A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening

Background: Prevention of early-onset Group B Streptococcal (GBS) infection has been attempted by employing universal maternal screening for GBS, intrapartum chemoprophylaxis, and a single dose of penicillin given to neonates in the first hour of life. This strategy, however, does not seem to prevent the occurrence of late-onset neonatal group B streptococcal disease. Study design: We assessed early and late-onset GBS disease with the use of a before–after study designed to evaluate the implementation of intrapartum antimicrobial prophylaxis. Moreover, universal neonatal screening for colonization of GBS was carried out with swabs of the external ear canal. Newborns with GBS colonization received a preventive treatment with oral amoxicillin for 10 days. Results: Early-onset GBS infection decreased from 0.5‰ at baseline period to 0.19‰ at the study period. The incidence of late-onset GBS disease decreased from 1:1348 (0.74‰) to 1:20,710 (0.048‰). The overall cost for universal neonatal screening paid for by the Italian Health System in the study period was US$ 31,065 with an antibiotic prophylaxis cost of US$ 2,399. Conclusions: A combined strategy based on GBS culture screening and assessment of risk factors for perinatal GBS disease can significantly reduce the rate of both early and late-onset GBS infections.