ACOG GUIDELINES UPDATE ON GBS INFECTION PROPHYLAXIS

New ACOG guidelines for preventing early-onset group B streptococcus infection in newborns

A significant number of pregnant mothers harbour the GBS bacteria in their gastrointestinal or genital tract, that may get transmitted the neonate shortly before or during delivery.

This passage of GBS can cause early as well late form of neonatal sepsis which comes with lots of complications 

Targeted IV intrapartum antibiotic prophylaxis has been found to be efficacious in preventing Group B Streptococcus early-onset disease in newborns of positive antepartum GBS cultures mothers and those at risk for intrapartum GBS colonization.

Previously the universal screenig program recommended the screening for GBS colonisation at 35 to 37 weeks which is now changed to 36 0/7 to 37 6/7 weeks of gestation.

No screening is required for Women with GBS bacteriuria any time in pregnancy or who had an infant with early-onset GBS infection in a previous pregnancy as they should routinely receive intrapartum antibiotic prophylaxis.

The time frame for screenig was changed because cultures obtained more than five weeks before delivery are not predictive of GBS status at the time of birth, and the later screening window decreases the number of women who need to be recultured if they have not delivered by their due date. 

Also in cases of  selected women with unknown GBS status and a history of GBS colonization in a previous pregnancy,intrapartum prophylactic antibiotics can be given as part of a shared decision-making process rather than basing the decision to initiate antibiotics on intrapartum risk factors or results of rapid testing.

Early-onset GBS infection should be diagnosed by blood or cerebrospinal fluid culture.

Evaluation for late-onset GBS disease, which is associated with preterm birth, should be based on clinical signs of illness.

The preferred antibiotic for confirmed GBS disease in infants is penicillin G, followed by ampicillin.