Routine culture-based screening versus risk-based management for the prevention of early-onset group B streptococcus disease in the neonate: a systematic review

Abstract

The results of this review come from nine studies published in peer reviewed journals. The treatment group consists of those screened as per the culture-based protocol, the control group the risk-based protocol. For combined term and preterm infants the odds of early-onset group B streptococcus disease for the treatment vs control groups is 0.45 (95% CI 0.37 to 0.53). The odds ratio in term infants is 0.45 (95% CI 0.36 to 0.57). Preterm infants are four times (OR 4.20 [95% CI 3.36 to 5.24]) more likely to develop early-onset group B streptococcus disease than term infants regardless of prevention technique. One study provides information on neonatal mortality in which there is one neonatal death in the risk-based cohort and none in the culture-based. The TRUNCATED AT 500 WORDS.

Universal antenatal screening for group B streptococcus may cause more harm than good

“…A systematic review of nine observational studies from Turkey, Australia, and the US found that the odds of early onset GBS infection under universal screening were 55% lower than under risk based prevention for all neonates and for term neonates (three studies) 80. A 2017 study in a UK maternity unit found that the rate of early onset GBS infection fell from 0.99 per 1000 live births in the risk based period to 0.33 per 1000 in the screening period, although this was not statistically significant, and screening was instigated based on high incidence so there may have been regression to the mean 81.…”

“…Risk of bias is higher in these studies because participants in the two arms are not contemporaneous, so other differences between these periods may contribute. The few observational studies that compare screening with concurrent controls often retrospectively compare women who have a culture result to all other women8990; this may be biased due to the risk of misclassification and because people who accept screening are systematically different from those who do not 8091. Finally, as most studies only assess early onset GBS infection confirmed on culture, changes in disease incidence may actually reflect a decreased likelihood of culturing GBS in the laboratory, owing to the presence of antibiotics in neonates’ blood 92.…”

Sanitization of Early Life and Microbial Dysbiosis

“…In another study, differing succession of bacterial community was observed between IAP exposed and control full-term infants [35]. In fact, women who are to receive IAP are indicated to have at-risk pregnancies and more likely to undergo a series of interventions such as increased hospitalization [36].…”

Protocol for a Diagnostic Accuracy Study of Polymerase Chain Reaction for Detecting Group B <i>Streptococcus</i> Colonisation in Early Labour or with Spontaneous Ruptured Membranes

“…The main concern with risk-factor screening is timely identification of the risk so that antibiotics can be administered [12]. The incidence of EOGBSD in settings that use this method of screening is 0.5/1000 live births [13].…”