Objective To assess whether the determination of the presence of group B streptococci (GBS) in the vagina using a rapid polymerase chain reaction (PCR) assay at delivery was able to spare useless antimicrobial treatments, as compared with conventional culture at 34-38 weeks of gestation.Design Practical evaluation and prospective cost-effectiveness analysis.Setting A university hospital in France.Population A cohort of 225 women in labour at the UniversityHospital of Saint-Etienne.Methods Each woman had a conventional culture performed at 34-38 weeks of gestation. At the beginning of labour, two vaginal swabs were sampled for rapid PCR testing and culture. The decision to prescribe a prophylactic antimicrobial treatment or not was taken according to the result of the PCR test. A comparative cost-effectiveness analysis of the two diagnostic strategies was carried out.Main outcome measures Number of women receiving inadequate prophylactic antimicrobial drugs following each testing strategy, costs of PCR testing and culture, frequency of vaginal GBS, and diagnostic performance of the PCR test at delivery. ResultsThe percentage of unnecessarily treated women was significantly reduced using the rapid test versus conventional culture (4.5 and 13.6%, respectively; P < 0.001). The rate of vaginal GBS at delivery was 12.5%. The incremental costeffectiveness ratio (ICER) for each inadequate management avoided was €36 and €173 from the point of view of the healthcare system and hospital, respectively.Conclusions The PCR assay reduced the number of inadequate antimicrobial treatments aimed to prevent the early onset of GBS disease. However, this strategy generates extra costs that must be put into balance with its clinical benefits.

The pregnant woman's admission and delivery; 3 The notification of the polymerase chain reaction (PCR) result and the administration of antibiotics. These details, plus any others that would help to establish the obstacles that there were to PCR testing, and using the results to inform the timely administration of intrapartum antibiotic prophylaxis against early-onset group B streptococcus infection, would be very interesting. & Reference 1 Poncelet-Jasserand E, Forges F, Varlet M, Chauleur C, Seffert P, Siani C, et al. Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real-time PCR assay.