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Abstract
Group B streptococcus (GBS) is the leading cause of neonatal sepsis and meningitis in developed countries. This article reviews the neonatal invasive GBS disease, maternal GBS colonization, and prevention strategies in the context of recent epidemiological changes in Korea. Although Korean neonates had been supposed to have low incidence of invasive GBS disease, GBS has been recently reported to be the most common cause of invasive neonatal infection after 1990s. Among Korean pregnant women, GBS carriage rate in the vagina and rectum has been reported to be much lower than that in Western countries. However, it has increased in recent studies. For decision making about preventive strategy for neonatal GBS disease in Korea, further studies are required in terms of the incidence of neonatal GBS infection and serotype distribution. In addition, studies about maternal carriage rate and serotype distribution have to be continued.
Figures and Tables
Fig. 1
Incidence of early- and late-onset invasive group B streptococcal (GBS) disease - Active Bacterial Core surveillance areas, 1990-2008, and activities for prevention of GBS disease in United States.
Abbreviations: ACOG, American College of Obstetricians and Gynecologists; AAP, American Academy of Pediatrics.
Source: Adopted from reference42).
Fig. 2
Recommended regimens for intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal (GBS) disease*.
Abbreviation: IV, intravenously.
*Broader spectrum agents, including an agent active against GBS, might be necessary for treatment of chorioamnionitis.
†Doses ranging from 2.5 to 3.0 million units are acceptable for the doses administered every 4 hours following the initial dose. The choice of dose within that range should be guided by which formulations of penicillin G are readily available to reduce the need for pharmacies to specially prepare doses.
§Penicillin-allergic patients with a history of anaphylaxis, angioedema, respiratory distress, or urticaria following administration of penicillin or a cephalosporin are considered to be at high risk for anaphylaxis and should not receive penicillin, ampicillin, or cefazolin for GBS intrapartum prophylaxis. For penicillin-allergic patients who do not have a history of those reactions, cefazolin is the preferred agent because pharmacologic data suggest it achieves effective intraamniotic concentrations. Vancomycin and clindamycin should be reserved for penicillin-allergic women at high risk for anaphylaxis.
¶If laboratory facilities are adequate, clindamycin and erythromycin susceptibility testing should be performed on prenatal GBS isolates from penicillin-allergic women at high risk for anaphylaxis. If no susceptibility testing is performed, or the results are not available at the time of labor, vancomycin is the preferred agent for GBS intrapartum prophylaxis for penicillin-allergic women at high risk for anaphylaxis.
**Resistance to erythromycin is often but not always associated with clindamycin resistance. If an isolate is resistant to erythromycin, it might have inducible resistance to clindamycin, even if it appears susceptible to clindamycin. If a GBS isolate is susceptible to clindamycin, resistant to erythromycin, and testing for inducible clindamycin resistance has been performed and is negative (no inducible resistance), then clindamycin can be used for GBS intrapartum prophylaxis instead of vancomycin.
Source: Adopted from reference42).
Table 3
Indications and Nonindications for Intrapartum Antibiotic Prophylaxis to Prevent Early-Onset Group B Streptococcal (GBS) Disease
Adopted from reference42)
Abbreviation: NAAT, Nucleic acid amplification tests
*Intrapartum antibiotic prophylaxis is not indicated in this circumstance if a cerarean delivery is performed before onset of labor on a woman with intact amniotic membranes.
†Optimal timing for prenatal GBS screening is at 35-37 weeks' gestation.
‡If amnionitis is suspected, broad-spectrum antibiotic therapy that includes an agent known to be active against GBS should replace GBS prophylaxis.
∫NAAT testing for GBS is optional and might not be avilable in all settings. If intrapartum NAAT is negative for GBS but any other intrapartum risk factor (delivery at <37 weeks' gestation, amniotic membrane rupture at ≥18 hours, or temperature ≥100.4°F [≥38.0℃]) is present, then intrapartum antibiotic prophylaxis is indicated.
Table 4
Treatment of Group B Streptococcal Infections in Infants
Adopted from reference58)
*Assumes that lumbar puncture has been performed and the cerebrospinal fluid has no abnormalities.
†Should be extended to 21 days or longer if ventriculitis, cerebritis, subdural empyema, or other suppurative complications occur.
‡In combination with low-dose gentamicin for the first 14 days.
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