TABLE 3

Missed Opportunities for GBS Prevention: Maternal GBS Screening and Indications for Intrapartum Antibiotic Therapy for Infants with EOS

All Patients (N = 389)GA of Infants With GBS, wk
22–34 (n = 35)35–36 (n = 8)37+ (n = 117)Overall (n = 160)
Screened for GBS, n (%)
    Yes243 (62)15 (43)4 (50)74 (63)93 (58)
    No96 (25)12 (34)3 (38)34 (29)49 (31)
    Unknown50 (13)8 (23)1 (12)9 (8)18 (11)
GBS screen result, n (%)a
    Positive60 (25)12 (80)2 (50)14 (19)28 (30)
    Negative182 (75)3 (20)2 (50)60 (81)65 (70)
    Unknown1 (<1)0 (0)0 (0)0 (0)0 (0)
Intrapartum antibiotics, n (%)b
    Received for GBS prophylaxis with or without another indication51 (13)5 (14)0 (0)3 (3)8 (5)
    Received for other reasons154 (40)12 (34)5 (63)36 (31)53 (33)
    No intrapartum antibiotics received182 (47)18 (51)3 (37)77 (66)98 (62)
Intrapartum prophylaxis indicated per CDC 2002 guidelines4
    Previous infant with GBS, n10 (0)0 (0)0 (0)0 (0)
        Antibiotics received, n (%)1 (100)
    Maternal GBS bacteriuria, n173227
        Antibiotics received, n (%)13 (76)2 (67)2 (100)1 (50)5 (71)
    Positive GBS screen (without C-section delivery in the absence of labor or ROM), n501011223
        Antibiotics received, n (%)38 (76)6 (60)0 (0)7 (58)13 (57)
    Unknown GBS status, with maternal risk factor, nc1132032346
        Antibiotics received, n (%)75 (66)8 (40)2 (67)19 (83)29 (63)
    Negative GBS screen >5 wk before delivery, no repeat test, delivery at <37 wk, nd30 (0)20 (0)2
        Antibiotics received, n (%)2 (67)1 (50)1 (50)
Intrapartum prophylaxis not indicated per CDC 2002 guidelines4
    Negative GBS screen ≤5 wk before delivery or C-section in the absence of labor or ROM, n14620 (0)4749
        Antibiotics received, n (%)65 (45)1 (50)7 (15)8 (16)
Other clinical scenarios
    Negative GBS screen >5 wk before delivery, with maternal risk factor (excluding delivery at <37 wk), n50 (0)0 (0)22
        Antibiotics received, n (%)2 (40)0 (0)0 (0)
    Negative GBS screen >5 wk before delivery, without maternal risk factor, n30 (0)0 (0)22
        Antibiotics received, n (%)0 (0)0 (0)0 (0)
    Negative GBS screen, timing unknown, with or without maternal risk factor, ne200 (0)0 (0)99
        Antibiotics received, n (%)5 (25)2 (22)2 (22)
    Unknown GBS status, without maternal risk factor or risk factor information missing, nf310 (0)0 (0)2020
        Antibiotics received, n (%)4 (13)3 (15)3 (15)
  • a Percents are among mothers screened for GBS.

  • b Maternal antibiotics received within 72 hours before delivery; information was missing for 2 infants.

  • c Maternal risk factors for EO GBS infection were any of the following: delivery at <37 weeks' gestation, ROM ≥18 hours before delivery, and intrapartum fever ≥38.0°C.

  • d According to the suggested approach for GBS prophylaxis management for women at risk for preterm delivery in the CDC 2002 guidelines,4 if delivery has not occurred within 4 weeks of GBS screening, screening should be repeated and the patient managed on the basis of the result (Figure 34). Because these mothers were not rescreened, GBS status may be considered unknown.

  • e Among all patients, 9 infants had mothers with 1 or more of the risk factors listed above, 9 were born to mothers with none of the risk factors, and 2 had missing information for maternal risk factors. Among infants who had GBS, 4 had mothers with 1 or more of the specified risk factors, 4 had mothers with none of the risk factors, and 1 had missing information for maternal risk factors.

  • f Maternal risk factor information was missing for 2 infants among all patients, and for 1 infant among those with GBS.