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. 2017 Nov 6;65(suppl_2):S143-S151.
doi: 10.1093/cid/cix654.

Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review

Kirsty Le Doare  1   2   3 , Megan O'Driscoll  1 , Kim Turner  4 , Farah Seedat  5 , Neal J Russell  6   7 , Anna C Seale  6   8 , Paul T Heath  3 , Joy E Lawn  6 , Carol J Baker  9 , Linda Bartlett  10 , Clare Cutland  11 , Michael G Gravett  12   13 , Margaret Ip  14 , Shabir A Madhi  11   15 , Craig E Rubens  12   16 , Samir K Saha  17 , Stephanie Schrag  18 , Ajoke Sobanjo-Ter Meulen  19 , Johan Vekemans  20 , Beate Kampmann  1   2 ; GBS Intrapartum Antibiotic Investigator Group
Collaborators, Affiliations

Intrapartum Antibiotic Chemoprophylaxis Policies for the Prevention of Group B Streptococcal Disease Worldwide: Systematic Review

Kirsty Le Doare et al. Clin Infect Dis. .

Abstract

Background: Intrapartum antibiotic chemoprophylaxis (IAP) prevents most early-onset group B streptococcal (GBS) disease. However, there is no description of how IAP is used around the world. This article is the sixth in a series estimating the burden of GBS disease. Here we aimed to review GBS screening policies and IAP implementation worldwide.

Methods: We identified data through (1) systematic literature reviews (PubMed/Medline, Embase, Literature in the Health Sciences in Latin America and the Caribbean [LILACS], World Health Organization library database [WHOLIS], and Scopus) and unpublished data from professional societies and (2) an online survey and searches of policies from medical societies and professionals. We included data on whether an IAP policy was in use, and if so whether it was based on microbiological or clinical risk factors and how these were applied, as well as the estimated coverage (percentage of women receiving IAP where indicated).

Results: We received policy information from 95 of 195 (49%) countries. Of these, 60 of 95 (63%) had an IAP policy; 35 of 60 (58%) used microbiological screening, 25 of 60 (42%) used clinical risk factors. Two of 15 (13%) low-income, 4 of 16 (25%) lower-middle-income, 14 of 20 (70%) upper-middle-income, and 40 of 44 (91%) high-income countries had any IAP policy. The remaining 35 of 95 (37%) had no national policy (25/33 from low-income and lower-middle-income countries). Coverage varied considerably; for microbiological screening, median coverage was 80% (range, 20%-95%); for clinical risk factor-based screening, coverage was 29% (range, 10%-50%). Although there were differences in the microbiological screening methods employed, the individual clinical risk factors used were similar.

Conclusions: There is considerable heterogeneity in IAP screening policies and coverage worldwide. Alternative global strategies, such as maternal vaccination, are needed to enhance the scope of global prevention of GBS disease.

Keywords: group B Streptococcus; intrapartum antibiotic chemoprophylaxis.

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Figures

Figure 1.
Figure 1.
Intrapartum antibiotic chemoprophylaxis in disease schema for group B streptococcal (GBS) disease, as described by Lawn et al [16].
Figure 2.
Figure 2.
Flowchart of intrapartum antibiotic chemoprophylaxis policy data identified through systematic searches and other means. Abbreviations: FIGO, International Federation of Gynecology and Obstetrics; GBS, group B Streptococcus; IAP, intrapartum antibiotic chemoprophylaxis; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses.
Figure 3.
Figure 3.
Distribution of national policies for maternal group B Streptococcus screening and administration of intrapartum antibiotics. Borders of countries/territories in map do not imply any political statement.
Figure 4.
Figure 4.
Distribution of policies for maternal group B Streptococcus screening by type of policy. Borders of countries/territories in map do not imply any political statement.
Figure 5.
Figure 5.
Scatterplot of early-onset disease incidence by national intrapartum antibiotic chemoprophylaxis (IAP) policy type.
See this image and copyright information in PMC

References

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