Reduced incidence of neonatal early-onset group B streptococcal infection after promulgation of guidelines for risk-based intrapartum antibiotic prophylaxis in Sweden: Analysis of a national population-based cohort

Research output: Contribution to journalArticle

Abstract

Introduction: To investigate the incidence of neonatal early-onset group B streptococcal (GBS) infection in Sweden after promulgation of guidelines (2008) for risk factor-based intrapartum antibiotic prophylaxis, and evaluate the presence of risk factors and obstetric management in mothers. Material and methods: National registers were searched for infants with early-onset GBS infection during 2006-2011. Medical records of cases and case mothers were abstracted. Verified cases of sepsis/meningitis and cases with clinical sepsis/pneumonia were documented, as well as risk factors in case mothers and timeliness of intrapartum antibiotic prophylaxis administration. Results: There were 227 cases with verified infection, with an incidence of 0.34‰ of live births during the whole period. There was a significant decrease after promulgation of guidelines, from 0.40 to 0.30‰ [odds ratio (OR) 0.75, 95% confidence interval (CI) 0.57-0.99]. A significant decrease in the number of cases with clinical GBS sepsis/pneumonia was also observed. In parturients with one or more risk factors, the incidence of any GBS infection was reduced by approximately 50% (OR 0.47, 95% CI 0.35-0.64), although there were many cases where the opportunity for timely administration of intrapartum antibiotic prophylaxis was missed. In infants of mothers without risk factor(s) there was no reduction in early-onset GBS morbidity. The mortality in verified cases was 4.8% (95% CI 2.1-7.6). Conclusions: The introduction of national guidelines for risk-based intrapartum antibiotic prophylaxis coincided with a significant 50% risk reduction of neonatal early-onset GBS infection in infants of parturients presenting with one or more risk factors. A stricter adherence to guidelines could probably have reduced the infant morbidity further.

Details

Authors
Organisations
External organisations
  • Umeå University
  • Norwegian Institute of Public Health
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Pediatrics
  • Infectious Medicine

Keywords

  • Antibiotic prophylaxis, Early-onset, Group B streptococcus, Neonatal, Risk-based, Streptococcal infection
Original languageEnglish
Pages (from-to)1475-1483
JournalActa Obstetricia et Gynecologica Scandinavica
Volume96
Issue number12
Early online date2017
Publication statusPublished - 2017
Publication categoryResearch
Peer-reviewedYes