Prevention of perinatal Group B streptococcal disease : a public health perspective

Group B streptococcus is a leading cause of serious neonatal infection. Most neonatal GBS infections can be prevented through the use of intrapartum antimicrobial prophylaxis in women who are at increased risk for transmitting the infection to their newborns. However, despite clinical trials that demonstrate the effectiveness of intrapartum antibiotic prophylaxis, prevention strategies have not been implemented widely or consistently, and the incidence of neonatal GBS disease has not declined. To promote a coordinated approach to prevention among obstetric- and pediatric-care practitioners and among supporting clinical microbiology laboratory personnel, CDC has developed prevention guidelines in conjunction with experts from relevant disciplines and with representatives of the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and other professional organizations. This report provides the epidemiologic basis for prevention protocols, summarizes results of clinical trials demonstrating the efficacy of intrapartum antimicrobial agents, examines limitations of different approaches to prevention, and presents guidelines for the prevention of GBS disease. CDC recommends use of one of two prevention strategies. In the first strategy, intrapartum antibiotic prophylaxis is offered to women identified as GBS carriers through prenatal screening cultures collected at 35\u201337 weeks\u2019 gestation and to women who develop premature onset of labor or rupture of membranes at