Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review

Kirsty Le Doare, Megan O'Driscoll, Kim Turner, Farah Seedat, Neal J Russell, Anna C Seale, Paul T Heath, Joy E Lawn, Carol J Baker, Linda Bartlett, Clare Cutland, Michael G Gravett, Margaret Ip, Shabir A Madhi, Craig E Rubens, Samir K Saha, Stephanie Schrag, Ajoke Sobanjo-Ter Meulen, Johan Vekemans, Beate Kampmann, GBS Intrapartum Antibiotic Investigator Group, Angela Ramoni, Rikke Bek Helmig, Kaarin Makikallio, Tengiz Asatiani, Menachem Fisher, Michael Feinstein, Yuval Oz, Matan Elami Suzin, Vered Eisenberg, Alberto Berardi, Indi Trehan, Georgia Leigh Macad, Miha Lucovnik, Claire Nkiruka Oluwalana, Pippa Letchworth, Martin Jagoutz-Herzlinger, Francis Githae Muriithi, Kouther Issa Yassen, Gerard Visser, Sophie Cooper, Kirsty Le Doare, Megan O'Driscoll, Kim Turner, Farah Seedat, Neal J Russell, Anna C Seale, Paul T Heath, Joy E Lawn, Carol J Baker, Linda Bartlett, Clare Cutland, Michael G Gravett, Margaret Ip, Shabir A Madhi, Craig E Rubens, Samir K Saha, Stephanie Schrag, Ajoke Sobanjo-Ter Meulen, Johan Vekemans, Beate Kampmann, GBS Intrapartum Antibiotic Investigator Group, Angela Ramoni, Rikke Bek Helmig, Kaarin Makikallio, Tengiz Asatiani, Menachem Fisher, Michael Feinstein, Yuval Oz, Matan Elami Suzin, Vered Eisenberg, Alberto Berardi, Indi Trehan, Georgia Leigh Macad, Miha Lucovnik, Claire Nkiruka Oluwalana, Pippa Letchworth, Martin Jagoutz-Herzlinger, Francis Githae Muriithi, Kouther Issa Yassen, Gerard Visser, Sophie Cooper

Abstract

Background: Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide.

Methods: We identified data through (1) systematic literature reviews (PubMed/Medline, Embase, Literature in the Health Sciences in Latin America and the Caribbean [LILACS], World Health Organization library database [WHOLIS], and Scopus) and unpublished data from professional societies and (2) an online survey and searches of policies from medical societies and professionals. We included data on whether an IAP policy was in use, and if so whether it was based on microbiological or clinical risk factors and how these were applied, as well as the estimated coverage (percentage of women receiving IAP where indicated).

Results: We received policy information from 95 of 195 (49%) countries. Of these, 60 of 95 (63%) had an IAP policy; 35 of 60 (58%) used microbiological screening, 25 of 60 (42%) used clinical risk factors. Two of 15 (13%) low-income, 4 of 16 (25%) lower-middle-income, 14 of 20 (70%) upper-middle-income, and 40 of 44 (91%) high-income countries had any IAP policy. The remaining 35 of 95 (37%) had no national policy (25/33 from low-income and lower-middle-income countries). Coverage varied considerably; for microbiological screening, median coverage was 80% (range, 20%-95%); for clinical risk factor-based screening, coverage was 29% (range, 10%-50%). Although there were differences in the microbiological screening methods employed, the individual clinical risk factors used were similar.

Conclusions: There is considerable heterogeneity in IAP screening policies and coverage worldwide. Alternative global strategies, such as maternal vaccination, are needed to enhance the scope of global prevention of GBS disease.

Keywords: group B Streptococcus; intrapartum antibiotic chemoprophylaxis.

© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

Figures

Figure 1.
Figure 1.
Intrapartum antibiotic chemoprophylaxis in disease schema for group B streptococcal (GBS) disease, as described by Lawn et al [16].
Figure 2.
Figure 2.
Flowchart of intrapartum antibiotic chemoprophylaxis policy data identified through systematic searches and other means. Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; GBS, group B Streptococcus; IAP, intrapartum antibiotic chemoprophylaxis; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Figure 3.
Figure 3.
Distribution of national policies for maternal group B Streptococcus screening and administration of intrapartum antibiotics. Borders of countries/territories in map do not imply any political statement.
Figure 4.
Figure 4.
Distribution of policies for maternal group B Streptococcus screening by type of policy. Borders of countries/territories in map do not imply any political statement.
Figure 5.
Figure 5.
Scatterplot of early-onset disease incidence by national intrapartum antibiotic chemoprophylaxis (IAP) policy type.

References

    1. Madrid L, Seale AC, Kohli-Lynch M et al. . Infant group B streptococcal disease incidence and serotypes worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S160–72.
    1. Russell N, Seale AC, O’Sullivan C et al. . Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S152–9.
    1. Schrag SJ, Verani JR. Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: experience in the United States and implications for a potential group B streptococcal vaccine. Vaccine 2013; 31 (suppl 4):D20–6.
    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. Baltimore RS. Consequences of prophylaxis for group B streptococcal infections of the neonate. Semin Perinatol 2007; 31:33–8.
    1. Martinelli P, Sarno L, Maruotti GM, Paludetto R. Chorioamnionitis and prematurity: a critical review. J Matern Fetal Neonatal Med 2012; 25(suppl 4):29–31.
    1. ACOG Committee Opinion. Prevention of early-onset group B streptococcal disease in newborns. Number 173—June 1996. Committee on Obstetric Practice. American College of Obstetrics and Gynecologists. Int J Gynaecol Obstet 1996; 54: 197–205.
    1. Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC. MMWR Recomm Rep 2002; 51:1–22.
    1. Colbourn T, Gilbert R. An overview of the natural history of early onset group B streptococcal disease in the UK. Early Hum Dev 2007; 83:149–56.
    1. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs) Report. Emerging Infections Program Network Group B Streptococcus, 2015. Atlanta, 2015.
    1. Ohlsson A, Shah VS. Intrapartum antibiotics for known maternal group B streptococcal colonization. Cochrane Database Syst Rev 2014; CD007467.
    1. Royal College of Obstetricians and Gynaecologists. The prevention of early onset neonatal group B streptococcal disease. London: RCOG, 2012.
    1. Nederlandse Vereniging voor Obstetrie en Gynaecologie. Preventie van neonatale groep B streptokokken [in Dutch]. Amsterdam: Nederlandse Vereniging voor Obstetrie en Gynaecologie, 2008.
    1. Royal College of Obstetricians and Gynaecologists. Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK. London: RCOG, 2012.
    1. Kolkman DG, Rijnders ME, Wouters MG et al. . Implementation of a cost-effective strategy to prevent neonatal early-onset group B haemolytic Streptococcus disease in the Netherlands. BMC Pregnancy Childbirth 2013; 13:155.
    1. Lawn JE, Bianchi-Jassir F, Russell 1et al.Group B streptococcal disease worldwide for pregnant women, stillbirths, and children: why, what and how to undertake estimates? Clin Infect Dis 2017; 65(suppl 2):S89–100.
    1. Russell N, Seale AC, O’Driscoll M et al. . Maternal colonization with group B Streptococcus and serotype distribution worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S100–11.
    1. Hall J, Hack Adams N, Bartlett L et al. . Maternal disease with group B Streptococcus and serotype distribution worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S112–24.
    1. Seale AC, Blencowe H, Bianchi-Jassir F et al. . Stillbirth with group B streptococcal disease worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S125–32.
    1. Bianchi-Jassir F, Seale AC, Kohli-Lynch M et al. . Preterm birth associated with group B Streptococcus maternal colonization worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S133–42.
    1. Tann CJ, Martinello K, Sadoo S et al. . Neonatal encephalopathy with group B streptococcal disease worldwide: systematic review, investigator group datasets, and meta-analysis. Clin Infect Dis 2017; 65(suppl 2):S173–89.
    1. Kohli-Lynch M, Russell N, Seale AC et al. . Neurodevelopmental impairment in children after group B streptococcal disease worldwide: systematic review and meta-analyses. Clin Infect Dis 2017; 65(suppl 2):S190–9.
    1. Seale AC, Bianchi-Jassir F, Russell N et al. . Estimates of the burden of group B streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin Infect Dis 2017; 65(suppl 2):S200–19.
    1. Liberati A, Altman DG, Tetzlaff J et al. . The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6:e1000100.
    1. Stevens GA, Alkema L, Black RE et al. . GATHER Working Group Guidelines for accurate and transparent health estimates reporting: the GATHER statement. PLoS Med 2016; 13:e1002056.
    1. International Federation of Gynecology and Obstetrics. Our members Available at: . Accessed 25 January 2017.
    1. World Health Organization. WHO recommendations for prevention and treatment of maternal peripartum infections. Geneva, Switzerland: WHO, 2015.
    1. Ledger WJ, Blaser MJ. Are we using too many antibiotics during pregnancy? BJOG 2013; 120:1450–2.
    1. Bizzarro MJ, Dembry LM, Baltimore RS, Gallagher PG. Changing patterns in neonatal Escherichia coli sepsis and ampicillin resistance in the era of intrapartum antibiotic prophylaxis. Pediatrics 2008; 121:689–96.
    1. Schrag SJ, Hadler JL, Arnold KE, Martell-Cleary P, Reingold A, Schuchat A. Risk factors for invasive, early-onset Escherichia coli infections in the era of widespread intrapartum antibiotic use. Pediatrics 2006; 118:570–6.
    1. Schrag SJ, Farley MM, Petit S et al. . Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics 2016; 138.
    1. Mulla ZD, Ebrahim MS, Gonzalez JL. Anaphylaxis in the obstetric patient: analysis of a statewide hospital discharge database. Ann Allergy Asthma Immunol 2010; 104:55–9.
    1. Cacho N, Neu J. Manipulation of the intestinal microbiome in newborn infants. Adv Nutr 2014; 5:114–8.
    1. Castanys-Muñoz E, Martin MJ, Vazquez E. Building a beneficial microbiome from birth. Adv Nutr 2016; 7:323–30.
    1. Kim SY, Russell LB, Park J et al. . Cost-effectiveness of a potential group B streptococcal vaccine program for pregnant women in South Africa. Vaccine 2014; 32:1954–63.

Source: PubMed

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