An area-based study on intrapartum antibiotic prophylaxis for preventing group B streptococcus early-onset disease: advances and limitations

Berardi, Alberto; Rossi, Cecilia; Reggiani, Maria Letizia Bacchi; Bastelli, Annalisa; Capretti, Maria Grazia; Chiossi, Claudio; Fiorini, Valentina; Gambini, Lucia; Gavioli, Sara; Lanari, Marcello; Memo, Luigi; Papa, Irene; Pini, Luana; Rizzo, Maria Vittoria; Zucchini, A.; Facchinetti, Fabio; Ferrari, Fabrizio

doi:10.1080/14767058.2016.1224832

Cited by 15 publications

(14 citation statements)

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“…A screening-based strategy (prenatal screening at 35–37 weeks of gestation) and IAP according to the CDC guidelines[1] are in place in Emilia-Romagna, which is a northern region of Italy. [13,14] Since 2003, a network of GBS active and area-based surveillance has included all regional birth facilities. Cases with a positive blood or cerebrospinal fluid (CSF) culture in an infant younger than 3 months of age are notified to the coordinating centre.…”

Section: Methodsmentioning

confidence: 99%

Group B Streptococcus early-onset disease and observation of well-appearing newborns

et al. 2019

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BackgroundInternational guidelines lack a substantial consensus regarding management of asymptomatic full-term and late preterm neonates at risk for early-onset disease (EOS). Large cohorts of newborns are suitable to increase the understanding of the safety and efficacy of a given strategy.MethodsThis is a prospective, area-based, cohort study involving regional birth facilities of Emilia-Romagna (Italy). We compared cases of EOS (at or above 35 weeks’ gestation) registered in 2003–2009 (baseline period: 266,646 LBs) and in 2010–2016, after introduction of a new strategy (serial physical examinations, SPEs) for managing asymptomatic neonates at risk for EOS (intervention period: 265,508 LBs).ResultsThere were 108 cases of EOS (baseline period, n = 60; intervention period, n = 48). Twenty-two (20.4%) remained asymptomatic through the first 72 hours of life, whereas 86 (79.6%) developed symptoms, in most cases (52/86, 60.5%) at birth or within 6 hours. The median age at presentation was significantly earlier in the intrapartum antibiotic prophylaxis (IAP)-exposed than in the IAP-unexposed neonates (0 hours, IQR 0.0000–0.0000 vs 6 hours, IQR 0.0000–15.0000, p<0.001). High number of neonates (n = 531) asymptomatic at birth, exposed to intrapartum fever, should be treated empirically for each newborn who subsequently develops sepsis. IAP exposed neonates increased (12% vs 33%, p = 0.01), age at presentation decreased (median 6 vs 1 hours, p = 0.01), whereas meningitis, mechanical ventilation and mortality did not change in baseline vs intervention period. After implementing the SPEs, no cases had adverse outcomes due to the strategy, and no cases developed severe disease after 6 hours of life.ConclusionsInfants with EOS exposed to IAP developed symptoms at birth in almost all cases, and those who appeared well at birth had a very low chance of having EOS. The risk of EOS in neonates (asymptomatic at birth) exposed to intrapartum fever was low. Although definite conclusions on causation are lacking, our data support SPEs of asymptomatic newborns at risk for EOS. SPEs seems a safe and effective alternative to laboratory screening and empirical antibiotic therapy.

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Section: Methodsmentioning

confidence: 99%

Group B Streptococcus early-onset disease and observation of well-appearing newborns

et al. 2019

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“…Area-based information has been recently reported from two Italian regions [ 9 – 11 ], but no nationwide data on GBS prevention practices has been previously published. Although partial and not area-based, the information obtained through the current study is a preliminary step for planning future interventions.…”

Section: Discussionmentioning

confidence: 99%

Strategies for preventing group B streptococcal infections in newborns: a nation-wide survey of Italian policies

et al. 2017

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BackgroundThere are no Italian data regarding the strategies for preventing neonatal group B streptococcal (GBS) infection. We conducted a national survey in order to explore obstetrical, neonatal and microbiological practices for the GBS prevention.MethodsThree distinct questionnaires were sent to obstetricians, neonatologists and microbiologists. Questionnaires included data on prenatal GBS screening, maternal risk factors, intrapartum antibiotic prophylaxis, microbiological information concerning specimen processing and GBS antimicrobial susceptibility.ResultsAll respondent obstetrical units used the culture-based screening approach to identify women who should receive intrapartum antibiotic prophylaxis, and more than half of the microbiological laboratories (58%) reported using specimen processing consistent with CDC guidelines. Most neonatal units (89 out of 107, 82%) reported using protocols for preventing GBS early-onset sepsis consistent with CDC guidelines.ConclusionsThe screening-based strategy is largely prevalent in Italy, and most protocols for preventing GBS early-onset sepsis are consistent with CDC guidelines. However, we found discrepancies in practices among centers that may reflect the lack of Italian guidelines issued by public health organizations.Electronic supplementary materialThe online version of this article (10.1186/s13052-017-0409-1) contains supplementary material, which is available to authorized users.

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“…Furthermore there is no national laboratory-based surveillance system to tracking serotypes, incidence rates of GBS-EOS, and the impact of perinatal prevention interventions. Nevertheless, area-based data have been obtained prospectively in two northern Italian regions (Emilia-Romagna and Friuli-Venzia Giulia) [ 5 – 10 ]. In Emilia-Romagna, a detailed information has been obtained during a 9 years GBS surveillance period [ 6 – 10 ].…”

Section: Main Textmentioning

confidence: 99%

“…Nevertheless, area-based data have been obtained prospectively in two northern Italian regions (Emilia-Romagna and Friuli-Venzia Giulia) [ 5 – 10 ]. In Emilia-Romagna, a detailed information has been obtained during a 9 years GBS surveillance period [ 6 – 10 ]. In both regions the prevention of EOS relies upon local protocols, mostly consistent with vagino-rectal screening and IAP according to the CDC guidelines (Table 1 ).…”

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Secondary prevention of early-onset sepsis: a less invasive Italian approach for managing neonates at risk

et al. 2018

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Strategies to prevent early-onset sepsis (EOS) have led to a substantial decline in many countries. However, one of the most controversial topics in neonatology is the management of asymptomatic full-term and late preterm neonates at risk for EOS, and guidelines lack substantial consensus regarding this issue. A strategy for managing neonates, entirely based on serial physical examinations, has been developed in two Italian regions. This strategy seems safe, while reducing laboratory tests and unnecessary antibiotics. In the current commentary we provide area-based data concerning the prevention of EOS in 2 northern Italian regions, and we detail the results of their strategy for managing healthy-appearing newborns at risk for EOS.

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An area-based study on intrapartum antibiotic prophylaxis for preventing group B streptococcus early-onset disease: advances and limitations

Abstract: Large-scale prenatal screening and IAP are feasible. Women delivering preterm are less likely to receive IAP when indicated. Most unnecessary antibiotics are given in cases of PROM.

Cited by 15 publications

References 15 publications

Group B Streptococcus early-onset disease and observation of well-appearing newborns

Group B Streptococcus early-onset disease and observation of well-appearing newborns

Strategies for preventing group B streptococcal infections in newborns: a nation-wide survey of Italian policies

Secondary prevention of early-onset sepsis: a less invasive Italian approach for managing neonates at risk

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