Reduced incidence of neonatal early‐onset group B streptococcal infection after promulgation of guidelines for risk‐based intrapartum antibiotic prophylaxis in Sweden: analysis of a national population‐based cohort

Håkansson, Stellan; Lilja, Maria; Jacobsson, Bo; Källén, Karin

doi:10.1111/aogs.13211

Cited by 18 publications

(25 citation statements)

References 21 publications

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“…Up to 40% of the cases of EOGBS invasive infection did not have maternal risk factors associated with them, and could therefore not be prevented under risk‐based policies. Håkansson et al further refuted the assumption that GBS‐infected infants born to mothers without risk factors had a better prognosis, as three of 11 deaths reported in their study occurred in such circumstances.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 17 observational studies could be included in the systematic review. Data for the meta-analysis could be extracted from 14 studies 12,[34][35][36][37][38][39][40][41][42][43][44][45][46] . Additional data for the meta-analysis were kindly provided by the authors of one study.…”

Section: Study Selectionmentioning

confidence: 99%

“…35,43,45 In analysis 2 (any policy versus no policy) the introduction of universal screening 26,35,38,43,45 was investigated in five studies and the introduction of risk-based protocols in seven. 12,13,[35][36][37]43,45 (Tables 1 and 2).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Bias post-intervention was low or moderate in most studies. All studies with historical controls, 12,13,26,27,[34][35][36][37][38][39]42,43,45 except one using a cross-over design, 42 suffered from bias due to healthcare improvement over time: 'performance bias'. All studies had possible problems due to missing data, resulting from underreported cases.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…12,13 Missed opportunities for EOGBS prevention exist in both protocols and lead to preventable infant morbidity, while overtreatment, undesirable in the light of rising antibiotic resistance and potential effects on the microbiome, occurs, too. [14][15][16][17] Although technical developments such as vaccines or polymerase chain reaction quick tests are promising for EOGBS prevention, they have not been widely implemented. [18][19][20] Improving efficacy of IAP through either of the targeting protocols will help reduce the incidence of EOGBS disease, and may reduce overtreatment.…”

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confidence: 99%

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Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Hasperhoven

Al‐Nasiry

Bekker

et al. 2020

BJOG

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Background Early‐onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening‐based protocol), whereas others employ risk‐based protocols. Objectives To compare the effectiveness of screening‐based versus risk‐based protocols in preventing EOGBS disease. Search strategy Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture‐based, risk‐based. Selection criteria Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk‐based protocols with each other or with controls. Data collection and analysis Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel‐Haenszel analyses with random effects. Main results Seventeen eligible studies were included. In this meta‐analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk‐based protocols (ten studies, RR 0.43, 95% CI 0.32–0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11–0.84). Meta‐analysis could not demonstrate a significant effect of risk‐based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61–1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%). Conclusions Screening‐based protocols were associated with lower incidences of EOGBS disease compared with risk‐based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking. Tweetable abstract Meta‐analysis: general screening is associated with lower rates of early‐onset group B strep. neonatal sepsis compared with risk‐based protocols.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

mentioning

confidence: 99%

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Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Hasperhoven

Al‐Nasiry

Bekker

et al. 2020

BJOG

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Antibiotic Use in Late Preterm and Full-Term Newborns

Gyllensvärd,

Studahl,

Gustavsson

et al. 2024

JAMA Netw Open

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ImportanceAntibiotic treatment saves lives in newborns with early-onset sepsis (EOS), but unwarranted antibiotic use is associated with resistant bacteria and adverse outcomes later in life. Surveillance is needed to optimize treatment strategies.ObjectiveTo describe antibiotic use in association with the incidence and mortality from EOS among late-preterm and full-term newborns.Design, Setting, and ParticipantsThe Sweden Neonatal Antibiotic Use study was a nationwide observational study that included all late-preterm and full-term neonates born from January 1, 2012, to December 31, 2020, in neonatal units of all levels. All hospital live births from 34 weeks’ gestation during the study period were included in the study. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. Data were analyzed from August 2022 to May 2023.ExposureAdmission for neonatal intensive care during the first week of life.Main Outcomes and MeasuresThe main outcomes were the usage of intravenous antibiotics during the first week of life, the duration of antibiotic therapy, the rate of culture-proven EOS, and mortality associated with EOS.ResultsA total of 1 025 515 newborns were included in the study; 19 286 neonates (1.88%; 7686 girls [39.9%]; median [IQR] gestational age, 40 [38-41] weeks; median [IQR] birth weight, 3610 [3140-4030] g) received antibiotics during the first week of life, of whom 647 (3.4%) had EOS. The median (IQR) duration of antibiotic treatment in newborns without EOS was 5 (3-7) days, and there were 113 antibiotic-days per 1000 live births. During the study period there was no significant change in the exposure to neonatal antibiotics or antibiotic-days per 1000 live births. The incidence of EOS was 0.63 per 1000 live births, with a significant decrease from 0.74 in 2012 to 0.34 in 2020. Mortality associated with EOS was 1.39% (9 of 647 newborns) and did not change significantly over time. For each newborn with EOS, antibiotic treatment was initiated in 29 newborns and 173 antibiotic-days were dispensed.Conclusions and RelevanceThis large nationwide study found that a relatively low exposure to antibiotics is not associated with an increased risk of EOS or associated mortality. Still, future efforts to reduce unwarranted neonatal antibiotic use are needed.

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A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

Oldendorff,

Nordberg,

Giske

et al. 2024

Eur J Clin Microbiol Infect Dis

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Purpose To assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016. Methods A population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency. Results We identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates. Conclusion GPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.

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Reduced incidence of neonatal early‐onset group B streptococcal infection after promulgation of guidelines for risk‐based intrapartum antibiotic prophylaxis in Sweden: analysis of a national population‐based cohort

Cited by 18 publications

References 21 publications

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Universal screening versus risk‐based protocols for antibiotic prophylaxis during childbirth to prevent early‐onset group B streptococcal disease: a systematic review and meta‐analysis

Antibiotic Use in Late Preterm and Full-Term Newborns

A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives

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