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CC BY-NC-ND 4.0 · AJP Rep 2020; 10(01): e26-e31
DOI: 10.1055/s-0039-3401807
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antenatal Screening for Group B Streptococcus in the Setting of Preterm Premature Rupture of Membranes: Empiric versus Culture-based Prophylaxis

Leena B. Mithal
1   Northwestern University Feinberg School of Medicine, Chicago, Illinois
2   Department of Pediatrics, Division of Infectious Diseases, Chicago, Illinois
,
Nirali Shah
1   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Anna Romanova
1   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Emily S. Miller
1   Northwestern University Feinberg School of Medicine, Chicago, Illinois
3   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Chicago, Illinois
› Author Affiliations Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant/award number: “K12HD050121–09”), and National Institutes of Health's National Center for Advancing Translational Sciences (grant/award number: “UL1TR001422”).
Further Information

Publication History

19 December 2018

15 October 2019

Publication Date:
11 February 2020 (online)

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Abstract

Objective Imperfect culture sensitivity and increase of early onset neonatal sepsis (EONS) risk in preterm neonates raise concern that culture-based intrapartum antibiotic prophylaxis (IAP) may be insufficient after preterm premature rupture of membranes (PPROM). Our objective was to compare rates of EONS after empiric versus culture-based IAP in PPROM.

Study Design This retrospective cohort study included women with a singleton gestation and PPROM between 23 and 33 weeks. Outcomes after culture-based IAP were compared with empiric IAP. The primary outcome was EONS. Secondary outcomes included group B streptococcus (GBS) bacteremia, bacteremia, and neonatal GBS infection. Bivariable and multivariable logistic analyses were performed.

Results Of the 270 women who met inclusion criteria, 136 (50%) had culture-based IAP of whom 36 (26.5%) were GBS positive. There was no significant difference in bacteremia (2.2 vs. 4.5%, p = 0.30), GBS infection (0.8 vs. 0.7%, p = 1.00), or EONS (11.8 vs. 12.7%, p = 0.82) in infants of women with culture-based IAP compared with empiric IAP. Multivariable analysis confirmed a lack of advantage to empiric versus culture-based IAP in EONS risk (adjusted odds ratio [aOR] = 0.82, 95% confidence interval [CI]: 0.44–1.93).

Conclusion In pregnancies complicated by PPROM, infants of women who received culture-based IAP had no significant difference in EONS or GBS infection compared with infants of women with empiric IAP.

Keywords

preterm premature rupture of membranes - early onset neonatal sepsis - group B streptococcusculture
 

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