Prevention of early-onset
GBS disease
CDC, 2010.
Prof. Aboubakr Elnashar
Benha university, Egypt
Aboubar Elnashar
Incidence
Asymptomatic carriage of GBS:
Common.
10-30% of all pregnant women
Organism
Streptococcus agalactiae:
Gram-posit...
• Found in pairs or chains
•6 groups:
A, B, C, D, F, and G by
antibodies that recognize
surface antigens
(Streptococcus fl...
Aboubar Elnashar
Complications
1.PTL
2.Premature ROM
3.Chorioamnionitis
4.Puerperal sepsis
5.Postpartum osteomylitis & mastitis.
6.Fetal & ...
Neonatal sepsis
USA:
GBS is the leading cause of neonatal
bacterial sepsis
UK:
GBS is the most frequent cause of
neonata...
Early onset disease
(<7 days of age)
Usually 6 -12 hrs after
birth
80% of GBS disease in
newborn
Respiratory distress,...
Indications of intrapartum GBS prophylaxis
1. Previous infant with invasive GBS disease
2. GBS bacteriuria during any trim...
Intrapartum GBS prophylaxis not indicated
1. Colonization with GBS during a previous
pregnancy (unless an indication for G...
Screening strategy
• Women with GBS isolated from the urine at any
time during the current pregnancy or who had a
previous...
•All other pregnant women should be screened at
35–37 weeks’ gestation for vaginal and rectal GBS
colonization (AII).
Abou...
Algorithm for GBS
prophylaxis in
preterm labor (<37W)
Aboubar Elnashar
Algorithm for GBS
prophylaxis in
rupture of
membranes at
<37w
Aboubar Elnashar
• Antibiotics given to prolong latency for preterm
premature rupture of membranes with adequate
GBS coverage (specifically...
Identification of GBS bacteriuria in pregnant
women
• Routine screening for asymptomatic bacteriuria is
recommended in pre...
Antibiotics
Aboubar Elnashar
Thank you
Aboubakr ElnasharAboubar Elnashar
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Prevention of early-onset GBS disease

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Prevention of early-onset GBS disease

  1. 1. Prevention of early-onset GBS disease CDC, 2010. Prof. Aboubakr Elnashar Benha university, Egypt Aboubar Elnashar
  2. 2. Incidence Asymptomatic carriage of GBS: Common. 10-30% of all pregnant women Organism Streptococcus agalactiae: Gram-positive Colonize the lower GIT & Spread to the genitourinary tract Aboubar Elnashar
  3. 3. • Found in pairs or chains •6 groups: A, B, C, D, F, and G by antibodies that recognize surface antigens (Streptococcus fluorescent antibody stain (digitally colorized). •The most important: A, B and D. •3 types of hemolysis after growth of streptococci on blood agar. Alpha: partial hemolysis Beta: complete clearing Gamma: no lysis. •Group A and group B are beta hemolytic Aboubar Elnashar
  4. 4. Aboubar Elnashar
  5. 5. Complications 1.PTL 2.Premature ROM 3.Chorioamnionitis 4.Puerperal sepsis 5.Postpartum osteomylitis & mastitis. 6.Fetal & neonatal infections Aboubar Elnashar
  6. 6. Neonatal sepsis USA: GBS is the leading cause of neonatal bacterial sepsis UK: GBS is the most frequent cause of neonatal severe early onset infection (0.5/1000 births). There is controversy about its prevention Aboubar Elnashar
  7. 7. Early onset disease (<7 days of age) Usually 6 -12 hrs after birth 80% of GBS disease in newborn Respiratory distress, apnea & shock. It should be DD from RDS Mortality: 25%. Long term neurological sequalae Late onset disease 1 w or more after birth Meningitis Mortality rate: less than early onset Neurological sequalae: common Aboubar Elnashar
  8. 8. Indications of intrapartum GBS prophylaxis 1. Previous infant with invasive GBS disease 2. GBS bacteriuria during any trimester of the current pregnancy* 3. Positive GBS vaginal-rectal screening culture in late gestation† during current pregnancy* 4. Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) and any of the following: – Delivery at <37 weeks’ gestation§ – Amniotic membrane rupture ≥18 hours – Intrapartum temperature ≥100.4°F (≥38.0°C)¶ – Intrapartum NAAT** positive for GBS Aboubar Elnashar
  9. 9. Intrapartum GBS prophylaxis not indicated 1. Colonization with GBS during a previous pregnancy (unless an indication for GBS prophylaxis is present for current pregnancy) 2. GBS bacteriuria during previous pregnancy (unless an indication for GBS prophylaxis is present for current pregnancy) 3. Negative vaginal and rectal GBS screening culture in late gestation† during the current pregnancy, regardless of intrapartum risk factors 4. Cesarean delivery performed before onset of labor on a woman with intact amniotic membranes, regardless of GBS colonization status or gestational age Aboubar Elnashar
  10. 10. Screening strategy • Women with GBS isolated from the urine at any time during the current pregnancy or who had a previous infant with invasive GBS disease should receive intrapartum antibiotic prophylaxis and do not need third trimester screening for GBS colonization (AII). Women with symptomatic or asymptomatic GBS urinary tract infection detected during pregnancy should be treated according to current standards of care for urinary tract infection during pregnancy and should receive intrapartum antibiotic prophylaxis to prevent early-onset GBS disease (AIII). Aboubar Elnashar
  11. 11. •All other pregnant women should be screened at 35–37 weeks’ gestation for vaginal and rectal GBS colonization (AII). Aboubar Elnashar
  12. 12. Algorithm for GBS prophylaxis in preterm labor (<37W) Aboubar Elnashar
  13. 13. Algorithm for GBS prophylaxis in rupture of membranes at <37w Aboubar Elnashar
  14. 14. • Antibiotics given to prolong latency for preterm premature rupture of membranes with adequate GBS coverage (specifically 2 g ampicillin administered intravenously followed by 1 g administered intravenously every 6 hours for 48 hours) are sufficient for GBS prophylaxis if delivery occurs while the patient is receiving that antibiotic regime (CIII). Oral antibiotics alone are not adequate for GBS prophylaxis (DII). Aboubar Elnashar
  15. 15. Identification of GBS bacteriuria in pregnant women • Routine screening for asymptomatic bacteriuria is recommended in pregnant women, and laboratories should screen urine culture specimens for the presence of GBS in concentrations of 104 colony- forming units (cfu)/ml or greater. • Laboratories should identify GBS when present at ≥104 cfu/ml in pure culture or mixed with a second microorganism. Aboubar Elnashar
  16. 16. Antibiotics Aboubar Elnashar
  17. 17. Thank you Aboubakr ElnasharAboubar Elnashar

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