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GBS sepsis
 

GBS sepsis

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GBS prevalence

GBS prevalence
GBS swab technique and collection
GBS tx
2002-2010 changes

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  • Swab the lower vagina (vaginal introitus), followed by the rectum (i.e., insert swab through the anal sphincter) using the same swab or two different swabs. Cultures should be collected in the outpatient setting by the health-care provider or, with appropriate instruction, by the patient herself. Cervical, perianal, perirectal or perineal specimens are not acceptable, and a speculum should not be used for culture collection.• Place the swab(s) into a nonnutritive transport medium. Appropriate transport systems (e.g., Stuart’s or Amies with or without charcoal) are commercially available. GBS isolates can remain viable in transport media for several days at room temperature; however the recovery of isolates declines over one to four days, especially at elevated temperatures, which can lead to false-negative results. When feasible, specimens should be refrigerated before processing.• Specimen requisitions should indicate clearly that specimens are for group B streptococcal testing. Patients who state that they are allergic to penicillin should be evaluated for risk for anaphylaxis. If a woman is determined to be at high risk for anaphylaxis,* susceptibility testing for clindamycin and erythromycin should be ordered. * Patients with a history of any of the following after receiving penicillin or a cephalosporin are considered to be at high risk for anaphylaxis: anaphylaxis, angioedema, respiratory distress, or urticaria.

GBS sepsis GBS sepsis Presentation Transcript

  • Privileged & Confidential: Subject to Peer Reviewand Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  •  GBS prevalence GBS swab technique and collection GBS tx  CHA guidelines 2002-2010 changes Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  • Privileged & Confidential: Subject to Peer Reviewand Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  • Now with active prevention, there is only In the 1970s, GBS had a case-fatality 4-6% overall case-mortality, ratio as high as 50%, with an 20-30% of preterm infants compared to estimated 7500 cases/year 2-3% of full-term infants. GBS = Group B strep = S. agalactiae Early-onset GBS disease = <1wk Sepsis & PNA most common Meningitis less common Late-onset GBS disease = >1wk-3moEarly onset: vertical transmission from the vagina of a colonized womanGI/GYN colonizers: ~10-30% of pregnant woman have (+)GBS swabsGU colonizers: 2-7% of pregnant women have (+)GBS bacteriuria Threshold is >105 CFU for most studies; little data on <104 CFU Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- n=10439 130 et seq. and 31-7-140 et seq.
  •  GBS swab technique GBS collection and cx medium/PCR:  Direct (50% false negative)  Selective (Sn 83.3-84.3%) ○ TransVag (+gentamicin) ○ Lim Broth (+colistin)  CAMP test vs serologic  Chromogenic agar NAAT/PCR  Sn 90.7-95.8% Selective broth + PCR  Sn 92.5-100% Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  • 86-89% effective 0.7-4% allergic reactions0.2% resistance 0.05% resistance 25-32% resistance Privileged & Confidential: Subject to Peer Review 0% resistance and Medical Review Protections, O.C.G.A. 31-7- 13-20% resistance 130 et seq. and 31-7-140 et seq.
  •  Key changes from 2002 guidelines:  Adequate tx = > 4hr of IV PCN/amp/Cefazolin ○ Well appearing 35-36 wk = no routine eval needed  Inadequate tx = everything else ○ Well appearing infants = 48 hr obs  Clinical signs of sepsis are more Sn than lab tests ○ <37+0 or ROM >18hr = ltd eval +48hr obs  Sn of CBC is better at 6-12hr of life than 0hr Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  • Case studies on GBS  1984: 15 infants / 4 year period ○ All <1000g, <28wk GA ○ 3 infants SROM > 24hr  “A history of intact membranes at the time of delivery does not exclude a diagnosis of an intrauterine infection with [group B strep] … highlighting the importance of routine bacteriologic studies of all perinatal deaths” Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  • Case studies on GBS with intactmembranes 1988: 16 infants / 3 years  6 infants had intact membranes Review of reports from OB and peds literature reveal that 10-50% of GBS infections occur in this manner Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  •  New changes on the horizon  GBS detection prior to delivery ○ NAAT needs enrichment ○ Not yet feasible in triage setting  GBS vaccine: ○ Type-III capsular polysaccharide antibody  Responsible for most meningitis and burden of early- onset GBS disease  Clinical trials are ongoing Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.
  • References ACOG Practice Bulletin: Management of Stillbirth. No 102, March 2009. ACOG Practice Bulletin: Use of Prophylactic Antibiotics in L&D June 2011. MMWR Prevention of Perinatal Group B Streptococcal Disease. Revised Guidelines from CDC, 2010  www.cdc.gov/mmwr/cmw/conted.html Desa, DJ., et al. Intrauterine infections with group B beta- haemolytic streptococci. Br J Obstet Gynaecol 1984;91:237-9  PMID 63667810 Katz V., et al. Perinatal GBS infections across intact amniotic membranes. J Reprod Med. 1988 May;33(5):445-9  PMID 3290476 Schuchat, A. Epidemiology of GBS Disease in the US: Shifting Paradigms. Clin Microbiol Rev. 7/1998;11:3:497-513 Privileged & Confidential: Subject to Peer Review and Medical Review Protections, O.C.G.A. 31-7- 130 et seq. and 31-7-140 et seq.