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Group B strep: the leading cause of serious infection for a newborn
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AP Photo/Palmer's/Rene Macura
Group B streptococcus, or group B strep (GBS for short), is a bacteria normally present in the vaginal secretions of up to 25% of healthy women. It does not cause symptoms for women; however, exposure to GBS during delivery can produce life threatening infections in the blood (sepsis), in the fluid and lining around the brain (meningitis), and in the lung tissue (pneumonia). Premature babies have a weaker immune system and immature lungs so they are even more vulnerable to GBS infections.
The American College of Obstetrics and Gynecology (ACOG) recommends that every pregnant woman be tested for GBS between 35 and 37 weeks in her pregnancy. The test is very easy; a sterile swab (like a long Q-tip) is used to collect samples from the vagina and then the rectum. GBS can easily travel from the rectum to the vagina so it is important to test both sites. The swab is sent to the lab for testing; results take about 24-48 hours.
A pregnant woman should know her GBS status; if she has tested positive she should head immediately to the hospital when her labor starts or her membranes rupture. In addition, membrane stripping to induce labor is controversial if a woman is GBS positive as reports of GBS infected babies after this procedure have been described.
The treatment for GBS is antibiotics when the membranes rupture or labor starts, which ever comes first. The first choice is penicillin, but ampicillin, a closely related drug, may also be used. Women with mild allergies to penicillin can usually receive a drug called cefazolin (also called Ancef). Options for women with a serious penicillin allergy include clindamycin and erythromycin; however, these drugs don’t always work so the lab has to perform special testing to see if these antibiotics can kill the strain of GBS that is present (this is called susceptibility testing). Penicillin, ampicillin, and cefazolin always work against GBS so testing isn’t necessary. If a woman has a penicillin allergy and her strain of GBS is resistant to clindamycin and erythromycin a very high-power antibiotic called vancomycin is needed.
How effective are antibiotics at preventing GBS related disease? Without antibiotics, a baby exposed to GBS during labor has a 1/200 risk of developing a GBS related infection but with antibiotics that risk drops to 1 in 4,000. Put another way, if a mother is GBS positive and does not receives antibiotics her baby’s is 20 times more likely to catch the infection and get sick.
Women planning on a home delivery should discuss their GBS status with their provider as receiving intravenous antibiotics at home is not always an option. In addition, even with antibiotics the risk of getting GBS, while greatly reduced, is not zero. Babies who become sick with GBS often look well for several hours, but can deteriorate very rapidly. Many of these babies can go from looking fine to needing intensive care within a couple of hours.
For more info: go to www.mayoclinic.com
Remember, this column does not constitute individual medical advice
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