Alberto Berardi1, Cecilia Rossi1, Caterina Spada2, Giulia Vellani3, Isotta Guidotti1, Angela Lanzoni4, Milena Azzalli5, Irene Papa6, Chiara Giugno7, Laura Lucaccioni1. 1. a Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile , Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy. 2. b Scuola di specializzazione in Pediatria, Università di Modena e Reggio Emilia , Modena , Italy. 3. c Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliera Carlo Poma , Mantova , Italy. 4. d Unità Operativa di Pediatria, Ospedale S Maria della Scaletta , Imola , Italy. 5. e Unità Operativa di Terapia Intensiva Neonatale, Ospedale S. Anna , Ferrara , Italy. 6. f Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi , Rimini , Italy. 7. g Unità Operativa di Pediatria, Ospedale B Ramazzini , Carpi , Italy.
Abstract
Objective: Group B streptococcus (GBS) early-onset sepsis (EOS) has declined after widespread intrapartum antibiotic prophylaxis. However, strategies for preventing EOS may differ across countries. The analysis of their strategies allows to compare the effectiveness of prevention in different countries and suggests opportunities for improvement. Methods: We compared six western countries. Prevention strategies, incidence rates of EOS and approaches for managing neonates at-risk were analysed. Countries were selected because of availability of recommendations for prevention and sufficient epidemiological data for comparison. Results: Five of six countries recommend antenatal vagino-rectal screening. The decline of GBS cases is relevant in most countries, particularly in those with a screening-based strategy, which have reached incidence rates from 0.1 to 0.3/1000 live births and zero or close to zero mortality in full-term newborns. The recommendation for managing asymptomatic neonates at risk for EOS varies according to gestational age and ranges from observation only to laboratory testing plus empirical antibiotics. Chorioamnionitis (suspected or confirmed) is the main indication for carry out laboratory testing and for administering empirical antibiotics. Conclusions: Wide variations exists in preventing EOS. They depend on national epidemiology of GBS infections, compliance, cost, and feasibility of the strategy. The extreme variability of approaches for managing neonates at risk for EOS reflects the even greater uncertainty regarding this issue, and may explain the persisting, great use of resources to prevent a disease that has become very rare nowadays.
Objective: Group B streptococcus (GBS) early-onset sepsis (EOS) has declined after widespread intrapartum antibiotic prophylaxis. However, strategies for preventing EOS may differ across countries. The analysis of their strategies allows to compare the effectiveness of prevention in different countries and suggests opportunities for improvement. Methods: We compared six western countries. Prevention strategies, incidence rates of EOS and approaches for managing neonates at-risk were analysed. Countries were selected because of availability of recommendations for prevention and sufficient epidemiological data for comparison. Results: Five of six countries recommend antenatal vagino-rectal screening. The decline of GBS cases is relevant in most countries, particularly in those with a screening-based strategy, which have reached incidence rates from 0.1 to 0.3/1000 live births and zero or close to zero mortality in full-term newborns. The recommendation for managing asymptomatic neonates at risk for EOS varies according to gestational age and ranges from observation only to laboratory testing plus empirical antibiotics. Chorioamnionitis (suspected or confirmed) is the main indication for carry out laboratory testing and for administering empirical antibiotics. Conclusions: Wide variations exists in preventing EOS. They depend on national epidemiology of GBS infections, compliance, cost, and feasibility of the strategy. The extreme variability of approaches for managing neonates at risk for EOS reflects the even greater uncertainty regarding this issue, and may explain the persisting, great use of resources to prevent a disease that has become very rare nowadays.
Entities:
Keywords:
Group B streptococcus; intrapartum antibiotic prophylaxis; neonatal sepsis; newborn infant; prevention; risk factors
Authors: Francesco Cavigioli; Francesca Viaroli; Irene Daniele; Michela Paroli; Luigi Guglielmetti; Elena Esposito; Francesco Cerritelli; Gianvincenzo Zuccotti; Gianluca Lista Journal: Antibiotics (Basel) Date: 2022-08-11