Risk-based maternal group B Streptococcus screening strategy is compatible with the implementation of neonatal early-onset sepsis calculator

Niek B Achten, J Wendelien Dorigo-Zetsma, Annemarie M C van Rossum, Rianne Oostenbrink, Frans B Plötz, Niek B Achten, J Wendelien Dorigo-Zetsma, Annemarie M C van Rossum, Rianne Oostenbrink, Frans B Plötz

Abstract

Background: The early-onset sepsis (EOS) calculator was developed and validated in a setting with routine-based group B Streptococcus (GBS) screening.

Purpose: The study aimed to evaluate the extent of influence exerted by risk-based GBS screening on management recommendations by the EOS calculator.

Methods: All newborns with a gestational age greater than 35 weeks were screened for EOS risk factors in a Dutch regional teaching hospital using a risk-based GBS screening strategy. We calculated the EOS risk at birth and stratified the infants into the following 3 risk levels with corresponding management recommendations: low, <0.65; intermediate, 0.65-1.54; and high, >1.54 per 1000 live newborns. Thereafter, we recalculated the EOS risk and recommendation for the newborn infants without available maternal GBS screening results at birth.

Results: In one year, 1,877 eligible births occurred; of them, 206 infants were included. Maternal GBS status was available for 28 of 206 infants (14%) at birth, while a definitive GBS status was later available for 162 of 206 infants (79%). Median EOS risk was slightly lower after definitive GBS status was determined (0.41 vs. 0.46 per 1,000 live births, P=0.004). In 199 of 206 newborn infants (97%), the EOS calculator recommendation remained unchanged after the GBS results unavailable at birth were updated to definitive GBS status. Use of GBS status at birth versus definitive GBS status did not result in the withholding of antibiotic treatment of the newborn infants included in this study.

Conclusion: Risk-based GBS screening is compatible with EOS calculator recommendations. Larger studies are needed to develop the best strategy for combining GBS screening and EOS calculator recommendations.

Keywords: Early-onset sepsis; Group B Streptococcus; Maternal screening; Neonatal; Sepsis calculator.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Study design and inclusion criteria. Flowchart of study design and inclusion criteria. Numbers denote the number of newborns. EOS, early-onset sepsis; GBS, group B Streptococcus.
Fig. 2.
Fig. 2.
EOS calculator recommendation changes resulting from definitive GBS status. Changes in EOS calculator recommendation after adjusting for definitive GBS carrier information unavailable at birth using the risk-based GBS screening. Numbers denote the number of newborns affected by the related category change. EOS, early-onset sepsis; GBS, group B Streptococcus.

References

    1. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet. 2017;390:1770–80.
    1. Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases. National Center for Immunization and Respiratory Diseases. Centers for Disease Control and Prevention (CDC) Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59:1–36.
    1. Di Renzo GC, Melin P, Berardi A, Blennow M, Carbonell-Estrany X, Donzelli GP, et al. Intrapartum GBS screening and antibiotic prophylaxis: a European consensus conference. J Matern Fetal Neonatal Med. 2015;28:766–82.
    1. Kim DH, Min BJ, Jung EJ, Byun JM, Jeong DH, Lee KB, et al. Prevalence of group B streptococcus colonization in pregnant women in a tertiary care center in Korea. Obstet Gynecol Sci. 2018;61:575–83.
    1. NVOG (Nederlandse Vereniging voor Obstetrie en Gynaecologie) NVK (Nederlandse Vereniging Kindergeneeskunde) Preventie en behandeling van early-onset neonatale infecties (Adaptatie van de NICE-richtlijn) Utrecht (the Netherlands): Nederlandse Vereniging voor Obstetrie en Gynaecologie; 2017.
    1. Homer CS, Scarf V, Catling C, Davis D. Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: a review of national guidelines. Women Birth. 2014;27:46–51.
    1. Hong JY, Kim SH, Kim SM, Yee CA, Choi SJ, Oh S, et al. Evaluation of the early onset neonatal sepsis according to two antenatal group B Streptococcus screening methods: risk-based versus universal screening. Perinatology. 2019;30:200–7.
    1. Mukhopadhyay S, Puopolo KM. Neonatal early-onset sepsis: epidemiology and risk assessment. Neoreviews. 2015;16:e221–30.
    1. Benitz WE, Wynn JL, Polin RA. Reappraisal of guidelines for management of neonates with suspected early-onset sepsis. J Pediatr. 2015;166:1070–4.
    1. Kuzniewicz MW, Walsh EM, Li S, Fischer A, Escobar GJ. Development and implementation of an early-onset sepsis calculator to guide antibiotic management in late preterm and term neonates. Jt Comm J Qual Patient Saf. 2016;42:232–9.
    1. Kuzniewicz MW, Puopolo KM, Fischer A, Walsh EM, Li S, Newman TB, et al. A Quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr. 2017;171:365–71.
    1. Warren S, Garcia M, Hankins C. Impact of neonatal early-onset sepsis calculator on antibiotic use within two tertiary healthcare centers. J Perinatol. 2017;37:394–7.
    1. van Herk W, Stocker M, van Rossum AM. Recognising early onset neonatal sepsis: an essential step in appropriate antimicrobial use. J Infect. 2016;72 Suppl:S77–82.
    1. Kerste M, Corver J, Sonnevelt MC, van Brakel M, van der Linden PD, M Braams-Lisman BA, et al. Application of sepsis calculator in newborns with suspected infection. J Matern Fetal Neonatal Med. 2016;29:3860–5.
    1. Achten NB, Dorigo-Zetsma JW, van der Linden PD, van Brakel M, Plötz FB. Sepsis calculator implementation reduces empiric antibiotics for suspected early-onset sepsis. Eur J Pediatr. 2018;177:741–6.
    1. NVOG (Nederlandse Vereniging voor Obstetrie en Gynaecologie) Preventie van neonatale groep-b-streptokokkenziekte (gbs-ziekte) Utrecht (the Netherlands): Nederlandse Vereniging voor Obstetrie en Gynaecologie; 2008.
    1. Escobar GJ, Puopolo KM, Wi S, Turk BJ, Kuzniewicz MW, Walsh EM, et al. Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation. Pediatrics. 2014;133:30–6.
    1. Puopolo KM, Draper D, Wi S, Newman TB, Zupancic J, Lieberman E, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors. Pediatrics. 2011;128:e1155–63.
    1. Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, Harrison LH, et al. Epidemiology of invasive early-onset and late-onset group b streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr. 2019;173:224–33.
    1. Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal Group B streptococcal colonization. Cochrane Database Syst Rev. 2013:CD007467.
    1. National Institute for Health and Clinical Excellence (NICE) London: NICE; 2012. Neonatal infection (early onset): antibiotics for prevention and treatment [Internet] [cited 2018 Jun 19]. Available from: .
    1. Björklund V, Nieminen T, Ulander VM, Ahola T, Saxén H. Replacing risk-based early-onset-disease prevention with intrapartum group B streptococcus PCR testing. J Matern Fetal Neonatal Med. 2017;30:368–73.
    1. Plainvert C, El Alaoui F, Tazi A, Joubrel C, Anselem O, Ballon M, et al. Intrapartum group B Streptococcus screening in the labor ward by Xpert® GBS real-time PCR. Eur J Clin Microbiol Infect Dis. 2018;37:265–270.

Source: PubMed

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