Table Of Contents
Group B Streptococcal (GBS) Colonization
Group B strep aka Streptococcus agalactiae is a gram positive commensal bug of the gastrointestinal and genitourinary tract in up to 30% of asymptomatic adults – hence the need for universal screening for GBS in pregnant women. It is commonly responsible for urinary tract infection, chorioamnionitis, and endometritis during pregnancy. GBS is also major cause of neonatal sepsis. Women should be screened via recto-vaginal culture at 35-37 weeks gestation for GBS. GBS prophylaxis (Penicillin) is given IV during labor for women with unknown status or GBS positive.
50% of exposed infants will be colonized by GBS. 1 in 500 (0.2%) will develop symptoms. Mortality rate if symptomatic from vertical infection (early-onset group B sepsis) is 50%.
- Indications for GBS prophylaxis
- Previous infant with GBS infection
- GBS bacteriuria with this pregnancy
- Preterm delivery (< 37 weeks gestation)
- Membrane rupture ≥ 18 hours (Prolonged rupture of membranes)
- Intrapartum temperature ≥ 38 C (100.4 F)
- When should you give penicillin in PROM
- Ideally if membrane rupture ≥ 18 hours.
- Err on the side of giving Penicillin to a GBS-unknown PROM patient uness delivery is imminent and ROM < 18 hours
- Which antibiotics given during PPROM are sufficient to cover GBS
- Penicillins including Ampicillin
- Complications of GBS
- Early onset neonatal GBS infection: fulminant pneumonia and sepsis due to vertical trasmission. Manifests within 7 days of delivery. Mortality rate of 50%. Risk factors include prematurity, previous baby affected, and positive urine culture.
- Late onset neonatal GBS infection: presents as meningitis, cellulitis or pneumonia after 7 days of life. May be acquired from the environment. Less common. Mortality rate of 25%
