Re: OB: Group B Strep
From: ainsron@sbcglobal.net
Tue Jul 30 10:06:09 2002
Unfortunately, they don't mention the other paradigm shift, increased
incidence of gram negative sepsis in the treated newborns. It is
disturbing that by preventing GBS, we may be creating a shift to a more
devastating neonatal illness by selecting resistant organisms.
>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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