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788 Eearly-Onset Neonatal Group B Streptococcus Sepsis (EGOBS): Comparison Of One Decade Pre-Protocol And The Impact Of Eight Years Of Preventive Measures Implementation

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Rosana Richtmann, MD , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Sandra Regina Baltieri , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Tatiane T. Rodrigues , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Camila de Almeida Silva , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Helenilce H. Costa , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Elisa Kusano , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Neusa B. Takagi , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Marcia R. M. Marques , Santa Joana Maternity Hospital, Sao Paulo, Brazil
Background: Group B Streptococcus is the most common etiological agent of EOGBS.

Objective: This study intends to assess the incidence of EOGBS before and after protocol implementation and check for possible protocol failures. 

Methods: Prospective study performed in the 1st period (P1) from April 1991 to March 2000, when there were no specific preventive measures implemented, and the 2nd period (P2) from April 2000 to December 2008 after protocol implementation. P2 was analyzed in two stages: early P2 (2000-03) and late P2 (2004-08). Protocol consists of anal/vaginal swab culture of all inpatient pregnant with gestation age >24w and intrapartum antibiotic prophylaxis (IAP) according to CDC guidelines. Positive culture was communicated by the laboratory to the infection control committee which, then, lets the attending physician know about the EOBGS risk and the preventive measures to be taken.  Results: See table below with P1 and P2 (early P2 and late P2):

Period

live births
EOGBS
EOGBS incidence
Mortality
P1- 1991-2000  
111.241
43
0.39/1000 lb
26(60%)
Early P2- 2000-2003
51.634
17
0.32/1000 lb
2(11%)
Late P2- 2004-2008
41.149
5
0.071000 lb
2(40%)
Total P2 -2000-2008   
103995
22
0.21/1000 lb (p=<0.01)
4(18.1%) (p=<0.05)

 

P2 presents significant decrease in EOGBS incidence and mortality rate. Of the 22 P2 EOGBS cases only 2 mothers were colonized, 2 received AIP, 1 neonate survived. The remaining 20 cases, colonization was unknown, 100% presented risk factors that indicated AIP regardless of screening but none were given. Occurrence of EOGBS in early P2 compared to late P2 was significantly different.

Conclusions: Implementation and maintenance of protocol results in significant decrease of EOGBS disease and death. Difference in occurrence between P2 stages is probably related to IAP use in risk factor subjects. There is need  for maintaining educational campaigns looking for colonized pregnant women in order not to have AIP used abusively in risk factor pregnant women.