[Colonization by group B hemolytic streptococcus in pregnancy. Note of prevention and therapy of the materno-neonatal infection. Casuistics].
As several international studies show, the knowledge of the wide clinical spectrum of perinatal group B streptococcal infection, particularly of the early and of the late-onset neonatal diseases in GBS carrier mothers, is basically important for medical diagnosis. Risk factors analysis further determines both the diagnosis and the maternal intrapartum chemoprophylaxis. The considerable rate of neonatal disease without risk factors and its possible serious and fatal consequences bring to tendentially non selective prevention approaches that must consider the local background. At Merate Hospital, in a 3 years time, vaginal and rectal specimens for GBS cultures were obtained from 1766 pregnant women either at the 32nd or at the 36th week of gestation and regularly at the labor. 376 women (21.29 percent) resulted GBS carriers; the maternal-fetal contamination rate was 15.42 percent (58/376) i.e. 32.6 per 1000 live births (58/1769). Intrapartum chemoprophylaxis was carried out with i.v. erytromycin, i.v. or i.m. cephalosporins, i.v. ampicillin and per os amoxicillin (which gave the most interesting results). In infants born to mothers who received an antibiotic therapy at labor as compared with those who received no treatment, GBS neonatal colonization was present in 31 of 286 (10.8 percent) versus 27 of 90 (30 percent; P < 0.001); heavy colonization was observed in 10 of 286 (3.4 percent) versus 15 of 90 (16.6 percent; P < 0.001) and early-onset neonatal disease (both symptomatic and asymptomatic) occurred in none of 286 versus 4 of 90 (4.44 percent; P = 0.0031). Perinatal risk factors (no-screened mothers, labor at 36th week of gestation, prolonged membrane rupture) were present only in 1 of 4 GBS infected infants (25 percent). Intrapartum therapy both in carriers and in no-screened women significantly reduced GBS neonatal colonization, particularly the heavy one and, consequently, the early-onset neonatal group B streptococcal disease.
Della Morte
M A
MA
Divisione di Pediatria, Ospedale Provinciale S. Leopoldo Mandic- Azjenda USSL n. 8 di Merate (LC), Italia.
Ratti
E
E
Sala
M R
MR
Colombo
B
B
D000328:Adult; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology* / Q000517:prevention & control; D013290:Streptococcal Infections / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D013292:Streptococcus agalactiae / Q000302:isolation & purification
Della colonizzazione da streptococco beta emolitico di gruppo B (SGB) in gravidanza. Note di prevenzione e terapia dell'infezione materno-neonatale. Casistica.