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September 11, 2024
ANTIMICROBIAL STEWARDSHIP
Article
Finnish Hospital Improves Care for Expectant Mothers with GBS PCR Screening
The Kätilöopisto Maternal Hospital in Helsinki implemented universal PCR screening for Group B Streptococcal infection (GBS) of expectant mothers using the Cepheid GeneXpert® system. With positive GBS results available in 36-56 minutes, the team is eliminating the status uncertainty of the previous risk-based assessment. Universal intrapartum PCR screening was associated with a reduction in the length of hospitalization of newborns by about 1 day.
Group B streptococcal infection (GBS) is the leading cause of early-onset disease (EOD) in newborns. If the mother is colonized with GBS, it can be transmitted to the baby in the maternal birth canal. Giving expectant mothers antibiotics during the childbirth process is effective in preventing GBS transmission and possible subsequent EOD in newborns. However, the Kätilöopisto Maternal Hospital was finding it difficult to quickly and accurately identify which women should receive prophylactic antibiotics.
In the past, the hospital utilized on a risk-based assessment to determine which women should receive Intrapartum Antibiotic Prophylaxis (IAP) at the time of birth. The assessment accounted for risk factors such as premature rupture of membranes for more than 18 hours, a history of GBS-positive vaginal or urine culture earlier during pregnancy, or a previous birth in which the child developed GBS-EOD. In recent years however, doubts about the efficiency of risk-based IAP have been raised. For example, according to the assessment, some mothers may have no risk factors, but yet they could still be positive for GBS. On the other hand, some mothers could have many risk factors but not be GBS positive, resulting in them receiving unnecessary antibiotics.
The Kätilöopisto Maternal Hospital in Helsinki needed a precise and fast method for detecting GBS colonization in expectant mothers, to support antimicrobial stewardship efforts, reduce the incidence rates of early-onset-disease in newborns, and to reduce the amount of time newborns need to be hospitalized.
A 2014 study performed at the Kätilöopisto Maternity Hospital, proved the added value of universal intrapartum PCR screening for GBS using the Xpert® GBS test versus standard practice risk-based assessment for IAP. Universal PCR intrapartum testing was associated with a reduction in length of stay for newborns by 1.13 days, without an increase in antibiotic use. Additionally, with intrapartum testing, there were no cases of EOD, compared to 3 cases when risk-based assessment was used.
Reference:
Björklund, V., Nieminen, T., Ulander, V. M., Ahola, T., & Saxén, H. (2017). Replacing risk-based early-onset-disease prevention with intrapartum group B streptococcus PCR testing. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 30(3), 368–373.
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