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Reply to: Group B streptococci and pregnancy
Volume 175, Number 4, Part 1 Am J Obstet Gynecol
time o f t h e b i r t h o f e a c h n e o n a t e t h a t s u b s e q u e n t l y h a d g r o u p B streptococci sepsis.
Elliot M. Levine, MD Department of Obstetrics and Gynecology, Illinois Masonic Medical Centeg, 836 W. Wellington, Chicago, IL 60657 REFERENCES l. Klebanoff MA, Regan JA, Rao AV, Nugent RP, Blackwelder WC, Eschenbach DA, et al. Outcome of the Vaginal Infections and Prematurity Study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci. A m J Obstet Gynecol 1995;172:1540-5. 2. Anthony BF, Eisenstadt R, Carter j, Kim KS, Hobel CJ. Genital and intestinal carriage of group B streptococci during pregnancy. J Infect Dis 1981;43:761-6.
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Reply To the Editors: We t h a n k Levine for his c o m m e n t s o n o u r r e c e n t article. A l t h o u g h we a g r e e t h a t o u r i n t e r p r e t a t i o n o f t h e utility o f s c r e e n i n g for g r o u p B streptococci early in t h e t h i r d t r i m e s t e r was conservative, we believe this was w a r r a n t e d b e c a u s e o f t h e rarity o f t h e o u t c o m e , n e o n a t a l sepsis. T h e original i n t e n t of o u r study was n o t to evaluate risk factors for n e o n a t a l sepsis b e c a u s e even in a data set as large as o u r s t h e r e were only 24 cases, m a k i n g it difficult to m a k e definitive r e c o m m e n d a t i o n s . T h e r e c e n t r e c o m m e n d a t i o n s f r o m t h e C e n t e r s for Disease C o n t r o l a n d P r e v e n t i o n ~ p r o v i d e two alternative strategies for the p r e v e n t i o n o f g r o u p B streptococcal n e o n a t a l sepsis, neit h e r o f w h i c h involve early t h i r d - t r i m e s t e r screening. This is d u e to t h e well-described i n t e r m i t t e n c y o f c o l o n i z a t i o n a n d lack of efficacy of t r e a t m e n t of g r o u p B streptococcal carriers r e m o t e f r o m delivery.
LottOrs
1085
T h e results o f t h e VIP Study 2 suggest t h a t g r o u p B streptococcal carriage conveys at m o s t a m o d e r a t e risk o f low b i r t h w e i g h t o r p r e t e r m delivery a n d t h a t early, p r o l o n g e d t r e a t m e n t o f carriers does n o t r e d u c e t h e occurr e n c e of these o u t c o m e s . I n a d d i t i o n , we have also s h o w n t h a t it is n o t possible to select a g r o u p o f w o m e n at h i g h risk o f g r o u p B streptococcal carriage. This f u r t h e r suggests t h a t universal s c r e e n i n g late in pregnancy, o r treatm e n t o f w o m e n with risk factors for n e o n a t a l sepsis regardless o f colonization, as r e c o m m e n d e d by t h e C e n t e r s for Disease C o n t r o l a n d P r e v e n t i o n , are t h e m o s t a p p r o priate strategies, F u r t h e r analysis o f o u r d a t a shows t h a t o f the 24 cases o f sepsis 12 o c c u r r e d in t h e p r e s e n c e o f p r e t e r m birth, m e m b r a n e r u p t u r e o f at least 18 hours, or b o t h . Alt h o u g h p r e s e n c e of i n t r a p a r t u m fever was n o t r e c o r d e d in o u r study, a n a d d i t i o n a l f o u r w o m e n h a d clinical chorioamnionitis noted during labor and presumably were febrile. We d o n o t k n o w h o w m a n y w o m e n h a d a p r i o r child w h o h a d g r o u p B streptococcal sepsis.
Mark A. Klebanoff MD, R.P. Nugent, PhD, and J.A. Regan, MD DESPR, NICHD, NIH, 6100 Building, Room 7B03, Bethesda, MD 20892 REFERENCES 1. Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR Morb Mortal Wkly Rep 1996;45:1-31. 2. Klebanoff MA, Regan JA, Rao AV, Nugent RP, Blackwelder WC, Eschenbach DA, et al. Outcome of the Vaginal Infections and Prematurity Study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci. A m J Obstet Gynecol 1995;172:1540-5.
6/8/76388
time o f t h e b i r t h o f e a c h n e o n a t e t h a t s u b s e q u e n t l y h a d g r o u p B streptococci sepsis.
Elliot M. Levine, MD Department of Obstetrics and Gynecology, Illinois Masonic Medical Centeg, 836 W. Wellington, Chicago, IL 60657 REFERENCES l. Klebanoff MA, Regan JA, Rao AV, Nugent RP, Blackwelder WC, Eschenbach DA, et al. Outcome of the Vaginal Infections and Prematurity Study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci. A m J Obstet Gynecol 1995;172:1540-5. 2. Anthony BF, Eisenstadt R, Carter j, Kim KS, Hobel CJ. Genital and intestinal carriage of group B streptococci during pregnancy. J Infect Dis 1981;43:761-6.
6/8/76389
Reply To the Editors: We t h a n k Levine for his c o m m e n t s o n o u r r e c e n t article. A l t h o u g h we a g r e e t h a t o u r i n t e r p r e t a t i o n o f t h e utility o f s c r e e n i n g for g r o u p B streptococci early in t h e t h i r d t r i m e s t e r was conservative, we believe this was w a r r a n t e d b e c a u s e o f t h e rarity o f t h e o u t c o m e , n e o n a t a l sepsis. T h e original i n t e n t of o u r study was n o t to evaluate risk factors for n e o n a t a l sepsis b e c a u s e even in a data set as large as o u r s t h e r e were only 24 cases, m a k i n g it difficult to m a k e definitive r e c o m m e n d a t i o n s . T h e r e c e n t r e c o m m e n d a t i o n s f r o m t h e C e n t e r s for Disease C o n t r o l a n d P r e v e n t i o n ~ p r o v i d e two alternative strategies for the p r e v e n t i o n o f g r o u p B streptococcal n e o n a t a l sepsis, neit h e r o f w h i c h involve early t h i r d - t r i m e s t e r screening. This is d u e to t h e well-described i n t e r m i t t e n c y o f c o l o n i z a t i o n a n d lack of efficacy of t r e a t m e n t of g r o u p B streptococcal carriers r e m o t e f r o m delivery.
LottOrs
1085
T h e results o f t h e VIP Study 2 suggest t h a t g r o u p B streptococcal carriage conveys at m o s t a m o d e r a t e risk o f low b i r t h w e i g h t o r p r e t e r m delivery a n d t h a t early, p r o l o n g e d t r e a t m e n t o f carriers does n o t r e d u c e t h e occurr e n c e of these o u t c o m e s . I n a d d i t i o n , we have also s h o w n t h a t it is n o t possible to select a g r o u p o f w o m e n at h i g h risk o f g r o u p B streptococcal carriage. This f u r t h e r suggests t h a t universal s c r e e n i n g late in pregnancy, o r treatm e n t o f w o m e n with risk factors for n e o n a t a l sepsis regardless o f colonization, as r e c o m m e n d e d by t h e C e n t e r s for Disease C o n t r o l a n d P r e v e n t i o n , are t h e m o s t a p p r o priate strategies, F u r t h e r analysis o f o u r d a t a shows t h a t o f the 24 cases o f sepsis 12 o c c u r r e d in t h e p r e s e n c e o f p r e t e r m birth, m e m b r a n e r u p t u r e o f at least 18 hours, or b o t h . Alt h o u g h p r e s e n c e of i n t r a p a r t u m fever was n o t r e c o r d e d in o u r study, a n a d d i t i o n a l f o u r w o m e n h a d clinical chorioamnionitis noted during labor and presumably were febrile. We d o n o t k n o w h o w m a n y w o m e n h a d a p r i o r child w h o h a d g r o u p B streptococcal sepsis.
Mark A. Klebanoff MD, R.P. Nugent, PhD, and J.A. Regan, MD DESPR, NICHD, NIH, 6100 Building, Room 7B03, Bethesda, MD 20892 REFERENCES 1. Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR Morb Mortal Wkly Rep 1996;45:1-31. 2. Klebanoff MA, Regan JA, Rao AV, Nugent RP, Blackwelder WC, Eschenbach DA, et al. Outcome of the Vaginal Infections and Prematurity Study: results of a clinical trial of erythromycin among pregnant women colonized with group B streptococci. A m J Obstet Gynecol 1995;172:1540-5.
6/8/76388