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1.  Duration of Intrapartum Antibiotics for Group B Streptococcus on the Diagnosis of Clinical Neonatal Sepsis 
Background. Infants born to mothers who are colonized with group B streptococcus (GBS) but received <4 hours of intrapartum antibiotic prophylaxis (IAP) are at-risk for presenting later with sepsis. We assessed if <4 hours of maternal IAP for GBS are associated with an increased incidence of clinical neonatal sepsis. Materials and Methods. A retrospective cohort study of women-infant dyads undergoing IAP for GBS at ≥37-week gestation who presented in labor from January 1, 2003 through December 31, 2007 was performed. Infants diagnosed with clinical sepsis by the duration of maternal IAP received (< or ≥4-hours duration) were determined. Results. More infants whose mothers received <4 hours of IAP were diagnosed with clinical sepsis, 13 of 1,149 (1.1%) versus 15 of 3,633 (0.4%), P = .03. Multivariate logistic regression analysis showed that treatment with ≥4 hours of IAP reduced the risk of infants being diagnosed with clinical sepsis by 65%, adjusted relative risk 0.35, CI 0.16–0.79, and P = .01. Conclusion. The rate of neonatal clinical sepsis is increased in newborns of GBS colonized mothers who receive <4 hours compared to ≥4 hours of IAP.
PMCID: PMC3625608  PMID: 23606801
2.  Accuracy of an Accelerated, Culture-Based Assay for Detection of Group B Streptococcus 
Objective. To determine the validity of a novel Group B Streptococcus (GBS) diagnostic assay for the detection of GBS in antepartum patients. Study Design. Women were screened for GBS colonization at 35 to 37 weeks of gestation. Three vaginal-rectal swabs were collected per patient; two were processed by traditional culture (commercial laboratory versus in-house culture), and the third was processed by an immunoblot-based test, in which a sample is placed over an antibody-coated nitrocellulose membrane, and after a six-hour culture, bound GBS is detected with a secondary antibody. Results. 356 patients were evaluated. Commercial processing revealed a GBS prevalence rate of 85/356 (23.6%). In-house culture provided a prevalence rate of 105/356 (29.5%). When the accelerated GBS test result was compared to the in-house GBS culture, it demonstrated a sensitivity of 97.1% and a specificity of 88.4%. Interobserver reliability for the novel GBS test was 88.2%. Conclusions. The accelerated GBS test provides a high level of validity for the detection of GBS colonization in antepartum patients within 6.5 hours and demonstrates a substantial agreement between observers.
PMCID: PMC3590750  PMID: 23509420
3.  Screening for Group B Streptococcus: A Private Hospital's Experience 
Objective. To assess the effect of universal screening and administration of intrapartum antibiotic prophylaxis to prevent early-onset neonatal GBS sepsis at a private tertiary care hospital since issuance of the 2002 CDC guidelines for preventing perinatal GBS disease. Methods. Retrospective analysis of women delivering between January 1, 2003 and December 31, 2004 at a private tertiary care hospital in Houston, Texas. The percentage of women screened, GBS positive women receiving intrapartum antibiotic prophylaxis, and infants developing early-onset GBS sepsis were determined. Results. 2,108 women delivered 2,135 infants with 1,874 (89%) screened for GBS. Of those screened, 1,322 (71%) tested negative and 552 (29%) tested positive for GBS. In this analysis of 2,135 infants, 3 (0.94 cases/1,000 live births) were diagnosed with invasive GBS sepsis. Conclusion. High rates of screening of pregnant women for GBS colonization and use of intrapartum antibiotic prophylaxis for GBS carriers can be achieved in a private tertiary care hospital setting. “Synopsis: High screening rates for group B streptococcus in a private tertiary care hospital reduce the incidence of maternal and early onset neonatal GBS infection.”
PMCID: PMC2905700  PMID: 20689734
4.  Cost-Effectiveness of Universal Prophylaxis in Pregnancy with Prior Group B Streptococci Colonization 
Objective. To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy. Study Design. A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis. Results. When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8 805 versus $12 710). Conclusion. Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.
PMCID: PMC2801019  PMID: 20052397
5.  Effect of Changing Gloves Before Placental Extraction on Incidence of Postcesarean Endometritis 
Objective: We sought to determine if changing the surgeon's gloves after delivery of the infant and prior to manual placental removal decreases the incidence of postcesarean endometritis.
Methods: Laboring women undergoing cesarean delivery between September 1, 1994, and August 31, 1995, were prospectively randomized into either a change or no-change glove group. In the change-glove group, the surgeon's gloves were changed after delivery of the infant and before manual removal of the placenta. All patients enrolled received a single prophylactic dose of an IV antibiotic after clamping of the umbilical cord. Endometritis was diagnosed by an oral temperature of ≥38℃ on 2 occasions at least 6 h apart and >24 h after delivery, uterine tenderness, peripheral blood leukocytosis (≥15,000 cells/ml), and the exclusion of other foci of infection. In order to detect a reduction in endometritis from 14% to 2%, at P < 0.05 with 80% power, we needed 95 patients in each group.
Results: Two hundred twenty-eight women were randomized to 2 groups: 113 were in the change group and 115 in the no-change group. No significant differences were noted between the groups with respect to demographics, duration of labor, length of ruptured membranes, number of vaginal examinations, duration of internal monitoring, length of surgery, blood loss, or infant weight. There was no decrease in the incidence of endometritis between the change group (17.7%) and the no-change group (15.7%) (relative risk 1.1, 95% confidence interval 0.75–1.47).
Conclusions: In this study, the incidence of postcesarean endometritis was not decreased by changing the surgeon's gloves after delivery of the infant but before placental extraction.
PMCID: PMC2364459  PMID: 18476058
6.  Randomized Prospective Study Comparing Erythromycin, Amoxicillin, and Clindamycin for the Treatment of Chlamydia trachomatis in Pregnancy 
Objective: The purpose of this study was to compare the efficacy and side effects of erythromycin, amoxicillin, and clindamycin in eradicating Chlamydia trachomatis from the lower genital tract of pregnant women.
Methods: A total of 174 women at <36 weeks gestation with positive cervical cultures for C. trachomatis were enrolled. Patients were assigned in a randomized prospective fashion to either erythromycin (500 mg q.i.d, for 7 days), amoxicillin (500 mg t.i.d, for 7 days), or clindamycin (600 mg t.i.d, for 10 days). Six women elected not to participate and 8 patients were lost to follow-up, leaving 53 patients in the erythromycin group, 55 patients in the amoxicillin group, and 52 patients in the clindamycin group. All sexual partners of the enrolled women were offered doxycycline (100 mg b.i.d. for 7 days) and patients were instructed to use barrier contraception until treatment was complete.
Results: All 3 medications were effective agents for the treatment of antenatal C. trachomatis infection with treatment efficacies of 96%, 94%, and 98% for the erythromycin, amoxicillin, and clindamycin groups, respectively. When the antibiotic groups were compared, no statistically significant differences were noted in intolerance. However, the differences in the incidence of gastrointestinal symptoms between erythromycin and amoxicillin and/or clindamycin were significant (P < 0.05).
Conclusions: These findings suggest that 1) all 3 antibiotic regimens are efficacious, 2) erythromycin has a higher incidence of side effects, and 3) amoxicillin or clindamycin are reasonable alternatives for the treatment of C. trachomatis in pregnant patients unable to tolerate erythromycin.
PMCID: PMC2364394  PMID: 18475393

Results 1-6 (6)