Preventing early-onset group B streptococcal sepsis: is there a role for rescreening near term?

• Published in: The journal of maternal-fetal & neonatal medicine 2020-11, Vol.33 (22), p.3791-3797
• Main Authors: Mirsky, Rachel, Carpenter, Diane M., Postlethwaite, Debbie A., Regenstein, Anne C.
• Format: Article
• Language: English
• Subjects: Early-onset neonatal sepsis; GBS; GBS rescreening; group B streptococcus; neonatal early-onset GBS
• ISSN: 1476-7058; 1476-4954
• DOI: 10.1080/14767058.2019.1586874

Objective: The Centers for Disease Control and Prevention 2010 guidelines recommend group B streptococcus (GBS) screening at 35-37-week gestation to identify women with positive cultures who should receive intrapartum antibiotics and notes that the predictive value of a negative culture declines after 5 weeks. However, despite the lack of evidence, current guidelines do not recommend rescreening for those screened between 35 and 37 weeks. Our objectives were to investigate the rate of conversion from negative to positive results in women rescreened after appropriate screening at 35-37-week gestation and to examine the impact of rescreening on the use of intrapartum antibiotics. Additionally, we examined cases of early-onset group B streptococcal sepsis (early-onset GBS) in term neonates. Methods: We performed a retrospective cohort study of women delivering liveborn infants 1 January, 2010-31 December, 2014 in Kaiser Permanente Northern California. Data were obtained from database extraction and chart review. Results: We identified 135,585 women with GBS screening at 35-37-week gestation; 4511 (3.3%) women were rescreened. Of the 3860 (85.6%) initially screened negative, 218 (5.6%) converted to positive. Fewer women in the discordant negative to positive group received GBS prophylaxis prior to delivery compared with women with a single positive culture (65.9 versus 92.3%, p