CDC seek to expand group B strep testing: New data show universal screening is more effective than the risk-based method. (Antibiotic Resistance A Concern).

CHICAGO -- The Centers for Disease Control and Prevention is drafting new guidelines for the prevention of early-onset group B streptococcal disease, recommending the universal screening-based method over the risk-based method.

The move is spurred by new CDC data showing that the group B streptococcal (CBS) risk in infants whose mothers had undergone universal screening was less than half that of those who had been evaluated using the risk-based method, Dr. Stephanie Schrag said during the annual Interscience Conference on Antimicrobials and Chemotherapy sponsored by the American Society for Microbiology.

The CDC will soon circulate its draft guideline to the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American Academy of Family Physicians, and other relevant professional groups. The CDC hopes to have its new guidelines released sometime this year, Dr. Schrag of the CDC's National enter for Infectious. Diseases, Atlanta, told this new paper.

Although the incidence of BS disease in infants less than days old has decreased by 70% the United States over the last decade, it remains a leading cause of neonatal morbidity and mortality, with an estimated 1,600 cases and 80 deaths annually.

In 1996, the CDC, ACOC, and AAP issued identical recommendations giving providers a choice of two CBS prevention methods: They could screen all pregnant women at 35-37 weeks' gestation and offer intrapartum antibiotics to those who test positive, or simply give prophylactic antibiotics to women with risk factors, including rupture of membranes for 18 hours or longer, maternal fever, or preterm delivery In both approaches, prophylaxis is offered to all women with CBS bacteriuria or a previous infant with invasive CBS disease (MMWR 45[RR-7]: 1-24, 1996).

In the recent CDC study, population based surveillance in eight U.S. states identified 312 cases of early-onset CBS disease during 1998 and 1999, for an approximate incidence of 0.5 / 1,000 live births. A total of 5,144 labor and delivery records were reviewed, Among those, 52% of deliveries had prenatal GBS screening.

In multivariate analysis, the risk for early-onset GBS disease in the screening cohort was less than half that seen with the risk-based method (relative risk 0.46), she reported.