Re: OB: Group B Strep
From: art fougner, md (evsono@pipeline.com)
Tue Jul 30 13:03:02 2002
another reason vaccination might be the way to go.
art
At Tue, 30 Jul 2002, ainsron@sbcglobal.net wrote:
>
>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
>>
--
art fougner, md
ich bin ein New Yorker
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