title: A trial of preventing early- and late-onset Group B streptococcal sepsis with combined intrapartum chemoprophylaxis and universal neonatal screening.
abstract: BACKGROUND
  Prevention of early-onset Group B Streptococcal (GBS) infection has been attempted by employing universal maternal screening for GBS, intrapartum chemoprophylaxis, and a single dose of penicillin given to neonates in the first hour of life. This strategy, however, does not seem to prevent the occurrence of late-onset neonatal group B streptococcal disease.
  
  
  METHODS
  We assessed early and late-onset GBS disease with the use of a before-after study designed to evaluate the implementation of intrapartum antimicrobial prophylaxis. Moreover, universal neonatal screening for colonization of GBS was carried out with swabs of the external ear canal. Newborns with GBS colonization received a preventive treatment with oral amoxicillin for 10 days.
  
  
  RESULTS
  Early-onset GBS infection decreased from 0.5 per thousand at baseline period to 0.19 per thousand at the study period. The incidence of late-onset GBS disease decreased from 1:1348 (0.74 per thousand) to 1:20,710 (0.048 per thousand). The overall cost for universal neonatal screening paid for by the Italian Health System in the study period was 31,065 US dollars with an antibiotic prophylaxis cost of 2,399 US dollars.
  
  
  CONCLUSIONS
  A combined strategy based on GBS culture screening and assessment of risk factors for perinatal GBS disease can significantly reduce the rate of both early and late-onset GBS infections.
authors.affiliation: Division of Neonatology, University of Florence Firenze, Toscana, Italy. giovanna.bertini@unifi.it
authors.forename: Giovanna
authors.initials: G
authors.lastname: Bertini
authors.forename: Carlo
authors.initials: C
authors.lastname: Dani
authors.forename: Domenico
authors.initials: D
authors.lastname: Cianciulli
authors.forename: Firmino F
authors.initials: FF
authors.lastname: Rubaltelli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Nicoletti
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D000667:Ampicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000379:methods*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D018805:Sepsis / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000517:prevention & control*; D013292:Streptococcus agalactiae
chemical_list: D000900:Anti-Bacterial Agents; D000667:Ampicillin; D000658:Amoxicillin