NEONATAL GROUP-B STREPTOCOCCAL SEPSIS DURING 2 YEARS OF A UNIVERSAL SCREENING-PROGRAM

Objective: To assess the feasibility and efficacy of a protocol for un iversal screening for group B streptococci combined with selective int rapartum prophylaxis at a teaching hospital. Methods: This is a descri ptive study of experience with a standardized protocol in which patien ts were screened at 26-28 weeks with a rectal and genital culture plac ed directly in selective media. As risk factors, we used clinical chor ioamnionitis, preterm birth, and rupture of the membranes greater than 12 hours. participants were all women receiving prenatal care at our hospital. Major outcomes were compliance and neonatal sepsis due to gr oup B streptococci. Results: The prevalence of rectal and genital grou p B streptococci was 18.5% of 3721 screened women. Of culture-positive women, 35% developed risk factors (9% chorioamnionitis, 13% preterm b irth, and 13% membrane rupture greater than 12 hours at term). With st rict application of criteria, the compliance rate in administering ind icated prophylaxis was 80.3%. Of women receiving prophylaxis, 42% had the first dose for 4 hours or less before delivery. There were five ca ses of group B streptococcal neonatal sepsis, resulting from either pr otocol violations, protocol failures, or both. Compared to the histori c rate of group B streptococcal sepsis of 1.5 per 1000 births at our h ospital, the rate in these 2 years was 1.0 per 1000 (1.6 per 1000 in t he first year and 0.5 per 1000 in the second). Conclusions: It is feas ible to conduct such a protocol, but compliance is only moderately goo d because the algorithm is complex. The protocol is not foolproof in p reventing neonatal group B streptococcal sepsis, as there are protocol failures and violations.