Antenatal Screening for Group B Streptococcus in the Setting of Preterm Premature Rupture of Membranes: Empiric versus Culture-based Prophylaxis

Abstract

Objective Imperfect culture sensitivity and increase of early onset neonatal sepsis (EONS) risk in preterm neonates raise concern that culture-based intrapartum antibiotic prophylaxis (IAP) may be insufficient after preterm premature rupture of membranes (PPROM). Our objective was to compare rates of EONS after empiric versus culture-based IAP in PPROM.

Study Design This retrospective cohort study included women with a singleton gestation and PPROM between 23 and 33 weeks. Outcomes after culture-based IAP were compared with empiric IAP. The primary outcome was EONS. Secondary outcomes included group B streptococcus (GBS) bacteremia, bacteremia, and neonatal GBS infection. Bivariable and multivariable logistic analyses were performed.

Results Of the 270 women who met inclusion criteria, 136 (50%) had culture-based IAP of whom 36 (26.5%) were GBS positive. There was no significant difference in bacteremia (2.2 vs. 4.5%, p = 0.30), GBS infection (0.8 vs. 0.7%, p = 1.00), or EONS (11.8 vs. 12.7%, p = 0.82) in infants of women with culture-based IAP compared with empiric IAP. Multivariable analysis confirmed a lack of advantage to empiric versus culture-based IAP in EONS risk (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI]: 0.44–1.93).

Conclusion In pregnancies complicated by PPROM, infants of women who received culture-based IAP had no significant difference in EONS or GBS infection compared with infants of women with empiric IAP.

Keywords

preterm premature rupture of membranes - early onset neonatal sepsis - group B streptococcusculture

• References

• 1 Regan JA, Klebanoff MA, Nugent RP. ; Vaginal Infections and Prematurity Study Group. The epidemiology of group B streptococcal colonization in pregnancy. Obstet Gynecol 1991; 77 (04) 604-610
• 2 Campbell JR, Hillier SL, Krohn MA, Ferrieri P, Zaleznik DF, Baker CJ. Group B streptococcal colonization and serotype-specific immunity in pregnant women at delivery. Obstet Gynecol 2000; 96 (04) 498-503
• 3 Verani JR, McGee L, Schrag SJ. ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1-36
• 4 Schuchat A. Epidemiology of group B streptococcal disease in the United States: shifting paradigms. Clin Microbiol Rev 1998; 11 (03) 497-513
• 5 Phares CR, Lynfield R, Farley MM. , et al; Active Bacterial Core surveillance/Emerging Infections Program Network. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008; 299 (17) 2056-2065
• 6 Lim DV, Morales WJ, Walsh AF, Kazanis D. Reduction of morbidity and mortality rates for neonatal group B streptococcal disease through early diagnosis and chemoprophylaxis. J Clin Microbiol 1986; 23 (03) 489-492
• 7 Matorras R, García-Perea A, Omeñaca F, Diez-Enciso M, Madero R, Usandizaga JA. Intrapartum chemoprophylaxis of early-onset group B streptococcal disease. Eur J Obstet Gynecol Reprod Biol 1991; 40 (01) 57-62
• 8 Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet 2008; 371 (9606): 75-84
• 9 Adair CE, Kowalsky L, Quon H. , et al. Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study. CMAJ 2003; 169 (03) 198-203
• 10 Schrag SJ, Farley MM, Petit S. , et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics 2016; 138 (06) e20162013
• 11 Stoll BJ, Hansen NI, Sánchez PJ. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Early onset neonatal sepsis: the burden of group B Streptococcal and E. coli disease continues. Pediatrics 2011; 127 (05) 817-826
• 12 Cagno CK, Pettit JM, Weiss BD. Prevention of perinatal group B streptococcal disease: updated CDC guideline. Am Fam Physician 2012; 86 (01) 59-65
• 13 American College of Obstetricians and Gynecologists Committee on Obstetric Practice. ACOG committee opinion no. 485: prevention of early-onset group B streptococcal disease in newborns. Obstet Gynecol 2011; 117 (04) 1019-1027
• 14 Bulletins ACoOaGCoP. Practice bulletin no. 172: premature rupture of membranes. Obstet Gynecol 2017; 128 (04) e165-e177
• 15 Schrag SJ, Zell ER, Lynfield R. , et al; Active Bacterial Core Surveillance Team. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med 2002; 347 (04) 233-239
• 16 Van Dyke MK, Phares CR, Lynfield R. , et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360 (25) 2626-2636
• 17 Benitz WE, Han MY, Madan A, Ramachandra P. Serial serum C-reactive protein levels in the diagnosis of neonatal infection. Pediatrics 1998; 102 (04) E41
• 18 Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979; 95 (01) 89-98
• 19 Hornik CP, Benjamin DK, Becker KC. , et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J 2012; 31 (08) 799-802
• 20 Schelonka RL, Yoder BA, Hall RB. , et al. Differentiation of segmented and band neutrophils during the early newborn period. J Pediatr 1995; 127 (02) 298-300
• 21 Owen J, Groome LJ, Hauth JC. Randomized trial of prophylactic antibiotic therapy after preterm amnion rupture. Am J Obstet Gynecol 1993; 169 (04) 976-981
• 22 Kenyon SL, Taylor DJ, Tarnow-Mordi W, Group OC. ; ORACLE Collaborative Group. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial. Lancet 2001; 357 (9261): 979-988
• 23 Rock RB-AH, Neuman H, Hanya H, Koren O, Youngster I. The impact of antibiotic use in breastfeeding women on the infant's gut microbiome:a prospective cohort study. Open Forum Infect Dis 2017; 4: 232
• 24 Lorthe E, Ancel PY, Torchin H. , et al. Impact of latency duration on the prognosis of preterm infants after preterm premature rupture of membranes at 24 to 32 weeks' gestation: a national population-based cohort study. J Pediatr 2017; 182: 47-52.e2
• 25 Mercer BM, Miodovnik M, Thurnau GR. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Antibiotic therapy for reduction of infant morbidity after preterm premature rupture of the membranes. A randomized controlled trial. JAMA 1997; 278 (12) 989-995