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Effects of GBS Prophylaxis
Early-Onset Neonatal Sepsis in the Era of Group B Streptococcal Prevention. Baltimore RS, Huie SM, Meek JI, et al. Pediatrics 2001 (Nov); 108:1094-8.
This study was done to determine whether intrapartum antibiotic prophylaxis (IAP) for neonatal group B streptococcal (GBS) disease has resulted in an increase incidence of non-GBS or antibiotic-resistant early onset invasive neonatal disease. Maternal and infant chart review was done on all infants with bacteria other than GBS isolated from blood or spinal fluid in 1996 through 1999 in 19 hospitals in Connecticut (representing 81% of in-state births to state residents).
Results. 94 cases of early-onset non-GBS sepsis or meningitis were detected. The rate of GBS-related early-onset infection dropped from 0.61/1000 to 0.23/1000, but the annual rate of non-GBS sepsis remained steady, ranging from 0.65 – 0.68 per 1000 during the surveillance period. There was an increase in the proportion of ampicillin-resistant E. coli infections between 1996 – 1998, but the proportion decreased in 1999.
Comment. This study demonstrated that IAP for GBS was very successful at lowering the incidence of early-onset GBS in the study population. This was achieved without causing a shift to a higher incidence of sepsis with non-GBS organisms. The question of whether IAP for GBS leads to an increased incidence of ampicillin-resistant E. coli remains unanswered. This pathogen can be far more virulent than GBS, especially for premature babies. Please refer to a study by Schuchat et al (Pediatrics 2000;105:21-26, reviewed in NeoNotes, Vol. 1, Issue 1, 2000) for further discussion of the emergence of ampicillin-resistant E. coli since the onset of IAP for GBS.
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