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Previous Volume 347:233-239 July 25, 2002 Number 4 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Eschenbach, D. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Guidelines issued in 1996 in the United States recommend either screening of pregnant women for group B streptococcal colonization by means of cultures (screening approach) or assessing clinical risk factors (risk-based approach) to identify candidates for intrapartum antibiotic prophylaxis.

Methods In a multistate retrospective cohort study, we compared the effectiveness of the screening and risk-based approaches in preventing early-onset group B streptococcal disease (in infants less than seven days old). We studied a stratified random sample of the 629,912 live births in 1998 and 1999 in eight geographical areas where there was active surveillance for group B streptococcal infection, including all births in which the neonate had early-onset disease. Women with no documented culture for group B streptococcus were considered to have been cared for according to the risk-based approach.

Results We studied 5144 births, including 312 in which the newborn had early-onset group B streptococcal disease. Antenatal screening was documented for 52 percent of the mothers. The risk of early-onset disease was significantly lower among the infants of screened women than among those in the risk-based group (adjusted relative risk, 0.46; 95 percent confidence interval, 0.36 to 0.60). Because women whose providers had no strategy for prophylaxis may have been misclassified in the risk-based group, we excluded all women with risk factors and adequate time for prophylaxis who did not receive antibiotics. The adjusted relative risk of early-onset disease associated with the screening approach in this secondary analysis was similar — 0.48 (95 percent confidence interval, 0.37 to 0.63).

Conclusions Routine screening for group B streptococcus during pregnancy prevents more cases of early-onset disease than the risk-based approach. Recommendations that endorse both strategies as equivalent warrant reconsideration.

Source Information

From the Centers for Disease Control and Prevention, Atlanta (S.J.S., E.R.Z., M.G., A.S.); the Minnesota Department of Health, Minneapolis (R.L.); the Connecticut Department of Public Health, Hartford (A. Roome); the Georgia Department of Human Resources, Atlanta (K.E.A.); the Tennessee Department of Health, Nashville (A.S.C.); Johns Hopkins University Bloomberg School of Public Health, Baltimore (L.H.H.); the School of Public Health, University of California at Berkeley, Berkeley (A. Reingold); the Department of Human Services–Health Services, Portland, Oreg. (K.S.); and the New York Department of Health, Albany (G.S.).

Address reprint requests to Dr. Schrag at the Respiratory Diseases Branch, MS-C23, Division of Bacterial and Mycotic Disease, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333, or at zha6{at}cdc.gov.

Full Text of this Article

Related Letters:

Prevention of Early-Onset Group B Streptococcal Disease in Neonates
Fay D. L., Wenninger C. J., Khandelwal M., Harmanli O. H., Schrag S. J., Schuchat A., Mohle-Boetani J.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1798-1799, Nov 28, 2002. Correspondence

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