Group B Streptococci: from Emerging Infection to Prevention Success Story

Anne Schuchat; Stephanie Schrag

doi:10.1128/9781555816971.ch8

8 : Group B Streptococci: from Emerging Infection to Prevention Success Story

Authors: Anne Schuchat¹, Stephanie Schrag¹

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Affiliations: 1: Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta. GA 30333

Content Type: Monograph

Publication Year: 2000

Category: Clinical Microbiology

Book DOI: 10.1128/9781555816971

Chapter DOI: 10.1128/9781555816971.ch8

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Abstract:

The inclusion of the group B streptococcus (GBS) in a book on emerging infections published in 2000 may puzzle some readers, since GBS was recognized as a new clinical problem three decades ago. By 1938, however, Fry reported three fatal postpartum maternal infections caused by GBS which presented as pneumonia with multiple liver abscesses and two cases of puerperal sepsis complicated by endocarditis. The responsibility for decisionmaking regarding GBS disease was diffused—therapy for neonatal infections was the province of pediatricians, but interventions to prevent this disease had to be administered by obstetric care givers before delivery. In the screening-based approach, women are screened at 35 to 37 week's gestation, and those who are GBS carriers are offered intrapartum antibiotics. The recommendations appear in the book Guidelines for Perinatal Care, published jointly by American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (AAP). While reported practice may be suggestive of increased prevention, the most important benchmark is whether actual disease patterns are altered. Antibiotic prophylaxis was intended to reduce maternal to infant transmission of GBS. Various unintended consequences are potential concerns, and monitoring systems or evaluation projects have been developed to assess some of them. Antibiotic resistance among GBS and other organisms was a major concern. To date, several investigators have evaluated GBS strains from recent patients for susceptibility testing. Clinicians can reduce the chances of serious anaphylaxis by taking very careful histories of penicillin allergy from patients.

Citation: Schuchat A, Schrag S. 2000. Group B Streptococci: from Emerging Infection to Prevention Success Story, p 107-120. In Scheld W, Craig W, Hughes J (ed), Emerging Infections 4. ASM Press, Washington, DC. doi: 10.1128/9781555816971.ch8

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Group B Streptococci: from Emerging Infection to Prevention Success Story

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Figure 1.

Number of hospitals adopting policies for prevention of group B streptococcal disease by year (bars) and incidence of early-onset group B streptococcal disease by year (line) in four stales (California, Georgia, Maryland, and Tennessee) participating in Active Bacterial Core surveillance from 1993 to 1997. Figure courtesy of CDC.

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Figure 1.

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Figure 2.

Incidence of early-onset (solid line) and late-onset (dashed line) group B streptococcal disease in cases per 1,000 births. Inset: incidence of invasive group B streptococcal disease in adults 65 years of age or older, in cases per 100,000. Data are from Active Bacterial Core surveillance for California, Georgia, Maryland, and Tennessee. Adapted from reference 46 . Figure courtesy of CDC.

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Figure 2.

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Figure 3.

Incidence of early-onset group B streptococcal disease by geographic area, Active Bacterial Core surveillance, 1993 to 1998. Symbols: ▪, California; □, Georgia; ◊, Maryland; ♦, Tennessee. Figure courtesy of CDC.

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Figure 3.

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Figure 4.

Incidence in cases per 100,000 of invasive group B streptococcal disease by race and age group. Active Bacterial Core surveillance in California, Georgia, Maryland, and Tennessee during 1997. Open bars represent nonblacks; filled bars represent blacks. Figure courtesy of CDC.

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Figure 4.

References

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Tables

Group B Streptococci: from Emerging Infection to Prevention Success Story

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Table 1.

Screening-based and risk-based strategies for prevention of early-onset group B streptococcal disease

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Table 1.

Screening-based and risk-based strategies for prevention of early-onset group B streptococcal disease

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Table 2.

Antimicrobial susceptibility testing of group B streptococcus from invasive and genital tract isolates

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Table 2.

Antimicrobial susceptibility testing of group B streptococcus from invasive and genital tract isolates