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that causes infection in newborns.
GBS colonization of the digestive and genitourinary tracts in pregnant women is a major risk factor
for early-onset GBS disease (GBS-EOD) in newborns.
The Expert Consensus on the Prevention of Perinatal Group B Streptococcal Disease (China) aims to standardize the timing and detection methods of GBS screening during pregnancy, the diagnosis and treatment of GBS bacteriuria during pregnancy, and the use of intrapartum prophylactic antibiotics, guide clinical practice, and prevent GBS-EOD
in newborns.
GBS screening during pregnancy
GBS screening is carried out for all pregnant women at 35~37 weeks of pregnancy, and those with GBS bacteriuria during pregnancy or those with a history of neonatal GBS in the past can be directly treated
as GBS positive.
(Recommended Level 1B)Prophylactic treatment
based on risk factors (intrapartum fever ≥ 38°C, unavoidable preterm membranes, preterm rupture of membranes, rupture of membranes ≥18 hours) is recommended in inadequate settings.
(Recommended Level 1B)GBS screening is valid for 5 weeks, and repeat screening
is recommended if GBS-negative patients have not given birth for more than 5 weeks.
(Recommended Level 1B)Without the use of a vaginal speculum, a swab is used to take a sample under the vagina, and then the same swab is taken
inside the rectum through the rectal sphincter.
(Recommended Level 1B)
Perinatal antibiotic regimens
Pregnant women who have a positive GBS screening at 35~37 weeks of pregnancy, or those who have a history of neonatal GBS in the past, or those who suffer from GBS bacteriuria during this pregnancy, prophylactic antibiotics
for GBS are recommended after premature rupture of membranes or labor.
(Recommended Level 1B)
Prophylactic broad-spectrum antibiotics
that cover GBS are recommended in pregnant women whose GBS colonization status is unknown and who have the following risk factors: intrapartum fever ≥ 38 °C, unavoidable premature birth, preterm premature rupture of membranes, and rupture of membranes ≥ 18 hours.
(Recommended Level 1B)
Pregnant women with unknown GBS colonization status who do not have high-risk factors but have a history of GBS colonization in a previous pregnancy may empirically be given prophylactic antibiotics
for GBS with informed consent.
(Recommended Level 1D)
Caesarean section without rupture and labour does not require prophylactic antibiotics
for GBS.
(Recommended Level 1B)
The preferred regimen of prophylactic antibiotics for GBS during delivery is intravenous penicillin
.
(Recommended Level 1B)
Penicillin skin test is performed in pregnant women before antibiotics, and penicillin is used if the skin test is negative; If the skin test is positive, cefazolin can be used if the cephalosporin antibiotic is not allergic or the cefazolin skin test is negative; Otherwise, according to the sensitivity of GBS strain to clindamycin, if sensitive to clindamycin, use clindamycin, if not sensitive, vancomycin
.
(Recommended Level 2B)
If a penicillin allergy has not undergone a penicillin skin test, cefazolin is selected when the risk of anaphylaxis is low according to previous allergic manifestations, and when the risk of anaphylaxis is high, clindamycin can be used when the sensitivity test shows that the GBS strain is sensitive to clindamycin, otherwise intravenous vancomycin is the only effective antibiotic option
.
(Recommended Level 1B)
Management of GBS bacteriuria during pregnancy
Indications for the treatment of GBS bacteriuria in pregnancy (one of the following): positive urine culture GBS and symptoms of urinary tract infection; Urine culture GBS colony count ≥ 104 colony formation (CFU)/ml
.
(Recommended Level 1D)
For GBS bacteriuria, penicillin is preferred and can be given orally or
intravenously.
If the penicillin skin test is positive, a sensitive antibiotic can be selected based on susceptibility testing, but clindamycin
is not recommended.
(Recommended Level 1B)
The above content is extracted from: Perinatal Medicine Branch of Chinese Medical Association, Obstetrics and Gynecology Branch of Chinese Medical Association.
Expert consensus on the prevention of perinatal group B streptococcal disease (China)[J].
Chinese Journal of Perinatal Medicine, 2021,24(8):561-566.
)
