Screening-based and Risk-based Strategy for the Prevention of Early-onset Group B Streptococcus/Non-group B Streptococcus Sepsis in the Neonate: A Systematic Review and Meta-analysis

Abstract

Background: Screening-based and risk-based strategies are the 2 strategies for preventing group B streptococcus (GBS) diseases in neonates. We aimed to compare the effects of these 2 strategies in reducing the incidence of early-onset GBS sepsis (GBS-EOS) and their effects on the incidence of non-GBS sepsis. Methods: PubMed, Embase, Web of Science and The Cochrane Central Register of Controlled Trials were searched for the period from January 1, 1996, to December 31, 2018. Randomized controlled trials and cohort studies that compared the effects of risk-based and screening-based strategies were eligible for the meta-analysis. The I 2 statistic was used for assessing the statistical heterogeneity across studies. Pooled relative risks (RRs) and corresponding 95% confidence intervals (CIs) were calculated using the random effects model. Results: There were 18 cohort studies comparing the incidence of GBS-EOS between the 2 strategies, involving a total of 604,869 newborns and 791 GBS-EOS cases. The heterogeneity across studies was moderate (I 2 = 45%), and the pooled analysis yielded a 55% decreased risk of GBS-EOS for screening-based versus risk-based strategy (RR = 0.45; 95% CI: 0.34–0.59). For total early onset non-GBS sepsis (non-GBS-EOS), 7 studies with low heterogeneity (I 2 = 18%) had a pooled RR of 0.91 (95% CI: 0.74–1.11), whereas for ampicillin resistant Escherichia coli-EOS, a subgroup of non-GBS-EOS, 3 studies with very low heterogeneity (I 2 = 0%) had a pooled RR of 1.28 (95% CI: 0.74–2.21) for screening-based strategy compared with risk-based strategy. Conclusions: Compared with risk-based strategy, screening-based prophylaxis was associated with a reduced risk of GBS-EOS.

Complicated Streptococcus agalactiae Sepsis with/without Meningitis in Young Infants and Newborns: The Clinical and Molecular Characteristics and Outcomes

“…The overall mortality rate in our cohort was compatible with recent studies [ 3 , 4 , 5 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ] and a reduction in mortality between 2012 and 2020 was observed in our cohort. As reported in recent studies, multiple factors may account for the reduced mortality rate, including widespread implementation of antibiotics in at-risk mothers and babies and advances in managing acutely ill neonates [ 33 , 34 ]. Based on our data, neonatal GBS EOD had a significantly higher rate of complicated sepsis and a higher rate of final mortality than GBS LOD.…”

Practice Summary of Antimicrobial Therapy for Commonly Encountered Conditions in the Neonatal Intensive Care Unit: A Canadian Perspective

“…Prevention IAP for at-risk women has become the standard of care in many countries over the past two decades and is an effective way to prevent EOS (102)(103)(104). A meta-analysis revealed that compared with a risk-based strategy, screening-based prophylaxis was associated with a reduced risk of GBS-EOS (105). The Society of Obstetricians and Gynecologists of Canada (SOGC), in 2018, reaffirmed the recommendation of offering all women screening for colonization with GBS at 35-37 weeks of gestation, by performing culture tests with one swab from the vagina and one from the rectum (106).…”

Should all pregnant women be offered testing for group B streptococcus?

“…Similar numbers of women received antibiotics with either approach. Table 2 lists findings from these reviews 171819. No difference was seen in early onset GBS infection rates between risk factor directed protocols for giving IAP compared with no consistent IAP protocol 17.…”

“…This yielded 60 results, including three systematic reviews of screening for GBS from 2019 to 2020131420 and one diagnostic test accuracy review of molecular testing methods, which was included in this article 12. The 2016 review of the National Screening Committee criteria and outputs from the British Perinatal Surveillance Unit provided further information 1218…”