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Acta Obstet Gynecol Scand. 2017 Dec;96(12):1475-1483. doi: 10.1111/aogs.13211. Epub 2017 Sep 15.

Reduced incidence of neonatal early-onset group B streptococcal infection after promulgation of guidelines for risk-based intrapartum antibiotic prophylaxis in Sweden: analysis of a national population-based cohort.

Author information

1
Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden.
2
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
3
Department of Genes and Environment, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
4
Center for Reproductive Epidemiology, Tornblad Institute, University of Lund, Lund, Sweden.

Abstract

INTRODUCTION:

This study aimed to investigate the incidence of neonatal early-onset group B streptococcal (GBS) infection in Sweden after promulgation of guidelines (2008) for risk factor-based intrapartum antibiotic prophylaxis, and evaluate the presence of risk factors and obstetric management in mothers.

MATERIAL AND METHODS:

National registers were searched for infants with early-onset GBS infection during 2006-2011. Medical records of cases and case mothers were abstracted. Verified cases of sepsis/meningitis and cases with clinical sepsis/pneumonia were documented, as well as risk factors in case mothers and timeliness of intrapartum antibiotic prophylaxis administration.

RESULTS:

There were 227 cases with verified infection, with an incidence of 0.34‰ of live births during the whole period. There was a significant decrease after promulgation of guidelines, from 0.40 to 0.30‰ [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.99]. A significant decrease in the number of cases with clinical GBS sepsis/pneumonia was also observed. In parturients with one or more risk factors, the incidence of any GBS infection was reduced by approximately 50% (OR 0.47, 95% CI 0.35-0.64), although there were many cases where the opportunity for timely administration of intrapartum antibiotic prophylaxis was missed. In infants of mothers without risk factor(s) there was no reduction in early-onset GBS morbidity. The mortality in verified cases was 4.8% (95% CI 2.1-7.6).

CONCLUSIONS:

The introduction of national guidelines for risk-based intrapartum antibiotic prophylaxis coincided with a significant 50% risk reduction of neonatal early-onset GBS infection in infants of parturients presenting with one or more risk factors. A stricter adherence to guidelines could probably have reduced the infant morbidity further.

KEYWORDS:

Group B streptococcus; antibiotic prophylaxis; early-onset; neonatal; risk-based; streptococcal infection

PMID:
28832916
DOI:
10.1111/aogs.13211
[Indexed for MEDLINE]

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