Infant GBS risk halved with universal screenings: resultant rise in antibiotic use a drawback. (Compared with Risk-based Approach).

QUEBEC CITY -- Universal culture screening of all pregnant women for group B streptococcus reduces by half the risk of a newborn developing early-onset group B streptococcal disease, compared with screening based on a risk-based approach, according to data presented at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.

But experts are still wrangling over whether the benefits of a universal screening strategy outweigh the downsides of this approach, including an increase in antibiotic usage.

In a retrospective cohort study, researchers at the Centers for Disease Control and Prevention examined 4,517 randomly selected labor and delivery records from live births. In all cases where there was no mention of screening on the birth or labor and delivery records, it was assumed that a risk-based strategy was followed, whereby women were given chemoprophylaxis if they had any risks factors for group B streptococcal (GBS) disease.

A preliminary analysis indicates that there were 272 cases of early-onset CBS neonatal diseases. In 54% of the cases, there was no indication for CBS prophylaxis under the risk-based approach. Meanwhile, compared with those women managed by a risk-based approach, those mothers who were screened by culture had an odds ratio of 0.47 for having newborns that developed early-onset GBS diseases, said Sharon Hillier, Ph.D., of Magee-Womens Hospital, Pittsburgh, who presented the study on behalf of her colleagues at the CDC.

Under guidelines currently endorsed by the CDC, the American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics, physicians have two choices: Either universally conduct culture screening at the 35th through the 37th gestational week and treat only those who are positive, or take a risk-based approach in which no ...