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Early-onset group B Streptococcus (EOGBS) infection subsequent to cessation of screening-based intrapartum prophylaxis: findings of an observational study in West London, UK
  1. Guduru Gopal Rao1,2,
  2. Jane Townsend1,
  3. Daniel Stevenson1,
  4. Grace Nartey3,
  5. Stephen Hiles4,
  6. Paul Bassett5,
  7. Theresa Lamagni6,
  8. Richard Nicholl7
  1. 1 Department of Microbiology, Northwick Park Hospital, Harrow, UK
  2. 2 Faculty of Medicine, Imperial College London, London, UK
  3. 3 Department of Maternity Services, Northwick Park Hospital, Harrow, UK
  4. 4 Department of Research and Development, Northwick Park Hospital, Harrow, UK
  5. 5 Statsconsultancy, Amersham, UK
  6. 6 National Infection Service, Public Health England Colindale, London, UK
  7. 7 Neonatology Unit, Northwick Park Hospital, Harrow, UK
  1. Correspondence to Dr Guduru Gopal Rao; ggopalrao{at}


Objectives To describe the impact on early-onset group B Streptococcus (EOGBS) infection rates following reversion from screening-based to risk-based intrapartum antimicrobial prophylaxis (IAP) for prevention.

Setting Maternity services provided by secondary healthcare organisation in North West London.

Participants All women who gave birth in the healthcare organisation between April 2016 and March 2017. There were no exclusions.

Design Observational study comparing EOGBS rates in the postscreening period (2016–2017) with prescreening (2009–2013) and screening periods (2014–2015).

Methods Local guidelines for risk-based IAP were reintroduced in April 2016. Compliance with guidelines was audited. Gestational age, mode of delivery, maternal demographics and EOGBS rates in three time periods were compared using Poisson regression analysis. EOGBS was defined through GBS being cultured from blood, cerebrospinal fluid or other sterile fluids within 6 days of birth.

Primary outcome EOGBS rates/1000 live births in prescreening, screening and postscreening periods

Results Incremental changes in maternity population were observed throughout the study period (2009 onwards), in particular the ethnic profile of mothers. Of the 5033 live births in postscreening period, 9 babies developed EOGBS infection. Only one of the mothers of affected babies had a risk factor indicating use of IAP. Comparison of postscreening period with screening period showed a fivefold increase in EOGBS rates after adjustment for ethnicity (1.79 vs 0.33/1000 live births; risk ratio =5.67, p=0.009). There was no significant difference between prescreening and postscreening periods with rates of infection reverting to their prescreening level.

Conclusions This study provides further evidence of efficacy of screening-based IAP compared with risk-based IAP in prevention of EOGBS in newborns in an area of high incidence.

  • maternal medicine
  • microbiology

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  • Contributors GGR, GN and RN were involved in all aspects of the study. JT and DS performed and analysed the audits under the supervision of GGR. SH and PB generated and analysed the data with external advice from TL. All authors contributed to drafting and editing of the manuscript.

  • Competing interests Dr G Gopal Rao is a member of the Medical Advisory Board of a UK charity, Group B Streptococcus Support (GBSS)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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