Early Onset Group B Streptococcus (EOGBS) infection subsequent to cessation of screening-based intrapartum prophylaxis: Findings of an observational study in West London, United Kingdom.
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Author(s)
Type
Journal Article
Abstract
Objectives To describe the impact on early-onset
group B Streptococcus (EOGBS) infection rates following
reversion from screening-based to risk-based intrapartum
antimicrobial prophylaxis (IAP) for prevention.
Setting Maternity services provided by secondary
healthcare organisation in North West London.
Participants All women who gave birth in the healthcare
organisation between April 2016 and March 2017. There
were no exclusions.
Design Observational study comparing EOGBS rates in
the postscreening period (2016–2017) with prescreening
(2009–2013) and screening periods (2014–2015).
Methods Local guidelines for risk-based IAP were
reintroduced in April 2016. Compliance with guidelines
was audited. Gestational age, mode of delivery, maternal
demographics and EOGBS rates in three time periods
were compared using Poisson regression analysis. EOGBS
was defined through GBS being cultured from blood,
cerebrospinal fluid or other sterile fluids within 6 days of
birth.
Primary outcome EOGBS rates/1000 live births in
prescreening, screening and postscreening periods
Results Incremental changes in maternity population
were observed throughout the study period (2009
onwards), in particular the ethnic profile of mothers. Of
the 5033 live births in postscreening period, 9 babies
developed EOGBS infection. Only one of the mothers of
affected babies had a risk factor indicating use of IAP.
Comparison of postscreening period with screening
period showed a fivefold increase in EOGBS rates after
adjustment for ethnicity (1.79 vs 0.33/1000 live births;
risk ratio =5.67, p=0.009). There was no significant
difference between prescreening and postscreening
periods with rates of infection reverting to their
prescreening level.
Conclusions This study provides further evidence of
efficacy of screening-based IAP compared with risk-based
IAP in prevention of EOGBS in newborns in an area of high
incidence.
group B Streptococcus (EOGBS) infection rates following
reversion from screening-based to risk-based intrapartum
antimicrobial prophylaxis (IAP) for prevention.
Setting Maternity services provided by secondary
healthcare organisation in North West London.
Participants All women who gave birth in the healthcare
organisation between April 2016 and March 2017. There
were no exclusions.
Design Observational study comparing EOGBS rates in
the postscreening period (2016–2017) with prescreening
(2009–2013) and screening periods (2014–2015).
Methods Local guidelines for risk-based IAP were
reintroduced in April 2016. Compliance with guidelines
was audited. Gestational age, mode of delivery, maternal
demographics and EOGBS rates in three time periods
were compared using Poisson regression analysis. EOGBS
was defined through GBS being cultured from blood,
cerebrospinal fluid or other sterile fluids within 6 days of
birth.
Primary outcome EOGBS rates/1000 live births in
prescreening, screening and postscreening periods
Results Incremental changes in maternity population
were observed throughout the study period (2009
onwards), in particular the ethnic profile of mothers. Of
the 5033 live births in postscreening period, 9 babies
developed EOGBS infection. Only one of the mothers of
affected babies had a risk factor indicating use of IAP.
Comparison of postscreening period with screening
period showed a fivefold increase in EOGBS rates after
adjustment for ethnicity (1.79 vs 0.33/1000 live births;
risk ratio =5.67, p=0.009). There was no significant
difference between prescreening and postscreening
periods with rates of infection reverting to their
prescreening level.
Conclusions This study provides further evidence of
efficacy of screening-based IAP compared with risk-based
IAP in prevention of EOGBS in newborns in an area of high
incidence.
Date Issued
2017-11-01
Date Acceptance
2017-10-02
Citation
BMJ Open, 2017, 7
ISSN
2044-6055
Publisher
BMJ Journals
Journal / Book Title
BMJ Open
Volume
7
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Publication Status
Published
Article Number
e018795