GBS Prophylaxis in Preterm Labor

The American College of Obstetricians and Gynecologists has updated guidelines on the prevention of early-onset GBS infection in newborns, which have replaced the third set of GBS prevention guidelines from the Centers for Disease Control and Prevention published in 2010.^{[3, 4]}

In summary, the recommendations are to perform a universal GBS screening between weeks 36 0/7 and 37 6/7 of gestation, regardless of the planned mode of delivery. This provides a 5-week window for valid cultures, which increases the accuracy of predicting GBS colonization status at the time of delivery.^{[24, 25, 26]} Screening is best done with vaginal-rectal cultures. For patients with positive cultures, it is best to offer early intrapartum intravenous antibiotics because 2 hours of antibiotic administration has been shown to be effective in decreasing the frequency of neonatal sepsis by decreasing the GBS vaginal colonies.^[27]

For prevention of early-onset GBS infection, penicillin G remains the agent of choice. For women with penicillin allergy in whom the risk for anaphylaxis is considered to be low and/or in whom the severity of a reaction is uncertain, first-generation cephalosporins can be used. For women with penicillin allergy in whom the risk for anaphylaxis is high, penicillin allergy testing should be performed, if available, and cultures should include testing for susceptibility to clindamycin. Intravenous vancomycin remains the agent of choice for patients with high-risk penicillin allergy and also for those with GBS isolates not susceptible to clindamycin.

The following scenarios are indications for intrapartum prophylaxis:

Maternal history of delivery of a neonate with invasive GBS disease
Positive GBS cultures obtained at 36 0/7 weeks of gestation or later during pregnancy
GBS bacteriuria during any trimester of current pregnancy
Unknown GBS status at onset of labor and any of the following:

-Delivery before 37 0/7 weeks of gestation

-Amniotic rupture of membranes 18 hours or more before delivery

-Maternal fever (≥38 °C) during labor

-Positive result of nucleic amplification testing for GBS

-Negative result of nucleic amplification testing for GBS but patient has 1 of the first 3 risk factors listed

Known GBS-positive status in a previous pregnancy.

Intrapartum antibiotics are not required for GBS carriers who are having a planned cesarean delivery with intact membranes and no labor.^[28]

Medication

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Author

Christian J Woods, MD, FACP, FCCP, FIDSA Associate Program Director for Internal Medicine, Program Director for Pulmonary/Critical Care, Associate MICU Director, Attending in Infectious Diseases/Pulmonary/Critical Care, MedStar Washington Hospital Center

Christian J Woods, MD, FACP, FCCP, FIDSA is a member of the following medical societies: American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Ihab Masri, MD Resident Physician, Department of Internal Medicine, Medstar Washington Hospital Center

Ihab Masri, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Cindy McCartney, MD Resident Physician, Department of Internal Medicine, Medstar Georgetown University/Washington Hospital Center

Cindy McCartney, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Charles S Levy, MD Associate Professor, Department of Medicine, Section of Infectious Disease, George Washington University School of Medicine

Charles S Levy, MD is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, Medical Society of the District of Columbia

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Mohamad Ossiani, MD, to the development and writing of this article.

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