Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline.
ABSTRACT Group B streptococcus is the leading cause of early-onset neonatal sepsis in the United States. Universal screening is recommended for pregnant women at 35 to 37 weeks' gestation. The Centers for Disease Control and Prevention recently updated its guideline for the prevention of early-onset neonatal group B streptococcal disease. The new guideline contains six important changes. First, there is a recommendation to consider using sensitive nucleic acid amplification tests, rather than just routine cultures, for detection of group B streptococcus in rectal and vaginal specimens. Second, the colony count required to consider a urine specimen positive is at least 104 colony-forming units per mL. Third, the new guideline presents separate algorithms for management of preterm labor and preterm premature rupture of membranes, rather than a single algorithm for both conditions. Fourth, there are minor changes in the recommended dose of penicillin G for intrapartum chemoprophylaxis. Fifth, the guideline provides new recommendations about antibiotic regimens for women with penicillin allergy. Cefazolin is recommended for women with minor allergies. For those at serious risk of anaphylaxis, clindamycin is recommended if the organism is susceptible or if susceptibility is unknown, and vancomycin is recommended if there is clindamycin resistance. Finally, the new algorithm for secondary prevention of early-onset group B streptococcal disease in newborns should be applied to all infants, not only those at high risk of infection. The algorithm clarifies the extent of evaluation and duration of observation required for infants in different risk categories.
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ABSTRACT: this study aimed to investigate the incidence of premature rupture of fetal membranes in preterm singleton pregnancies and its association with sociodemographic factors and maternal self-reported genitourinary infections. this was a population-based cross-sectional study, which included all mothers of newborns of singleton deliveries that occurred in 2010, with birth weight ≥ 500 rams, who resided in the city of Rio Grande. Women were interviewed in the two maternity hospitals. Cases were women who had lost amniotic fluid before hospitalization and whose gestational age was less than 37 weeks. Statistical analysis was performed by levels to control for confounding factors using Poisson regression. of the 2,244 women eligible for the study, 3.1% had preterm premature rupture of fetal membranes, which was more frequent, after adjustment, in women of lower socioeconomic status, (prevalence ratio [PR]=1.94), with lower level of schooling (PR=2.43), age > 29 years (PR=2.49), and smokers (PR=2.04). It was also associated with threatened miscarriage (PR=1.68) and preterm labor, (PR=3.40). There was no association with maternal urinary tract infection or presence of genital discharge. the outcome was more common in puerperal women with lower level of schooling, lower socioeconomic status, older, and smokers, as well as those with a history of threatened miscarriage and premature labor. These factors should be considered in the prevention, diagnosis, and therapy approach.Jornal de pediatria 10/2013; 90(2). DOI:10.1016/j.jped.2013.08.003 · 0.94 Impact Factor
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ABSTRACT: Neonatal Streptococcus agalactiae infections cause significant morbidity and mortality and antenatal screening is recommended. We compared three FDA-cleared nucleic acid amplification tests (NAAT) to culture using 314 vaginal/rectal swabs after 18-24 hour (recommended) and 4-8 hour (shortened) broth enrichment. Agreement of NAATs to each other was high (97.1-98.4%) but culture was less sensitive than all NAATs (67-73%). Shortened broth enrichment resulted in 1/68 (1.5%) false-negative result. NAATs performed comparably and were more sensitive than culture.Journal of Clinical Microbiology 07/2014; 52(9). DOI:10.1128/JCM.01081-14 · 4.23 Impact Factor
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ABSTRACT: The streptococci are important bacteria which cause serious childhood infections. We investigated cardiopulmonary morbidity associated with streptococcal infection and pediatric intensive care unit (PICU) admission. A retrospective study between 2002 and 2013 of all children with a laboratory isolation of Streptococcus. There were 40 (2.3%) PICU patients with streptococcal isolations including Streptococcus pyogenes (Group A streptococcus, GAS, n=7), Streptococcus agalactiae (Group B streptococcus, GBS, n=5), Streptococcus pneumoniae (SP, n=20), alpha-hemolytic (n=4), beta-hemolytic (n=2) and gama-hemolytic (n=2) streptococci. Comparing among GAS, GBS and SP, respiratory isolates were more likely positive for GAS or SP (p=0.023), whereas cerebrospinal fluid was more likely positive for GBS (p=0.002). All GAS and GBS and the majority of SP (90%) were sensitive to penicillin. All SP specimens were sensitive to cefotaxime and vancomycin. These infections were associated with high PICU mortality of 43%, 20%, 25%, respectively. Isolation of streptococci was associated with a 30% mortality, and high rates of need for mechanical ventilatory and inotropic supports. Patients with GAS, SP or any streptococcal isolation had odds of PICU deaths of 12.3 (p=0.0011), 5.96 (p=0.0008) and 12.0 (p<0.0001), respectively. In SP, older children had significantly higher prevalence of premorbid conditions such as malignancy, mental retardation/cerebral palsy (MRCP)+/-seizure disorders, chromosomal or genetic disorders (p=0.003) than children < 5 years of age. Serotypes were available for some of these specimens which included 19A, 19F, 6B, 3 and 6C. There were 4 SP deaths with multi-organ system failure and hemolytic uremic syndrome (two 19A, and two serotype 3). Severe streptococcal infections are associated with significant morbidity and mortality despite treatment with systemic antibiotics and ICU support. GAS and SP affect the lungs of children whereas GBS more likely causes meningitis in infants. The expanded coverage of newer polyvalent pneumococcal vaccines can probably prevent infections by serotypes 19A, 19F, 6B and 3.The Clinical Respiratory Journal 01/2014; 9(1). DOI:10.1111/crj.12103 · 2.20 Impact Factor