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OB: Group B StrepFrom: art fougner, md (evsono@pipeline.com)Thu Jul 25 08:24:19 2002
This in today's ReutersHealth Screening approach best for preventing streptococcal disease in neonates Last Updated: 2002-07-24 17:00:37 -0400 (Reuters Health) By Anthony J. Brown, MD NEW YORK (Reuters Health) - Routine screening of pregnant women for group B streptococcal colonization prevents more cases of neonatal disease than a risk-based approach, according to a report published in the July 25th issue of The New England Journal of Medicine. With the screening approach, women are tested in late pregnancy for group B streptococcal colonization. If positive for the bacteria, the woman receives antibiotic prophylaxis during labor. In contrast, with the risk-based approach, only women with risk factors for disease transmission at the time of labor receive antibiotic prophylaxis. In 1996, several US health groups collaborated on guidelines that recommended either the screening or risk-based approach to identify pregnant women who should receive intrapartum antibiotic prophylaxis to prevent vertical transmission of group B streptococci. The guidelines did not favor either approach, but only recommended one of them should be employed. However, findings from the current study indicate that the screening approach is clearly superior to the risk-based approach in preventing neonatal transmission of the disease. Dr. Stephanie J. Schrag, from the US Centers for Disease Control and Prevention in Atlanta, and colleagues analyzed data from 5144 births reported in 1998 and 1999. Approximately half of the mothers received the screening approach and the remainder were considered to have received the risk-based approach because no cultures were taken. The overall incidence of neonatal streptococcal disease was 0.5 cases per 1000 live births, the authors note. Infants whose mothers were screened were 54% less likely to develop streptococcal disease than those whose mothers received a risk-based approach. Even after excluding women who may not have actually received a risk-based approach because they were given no antibiotics, the relative risk reduction was 52%. "In 1996, there wasn't sufficient data to compare the two approaches and they were recommended as equally acceptable," Dr. Schrag told Reuters Health. "The current findings indicate that the screening approach is at least 50% more effective than the risk-based approach," she added. "We think the screening approach is better because it allows the detection of women who are carrying the bacteria but who do not have other clinical risk factors," Dr. Schrag pointed out. "These woman would be missed with a risk-based approach," she noted. "In fact, in our study 63% of infants with streptococcal disease were born to mothers without risk factors." Dr. Schrag said that in August the CDC will be revising its guidelines in accordance with the new findings. In a related editorial, Dr. David A. Eschenbach, from the University of Washington in Seattle, comments that the way to combat group B streptococcal disease is through immunization, not antibiotics. "Not only does immunization have the potential to prevent group B streptococcal sepsis without engendering antibiotic resistance, but it might also address two associated problems that antibiotics have failed to affect: preterm delivery and serious illness after neonatal sepsis," he notes. N Engl J Med 2002;347:233-239,280-281. art
-- art fougner, md ich bin ein New Yorker
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