title: Impact of a risk-based prevention policy on neonatal group B streptococcal disease.
abstract: OBJECTIVE
  Neonatal group B streptococcal infections can be prevented by intrapartum antibiotic prophylaxis. Beginning in 1992, women with obstetric risk factors at University of Miami-Jackson Memorial Medical Center were targeted to receive intrapartum antibiotic prophylaxis. We evaluated these preventive efforts.
  
  
  METHODS
  A case was defined as isolation of group B streptococci from a sterile site in an infant <7 days old born during the study period, 1992-1995. We reviewed systematic samples of women with preterm delivery and prolonged rupture of membranes to assess use of intrapartum antibiotic prophylaxis.
  
  
  RESULTS
  Group B streptococcal cases declined from 1.7 cases/1000 live births to 0.2 cases/1000 live births (Poisson regression, P =.002). Intrapartum antibiotic prophylaxis use increased from 13% of preterm deliveries in 1992 to 42% in 1995, and from 20% of deliveries with prolonged rupture of membranes in 1992 to 72% in 1995 (chi2 test for linear trend P =.007 and P <.001, respectively).
  
  
  CONCLUSIONS
  Provision of intrapartum antibiotic prophylaxis on the basis of risk factors was associated with decreased group B streptococcal disease.
authors.affiliation: Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, University of Miami-Jackson Memorial Medical Center, Miami, Florida, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Factor
authors.forename: O S
authors.initials: OS
authors.lastname: Levine
authors.forename: A
authors.initials: A
authors.lastname: Nassar
authors.forename: J
authors.initials: J
authors.lastname: Potter
authors.forename: A
authors.initials: A
authors.lastname: Fajardo
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: A
authors.initials: A
authors.lastname: Schuchat
mesh_terms: D019072:Antibiotic Prophylaxis; D016009:Chi-Square Distribution; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D016012:Poisson Distribution; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification