BACKGROUND AND PURPOSE:

• There are 2 strategies for prevention of early onset GBS
  • Universal culture (36 to 38 weeks)
    • Approach in the US (CDC)
  • Risk-based (e.g. prolonged rupture of membranes, bacteriuria, an earlier child with early onset GBS, and maternal fever)
    • Approach in the UK, the Netherlands, and New Zealand
    • There has been an increase in early onset GBS disease in Netherlands and the UK
  • Gasperhoven et al. (BJOG, 2020) sought to determine whether screening-based or risk-based protocols were more effective at preventing early onset GBS disease

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria: Studies that
  • Assessed GBS disease incidence in newborn infants
  • Compared screening or risk-based protocols with each other or with controls
• Statistical analysis
  • Risk ratios (RR) were calculated using a random-effect model

RESULTS:

• 17 studies included
• Universal screening was associated with a reduced risk for GBS disease compared with either
  • Risk-based protocols
    • RR 0.43 (95% CI, 0.32 to 0.56; 10 studies)
  • No policy
    • RR 0.31 (95% CI, 0.11 to 0.84; 4 studies)
• When comparing risk-based protocols compared to no policy, there was no difference noted in outcome
  • RR 0.86 (95% CI, 0.61 to 1.20; 7 studies)
• Antibiotic administration: Universal screening was not associated with higher antibiotics administration rates
  • Universal screening: 31%
  • Without universal screening: 29%

CONCLUSION:

• Universal screening-based protocols for GBS antibiotic prophylaxis vs risk-based strategies
  • Were associated with a lower incidence of GBS in infants
  • Were not associated with higher antibiotic administration rates
• The authors conclude that risk-based GBS strategies

…might not be able to protect infants from early onset GBS disease to the same extent as general screening does

These findings can be of help to future policy‐making and individual pregnancy counselling

Learn More – Primary Sources:

Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis

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