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Questions raised over intrapartum antibiotics to prevent neonatal streptococcus B


 

FROM THE LANCET INFECTIOUS DISEASES

References

The introduction of antibiotic prophylaxis in the Netherlands to prevent invasive neonatal group B streptococcus infection has failed to achieve a decrease in the incidence of infection, prompting calls for guidelines to be reassessed and alternative prevention methods considered.

Analysis of nationwide surveillance data from 1987 to 2011 showed that the incidence of invasive group B streptococcus in infants aged 3 months and under actually increased from 0.20 per 1,000 live births to 0.32 per 1,000 (P < .0001), while the incidence of early-onset disease increased from 0.11 per 1,000 live births to 0.19 per 1,000 (P < .0001).

The incidence of invasive group B streptococcus in infants actually increased after introduction of antibiotic prophylaxis. Courtesy CDC / Melissa Brower

The incidence of invasive group B streptococcus in infants actually increased after introduction of antibiotic prophylaxis.

Researchers also noted an increase in cases of disease caused by clonal complex 17 – which has been associated with invasive disease in neonates – and fewer cases caused by clonal complex 19, as well as a nonsignificant increase in the incidence of invasive Escherichia coli infection after the 1999 implementation of intravenous antibiotic prophylaxis during labor.

“Our findings offer no explanation for the increase in incidence over the past 25 years in Netherlands, [however] possible explanations include changes in the host, medical practice, increased submission of isolates to the National Laboratory, or the pathogen itself,” wrote Dr. Vincent Bekker, from the Emma Children’s Hospital, Academic Medical Center, Amsterdam, and colleagues (Lancet Infect. Dis. 2014 Oct. 19).

In an accompanying editorial, Dr. Shannon D. Manning of Michigan State University, East Lansing, pointed out that the results ran counter to those of other studies, such as one from the United States which showed that intrapartum antibiotic prophylaxis was associated with a 65% reduction in early-onset disease.

“The findings of Bekker and colleagues confirm that group B streptococcus disease in babies remains a global public health concern and show the importance of continuous surveillance in different geographic locations,” Dr. Manning noted.

The study was supported by the National Institute of Public Health and the Environment. There were no other conflicts of interest declared.

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