GROUP –B STREPTOCOCCAL INFECTION

INTRODUCTION

•Group B streptococci- Streptococcus agalactiae is a gram positive encapsulated coccus

• Important cause of perinatal morbidity and mortality .

•20% and 30% of pregnant women are colonized with GBS in the vagina or rectum .

•Gram positive cocci colonizes in the gastrointestinal tract with secondary to genito urinary tract.

• Invasive group B streptococcal disease in the newborn: can cause early & late neonanatal sepsis..

EPIDEMIOLOGY

• PREVELENCE: 0.5 per 1000 live birth• Attack rate in colonized patients with risk

factor : 40 to 50% absence of risk factors < 5%Neonatal mortality rate if RISK FACTORS PRESENT: 35% NO RISK FACTORS : <5%

a) maternal urinary tract infection b)Pre term labour c)PROM d)Clinical and sub clinicalchorioamnionitis e) endometritis, sepsis f) Pylonephritis g) Post partum mastits; osteomylitis h) wound infection

CLINICAL INFECTION

Maternal Neonatal

Early Onset Neonatal outcome

Late onset neonatal outcomeEarly Onset Neonatal outcome Late onset neonatal outcomes

Vertical transmission during labour from mother to the baby

Can be vertical transmission, nosocomial or community accquired

Less than 7 days after birth 1week-3 months after birth

Septicemia , severe pneumonia Menigitis , pneumonia

Seen in 0.24per 1000 live births Seen in 0.32 per1000 live births

Septicemia develops within 6 to 12 hrs after birth develop respiratory distress, apnea and hypotension

Exhibits with neurological sequelae

Mortality rate : preterm : 25% Term : 5%

Preterm & Term : 5%

NEONATAL INFECTION

• CULTURE BASED SCREENING APPROACH

• Recommended universal screening for GBS is between 35 to 37 weeks of gestation (CDC 2002)

RECOMMENDED PREVENTION STRATEGIES

Table 2. Indications and Nonindications for Intrapartum Antibiotic Prophylaxis to Prevent Early-Onset Group B Streptococcal Disease

Intrapartum GBS Prophylaxis Indicated Intrapartum GBS Prophylaxis not Indicated

Previous infant with invasive GBS diseaseGBS bacteriuria during any trimester of the currentpregnancyPositive GBS screening culture during current pregnancy* (unless a cesarean delivery, is performed before onset of labor on a woman with intact amniotic membranes)Unknown GBS status at the onset of labor (culture not done, incomplete, or results unknown) and any ofthe following: Delivery at less than 37 weeks of

gestation†

Amniotic membrane rupture greater than or equal to 18 hours

Intrapartum temperature greater than or equal to 100.4°F (greater than or equal to 38.0°C)‡

Intrapartum NAAT§ positive for GBS

Colonization with GBS during a previous pregnancy (unless an indication for GBS prophylaxis is present for current pregnancy)GBS bacteriuria during previous pregnancy (unlessanother indication for GBS prophylaxis is present for current pregnancy)Cesarean delivery performed before onset of labor on a woman with intact amniotic membranes, regardless of GBS colonization status or gestational ageNegative vaginal and rectal GBS screening culture result in late gestation* during the current pregnancy, regardless of intrapartum risk factors

•Laboratory testing with culture media, which typically requires 36 to 72 hours of incubation time,

•Blood agar

•selective enrichment broth (that is, Lim Broth, TransVag Broth or Carrot Broth)

•latex agglutination methods

•Optical immunoassay, enzyme immunoassay, and DNA hybridization

•polymerase chain reaction (PCR) or nucleic acid amplification tests (NAAT)

•The two main tests—Xpert GBS Assay and IDI-Strep

EVALUATION

Xpert GBS assay

CARROT BROTH

INTRA PARTUM PROPHYLAXSIS

•Penicillin remains the agent of choice for intrapartum prophylaxis.

•Ampicillin is an acceptable alternative, but penicillin is preferred.

•Data also show that GBS isolates are increasingly resistant to second‐line therapies.

•Up to 15% of GBS isolates are resistant to clindamycin and 7–25% of isolates are resistant to erythromycinIntravenous administration is the only route recommended for intrapartum GBS prophylaxis because of the higher intraamniotic concentrations achieved with this route.

REGIMEN TREATMENT

RECOMMENDED PENICILLIN G 5milion units IV initial dose ; then 2.5 million units IV every 4 hours ntil delivery

ALTERNtive Ampicillin 2gm IV initial dose , then 1gm IV every 4hrs or 2gm IV every 6hrs until delivery

Penicillin allergic Cefazolin 2gm IV initial dose, then 1gm IV every 8 hrs until delivery; clindamycin 900mg IV every 8 hrs until delivery

Vancomycin 1gm IV every 12hrs until delivery

The infant's risk for group B streptococcal septicemia:

•prematurity, preterm labor

•Mother who has already given birth to a baby with GBS sepsis

•Intrapartum temperature of 100.4 deg and above

Mother who has group B streptococcus in her gastrointestinal, reproductive, or urinary tract

•Rupture of membranes more than 18 hours

•Use of intrauterine fetal monitoring ("scalp lead") during labor

NEONATAL GROUP B SEPTIECEMIA

• SYMPTOMS•Anxious or stressed appearance•cyanosis•Breathing difficulties such as:

Flaring of the nostrilsGrunting noisesRapid breathingApnea

•Tachycardia/ bradicardia•Pallor with cold skin•Poor feeding•Unstable body temperature (low or high)

Investigations::

•Blood clotting tests - prothrombin time (PT) and partial thromboplastin time (PTT)

•Blood gases (to see if the baby needs help with breathing)

•Complete blood count

•CSF culture (to check for meningitis)

•Urine culture

•X-ray of the chest

Complications:•DIC•Pneumonia•Hypoglycemia•Respiratory distress•Meningitis

TREATMENT:IV Antibiotics: inj. Penicillin/ ampicillin

PREVENTION: GBS screening during 35-37weeksTeatment with iv antibiotic during labour.

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