GROUP B

STREPTOCOCCAL
INFECTION

INTRODUCTION
Group B streptococci-Streptococcus agalactiae is a gram positive
encapsulated coccus
Important cause of perinatal morbidity and mortality .
20% and 30% of pregnant women are colonized with GBS in the
vagina or rectum .
Gram positive cocci colonizes in the gastrointestinal tract with
secondary to genito urinary tract.
Invasive group B streptococcal disease in the newborn: can cause
early & late neonanatal sepsis..

EPIDEMIOLOGY
PREVELENCE: 0.5 per 1000 live birth
Attack rate in colonized patients with
risk factor : 40 to 50%
absence of risk factors
< 5%
Neonatal mortality rate if
RISK FACTORS PRESENT: 35%
NO RISK FACTORS : <5%

CLINICAL
INFECTION
Maternal

Neonatal

a) maternal urinary tract infection

b)Pre term labour
c)PROM
d)Clinical and sub
clinicalchorioamnionitis
e) endometritis, sepsis
f) Pylonephritis
g) Post partum mastits; osteomylitis
h) wound infection

NEONATAL INFECTION

Early Onset
Neonatal
onset
neonatal
Early
Onset Neonatal Late
Late
onset
neonatal
outcome outcome
outcomes
outcome
Vertical transmission during
labour from mother to the baby

Can be vertical transmission,

nosocomial or community
accquired

Less than 7 days after birth

1week-3 months after birth

Septicemia , severe pneumonia

Menigitis , pneumonia

Seen in 0.24per 1000 live births

Seen in 0.32 per1000 live births

Septicemia develops within 6 to

12 hrs after birth develop
respiratory distress, apnea and
hypotension

Exhibits with neurological

sequelae

Mortality rate : preterm : 25%

Term
: 5%

Preterm & Term : 5%

RECOMMENDED PREVENTION
STRATEGIES
CULTURE BASED SCREENING APPROACH
Recommended universal screening for GBS

35 to 37 weeks of gestation (CDC 2002)

is between

Table 2.Indications and Nonindications for Intrapartum Antibiotic Prophylaxis to Prevent Early-Onset Group B Streptococcal Disease

Intrapartum GBS Prophylaxis Indicated

Intrapartum GBS Prophylaxis not Indicated

Previous infant with invasive GBS disease

GBS bacteriuria during any trimester of
the currentpregnancy
Positive GBS screening culture during
current pregnancy* (unless a cesarean
delivery, is performed before onset of
labor on a woman with intact amniotic
membranes)

Colonization with GBS during a previous

pregnancy (unless an indication for GBS
prophylaxis is present for current
pregnancy)

GBS bacteriuria during previous pregnancy

Unknown GBS status at the onset of labor (unlessanother indication for GBS
(culture not done, incomplete, or results prophylaxis is present for current
pregnancy)
unknown) and any ofthe following:

Delivery at less than 37 weeks of

gestation
Amniotic membrane rupture greater
than or equal to 18 hours
Intrapartum temperature greater than
or equal to 100.4F (greater than or
equal to 38.0C)
Intrapartum NAATpositive for GBS

Cesarean delivery performed before onset

of labor on a woman with intact amniotic
membranes, regardless of GBS colonization
status or gestational age
Negative vaginal and rectal GBS screening
culture result in late gestation* during the
current pregnancy, regardless of
intrapartum risk factors

EVALUATION
Laboratory testing with culture media, which typically requires 36 to 72
hours of incubation time,

Blood agar
selective enrichment broth (that is, Lim Broth, TransVag Broth or
Carrot Broth)
latex agglutination methods
Optical immunoassay, enzyme immunoassay, and DNA hybridization
polymerase chain reaction (PCR) or nucleic acid amplification tests
(NAAT)

The two main testsXpert GBS Assay and IDI-Strep

CARROT
BROTH

Xpert GBS
assay

PARTUM
Penicillin remains the agentINTRA
of choice
for intrapartum
PROPHYLAXSIS
prophylaxis.

Ampicillin is an acceptable alternative, but penicillin is

preferred.
Data also show that GBS isolates are increasingly
resistant to secondline therapies.
Up to 15% of GBS isolates are resistant to clindamycin
and 725% of isolates are resistant to
erythromycinIntravenous administration is the only route
recommended for intrapartum GBS prophylaxis because
of the higher intraamniotic concentrations achieved with
this route.

REGIMEN

TREATMENT

RECOMMENDED

PENICILLIN G 5milion units IV

initial dose ; then 2.5 million
units IV every 4 hours ntil
delivery

ALTERNtive

Ampicillin 2gm IV initial dose ,

then 1gm IV every 4hrs or 2gm
IV every 6hrs until delivery

Penicillin allergic

Cefazolin 2gm IV initial dose,

then 1gm IV every 8 hrs until
delivery; clindamycin 900mg IV
every 8 hrs until delivery
Vancomycin 1gm IV every
12hrs until delivery

NEONATAL GROUP B
SEPTIECEMIA
The infant's risk for
group B streptococcal septicemia:
prematurity, preterm labor
Mother who has already given birth to a baby with GBS sepsis

Intrapartum temperature of 100.4 deg and above

Mother who has group B streptococcus in her gastrointestinal, reproductive, or
urinary tract
Rupture of membranes more than 18 hours
Use of intrauterine fetal monitoring ("scalp lead") during labor


SYMPTOMS
Anxious or stressed appearance
cyanosis
Breathing difficulties such as:
Flaring of the nostrils
Grunting noises
Rapid breathing
Apnea
Tachycardia/ bradicardia
Pallor with cold skin
Poor feeding
Unstable body temperature (low or high)

Investigations::
Blood clotting tests - prothrombin time (PT) and
partial thromboplastin time (PTT)
Blood gases (to see if the baby needs help with
breathing)
Complete blood count
CSF culture (to check for meningitis)
Urine culture
X-ray of the chest

Complications:
DIC
Pneumonia
Hypoglycemia
Respiratory distress
Meningitis
TREATMENT:
IV Antibiotics: inj. Penicillin/ ampicillin
PREVENTION:
GBS screening during 35-37weeks
Teatment with iv antibiotic during labour.

THANK
YOU