↑ Boulvain M, Stan C, Irion O (2001). "Membrane sweeping for induction of labour". Cochrane Database Syst Rev (2): CD000451. doi:10.1002/14651858.CD000451. PMID 11405964.
- ↑ Heinemann J, Gillen G, Sanchez-Ramos L, Kaunitz AM (2008). "Do mechanical methods of cervical ripening increase infectious morbidity? A systematic review". Am J Obstet Gynecol. 199 (2): 177–87, discussion 187-8. doi:10.1016/j.ajog.2008.05.005. PMID 18674661.