title: Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real-time PCR assay.
abstract: OBJECTIVE
  To assess whether the determination of the presence of group B streptococci (GBS) in the vagina using a rapid polymerase chain reaction (PCR) assay at delivery was able to spare useless antimicrobial treatments, as compared with conventional culture at 34-38 weeks of gestation.
  
  
  METHODS
  Practical evaluation and prospective cost-effectiveness analysis.
  
  
  METHODS
  A university hospital in France.
  
  
  METHODS
  A cohort of 225 women in labour at the University-Hospital of Saint-Etienne.
  
  
  METHODS
  Each woman had a conventional culture performed at 34-38 weeks of gestation. At the beginning of labour, two vaginal swabs were sampled for rapid PCR testing and culture. The decision to prescribe a prophylactic antimicrobial treatment or not was taken according to the result of the PCR test. A comparative cost-effectiveness analysis of the two diagnostic strategies was carried out.
  
  
  METHODS
  Number of women receiving inadequate prophylactic antimicrobial drugs following each testing strategy, costs of PCR testing and culture, frequency of vaginal GBS, and diagnostic performance of the PCR test at delivery.
  
  
  RESULTS
  The percentage of unnecessarily treated women was significantly reduced using the rapid test versus conventional culture (4.5 and 13.6%, respectively; P < 0.001). The rate of vaginal GBS at delivery was 12.5%. The incremental cost-effectiveness ratio (ICER) for each inadequate management avoided was €36 and €173 from the point of view of the healthcare system and hospital, respectively.
  
  
  CONCLUSIONS
  The PCR assay reduced the number of inadequate antimicrobial treatments aimed to prevent the early onset of GBS disease. However, this strategy generates extra costs that must be put into balance with its clinical benefits.
authors: Department of Obstetrics, Gynaecology and Reproductive Medicine, University-Hospital of Saint-Etienne, France.
authors: E
authors: E
authors: Poncelet-Jasserand
authors: F
authors: F
authors: Forges
authors: M-N
authors: MN
authors: Varlet
authors: C
authors: C
authors: Chauleur
authors: P
authors: P
authors: Seffert
authors: C
authors: C
authors: Siani
authors: B
authors: B
authors: Pozzetto
authors: A
authors: A
authors: Ros
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D036861:Delivery, Obstetric; D004334:Drug Administration Schedule; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008403:Mass Screening; D008581:Meningitis / Q000517:prevention & control*; D011014:Pneumonia / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction / Q000191:economics; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000191:economics / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D014621:Vagina / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents
keywords: Cost-effectiveness analysis; group B streptococcus; intrapartum antimicrobial prophylaxis; real-time PCR assay