Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 May;127(6):680-691.
doi: 10.1111/1471-0528.16085. Epub 2020 Feb 4.

Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis

G F Hasperhoven  1 , S Al-Nasiry  2 , V Bekker  3 , E Villamor  4 , Bww Kramer  4
Affiliations
Meta-Analysis

Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis

G F Hasperhoven et al. BJOG. 2020 May.

Abstract

Background: Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria exist to identify eligible women for prophylaxis. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), whereas others employ risk-based protocols.

Objectives: To compare the effectiveness of screening-based versus risk-based protocols in preventing EOGBS disease.

Search strategy: Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based.

Selection criteria: Studies were included if they investigated EOGBS disease incidence in newborn infants and compared screening or risk-based protocols with each other or with controls.

Data collection and analysis: Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects.

Main results: Seventeen eligible studies were included. In this meta-analysis, screening was associated with a reduced risk for EOGBS disease compared either with risk-based protocols (ten studies, RR 0.43, 95% CI 0.32-0.56) or with no policy (four studies, RR 0.31, 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols versus no policy (seven studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31 versus 29%).

Conclusions: Screening-based protocols were associated with lower incidences of EOGBS disease compared with risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking.

Tweetable abstract: Meta-analysis: general screening is associated with lower rates of early-onset group B strep. neonatal sepsis compared with risk-based protocols.

Keywords: Antibiotic prophylaxis; Streptococcus agalactiae; early-onset neonatal sepsis; group B streptococcus; meta-analysis; newborn infant; risk-based; screening; sepsis; streptococcal infections; systematic review; vertical transmission.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Forest plot of risk ratio (with 95% confidence intervals) of EOGBS disease (defined as positive GBS culture from a normally sterile site <7 days of age) in universal screening policy groups versus risk‐based policy groups. CI, confidence interval; M‐H, Mantel‐Haenszel.
Figure 2
Figure 2
Forest plot of risk ratio (with 95% confidence intervals) of EOGBS disease (defined as positive GBS culture from a normally sterile site <7 days of age) in universal screening policy groups versus no policy groups. CI, confidence interval; M‐H, Mantel‐Haenszel.
Figure 3
Figure 3
Forest plot of risk ratio (with 95% confidence intervals) of EOGBS disease (defined as positive GBS culture from a normally sterile site <7 days of age) in risk‐based policy groups versus no policy groups. CI, confidence interval; M‐H, Mantel‐Haenszel.
See this image and copyright information in PMC

Comment in

References

    1. Madrid L, Seale AC, Kohli‐Lynch M, Edmond KM, Lawn JE, Heath PT, et al. Infant group B streptococcal disease incidence and serotypes worldwide: systematic review and meta‐analyses. Clin Infect Dis 2017;65(suppl_2):S160–172. - PMC - PubMed
    1. Seale AC, Bianchi‐Jassir F, Russell NJ, Kohli‐Lynch M, Tann CJ, Hall J, et al. Estimates of the burden of group B streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin Infect Dis 2017;65:S200–19. - PMC - PubMed
    1. Russell NJ, Seale AC, O’Driscoll M, O’Sullivan C, Bianchi‐Jassir F, Gonzalez‐Guarin J, et al. Maternal colonization with group b streptococcus and serotype distribution worldwide: systematic review and meta‐analyses. Clin Infect Dis 2017;65:S100–11. - PMC - PubMed
    1. Desa DJTC. Intrauterine infections with group B beta‐haemolytic streptococci. Br J Obstet Gynaecol 1984;91:237–9. - PubMed
    1. Boyer KM. Maternal screening in prevention of neonatal infections: current status and rationale for group B streptococcal screening. J Hosp Infect 1988;11:328–33. - PubMed

MeSH terms