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Andrew B. Kairalla MD, Editor
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Screening for Group B Strep
Perinatal Screening for Group B Streptococci: Cost-Benefit Analysis of Rapid Polymerase Chain Reaction.
Haberland CA, Benitz WE, Sanders GD, et al. Pediatrics (Sept 2002); 110: 471-480.Objective. To evaluate the costs and benefits of a group B streptococci screening strategy using a new, rapid polymerase chain reaction test.
Interventions. Screening strategies for group B streptococci using the new polymerase chain reaction technique, the 35- to 37-week culture, or maternal risk factors.
Outcome Measures. Infant infections averted, infant deaths, infant disabilities, costs, and societal benefits of healthy infants.
Results. A screening strategy using the new polymerase chain reaction test generates a net benefit of $7 per birth when compared with the maternal risk-factor strategy, and $6 per birth when compared with the 35- to 37-week prenatal culture strategy. It results in fewer maternal courses of antibiotics, fewer perinatal infections with early-onset group B streptococci, and a reduction in infant deaths and severe infant disability. The benefits hold over a wide range of assumptions regarding key factors in the analysis.
Conclusions. Although additional clinical trials are needed to establish the accuracy of this new polymerase chain reaction test, initial studies suggest that strategies using this test will be superior to the other 2 strategies. Using the rapid polymerase chain reaction test becomes less attractive as the cost of the test increases. The test’s greatest strengths lie in its ability to identify women and infants at risk at the time of labor, thereby decreasing the number of false-positives and false-negatives seen with the other 2 strategies and allowing for more accurate and effective intrapartum prophylaxis.
Comment: The new rapid PCR test for Group B Strep looks too good to be true. It has a reported sensitivity of 100% and specificity of 98.9% compared with rectovaginal culture. The test takes 30-45 minutes to run, and it would need to be available 24 hours a day to be useful. If these results hold up in further studies, this could replace both current strategies for prevention of GBS infection. ABK.
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