Low Colony Counts of Asymptomatic Group B Streptococcus Bacteriuria: A Survey of Practice Patterns

The purpose of this study was to survey expert opinion on the management of low colony counts (< 100,000 colony forming units/mL) of asymptomatic group B streptococcus (GBS) bacteriuria discovered in the first trimester. A survey was sent to the 241 senior obstetricians affiliated with each of the Obstetrics and Gynecology training programs in the United States on July 10, 2002. Surveys received by the deadline (September 1, 2002) were included in the dataset. Eighty-five completed surveys were returned for a response rate of 35%. Seventy-seven percent reported treating low colony counts of asymptomatic GBS bacteriuria in the first trimester at the time of diagnosis, whereas 23% stated they did not treat prior to labor (margin of error 7.5% with 95% confidence). Nine percent stated that their institution had a written protocol for the treatment of low colony counts of asymptomatic GBS bacteriuria. Two physicians indicated that they screened for asymptomatic GBS bacteriuria at 28 weeks. Currently, no generally accepted protocol for the management of low colony counts of asymptomatic GBS bacteriuria exists. This survey indicates that most of the responding senior obstetricians at United States training programs treat low colony counts of asymptomatic GBS bacteriuria in the first trimester.

KEYWORDS

Asymptomatic bacteriuria - group B streptococcus - preterm labor

REFERENCES

• 1 Kass E H. Bacteriuria and pyelonephritis of pregnancy.  Arch Intern Med. 1960;  105 194-198
• 2 American College of Obstetricians and Gynecologists .Antimicrobial therapy for obstetric patients. ACOG Educational Bulletin No. 245. Washington, DC; American College of Obstetricians and Gynecologists 1998
• 3 Kass E H. Asymptomatic infections of the urinary tract.  Trans Assoc Am Physicians. 1957;  69 56-64
• 4 Stamm W E, Hooten T M. Management of urinary tract infections in adults.  N Engl J Med. 1993;  329 1328-1334
• 5 Moller M, Thomsen A C, Borch K, Dinesen K, Zdravkovic M. Rupture of fetal membranes and premature delivery associated with group B streptococci in urine of pregnant women.  Lancet. 1984;  2 69-70
• 6 Wood E G, Dillon H C. A prospective study of group B streptococcal bacteriuria in pregnancy.  Am J Obstet Gynecol. 1981;  140 515-520
• 7 Thomsen A C, Morup L, Hansen K B. Antibiotic elimination of group-B streptococci in urine in prevention of preterm labour.  Lancet. 1987;  1 591-593
• 8 CDC . Prevention of perinatal group B streptococcal disease.  MMWR Morb Mortal Wkly Rep. 2002;  51(RR-11) 1-21
• 9 White C P, Wilkins E G, Roberts C, Davidson D C. Premature delivery and group B streptococcal bacteriuria.  Lancet. 1984;  2 586
• 10 Thomas I L, Mackay E V. Urine-dipslide testing for group-B streptococci to identify those at risk of premature rupture of membranes.  Med J Aust. 1989;  151 300
• 11 McKenzie H, Donnet L M, Howie P W, Patel N B, Benvie D T. Risk of preterm delivery in pregnant women with group B streptococcal urinary infections or urinary antibodies to group B streptococcal and E. coli antigens.  Br J Obstet Gynaecol. 1994;  101 107-113
• 12 Persson K, Christensen K K, Christensen P, Forsgren A, Jorgensen C, Persson P. Asymptomatic bacteriuria during pregnancy with special reference to group B streptococci.  Scand J Infect Dis. 1985;  17 195-199
• 13 Persson K, Bjerre B, Elfstrom L, Polberger S, Forsgren A. Group B streptococci at delivery: high count in urine increases risk for neonatal colonization.  Scand J Infect Dis. 1986;  18 525-531
• 14 Regan J A, Klebanoff M A, Nugent R P et al.. Colonization with group B streptococci in pregnancy and adverse outcome.  Am J Obstet Gynecol. 1996;  174 1354-1360
• 15 Gardner S E, Yow M D, Leeds L J, Thompson P K, Mason E O, Clark D J. Failure of penicillin to eradicate group B streptococcal colonization in the pregnant woman.  Am J Obstet Gynecol. 1979;  135 1062-1065