title: Beyond screening: identifying new barriers to early onset group B streptococcal disease prevention.
abstract: BACKGROUND
  Group B streptococcal infections remain an important cause of morbidity and mortality in newborns.
  
  
  METHODS
  Neonatal group B streptococcal cases were identified by active surveillance in 4 urban Tennessee counties. Medical records of mothers of cases and a sample of other pregnant women with live births from the same population were reviewed to determine whether the screening or risk-based approach was used for prevention of early onset group B streptococcal disease and to assess other factors affecting preventability of cases.
  
  
  RESULTS
  During 1998 and 1999, 43% of women underwent prenatal group B streptococcal screening. County of residence was the only factor independently associated with not being screened [odds ratio, 7.85; 95% confidence interval (4.69, 13.16)]. Ten affected babies were born to screened mothers (0.40 per 1000). In 9 of these 10, problems were identified: mothers had positive screening cultures but did not receive optimal intrapartum antibiotics (n = 3 of 4); mothers had negative screening cultures (n = 4); and mothers were screened, but the results were unknown, and intrapartum antibiotics were not given (n = 2).
  
  
  CONCLUSIONS
  Challenges to implementation of group B streptococcal screening and prophylaxis include insufficient screening, suboptimal intrapartum antibiotics, disease despite negative screening cultures and timely communication of screening results at delivery. An awareness of such problems may lead to supplemental measures to further reduce group B streptococcal disease.
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: Esther
authors.initials: E
authors.lastname: Eisenberg
authors.forename: Allen S
authors.initials: AS
authors.lastname: Craig
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Marwa M
authors.initials: MM
authors.lastname: Khalil
authors.forename: Bashar
authors.initials: B
authors.lastname: Shaktour
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008403:Mass Screening; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000382:microbiology; D011295:Prenatal Care; D012307:Risk Factors; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000302:isolation & purification; D013714:Tennessee
chemical_list: D000900:Anti-Bacterial Agents