New perinatal GBS infection guidelines update prevention, treatment

The American College of Obstetricians and Gynecologists (ACOG) has issued revised guidelines for preventing and treating perinatal group B streptococcal (GBS) disease. Committee Opinion No. 485, published in Obstetrics & Gynecology (2011;117[4]:119-127), summarizes the ACOG-endorsed 2010 guidelines from the United States Centers for Disease Control and Prevention and highlights changes in clinical practice for obstetricians and gynecologists.

Universal screening for GBS at 35 to 37 weeks’ gestation and intrapartum antibiotic prophylaxis remain the basic preventive strategy. Changes in clinical practice outlined in the new guidelines include expanded recommendations for laboratory identification of GBS; updated algorithms for screening and antibiotic treatment of women with preterm labor or preterm premature rupture of membranes; updated antibiotic regimens for women with penicillin allergy; and revised algorithms for managing newborns at risk for early onset GBS infection. Erythromycin is no longer recommended for intrapartum prophylaxis because of increasing resistance of the bacterium to it.

“National guidelines to prevent mother-to-infant GBS transmission have led to an 80% reduction in early onset sepsis in neonates,” says Ronald S Gibbs, MD, a member of ACOG’s Committee on Obstetric Practice. “Unfortunately, despite these strides, GBS remains the leading cause of infectious mortality and morbidity among newborns.”

“While the core recommendations are the same, the new document provides further direction for clinicians in implementing and improving prevention strategies,” Dr Gibbs adds. The report notes that “even complete implementation of this complex strategy will not eliminate all cases of early onset group B streptococcal disease.”

An estimated 10% to 30% of pregnant women are infected with GBS-which is fatal in about 5% of infants who carry it-and as many as 2% transmit it to their newborns during delivery. Babies born to African American and Hispanic women and women younger than 20 years of age are at increased risk.