Name / organisation - Group B Strep Support
Summary P6-8 The condition should be an important health problem, EOGBS Incidence P9-11 Presentation of EOGBS, P19-20 Incidence of early-onset GBS infection in babies – anticipated effect of risk-based prevention in 2003 ignored Implication that any antenatal or intrapartum risk factor for early-onset GBS infection in babies will mean mothers will be offered intravenous antibiotics in labour which does not happen in practice the bacteria is detected, antibiotics in labour 92% believe that information on GBS should be given to all pregnant women 92% would welcome the opportunity for pregnant women to be screened for group B Strep in the later stages of pregnancy and believe that such screening should be offered to women routinely 95% believe antibiotics should be offered to women in labour with group B Strep and that they themselves would definitely or probably accept the offer (89%) The review compares the incidence of early-onset GBS infection voluntarily reported to the Health Protection Agency in 2003 of 0.37 per 1,000 live births reported in England, Wales & Northern Ireland i with 0.41 in 2010 ii . This ignores the fact that the preventative strategy against EOGBS infection recommended in 2003 by the Royal College of Obstetricians & Gynaecologists xv should have reduced UK incidence by 50-60% xvi . The effectiveness of our existing strategy, with the relatively unchanged incidence from 2003 to 2010, must be viewed taking this into consideration. The review states that “a third of EOGBS cases might be born to women with no known risk factors for GBS, and therefore not targeted with IAP [intrapartum antibiotic prophylaxis – antibiotics given as preventative medicine in labour] in the absence of universal screening.” This presupposes that all women with any risk factor would be offered antibiotics in labour, which does not happen in practice.
Summary P6-8 3. All the costeffective primary prevention interventions should have been implemented as far as practicable P21-22 Antibiotic resistance P61-62 15. The benefit from the screening programme should outweigh the physical Risk of antibiotic resistance as a result of antibiotics given in labour against early-onset group B Strep infection The Royal College of Obstetricians & Gynaecologists’ 2012 GBS guideline xvii does not recommend antibiotics in labour for mothers in preterm labour or for those with prolonged rupture of membranes. Excluding these risk factors would mean that not 32% but 48% of babies with EOGBS infection in the Vergnano study xviii referred to would have been born to women without known risk factors and where no prevention would take place. As a result, significantly fewer cases of EOGBS infection in babies will be prevented using the risk factor approach recommended by the Royal College of Obstetricians & Gynaecologists than the expert review suggests – almost half of all EOGBS infections in babies would still occur. Antibiotic resistance of group B Strep is of concern although is not currently an issue when the recommended penicillin is used, although there is increasing resistance with clindamycin or erythromycin. Likewise, concerns about encouraging antibiotic resistance in other organisms, such as E coli, have not been realised so long as penicillin is used. Experience from other countries shows the risk of antibiotic resistance to be very small when the recommended antibiotics are used. xix A UK study xii showed that similar percentages of women would be offered antibiotics in labour regardless of whether they were identified by screening late in pregnancy or through recognised risk factors. Therefore, the issue of antibiotic resistance is of equal concern for either strategy. However, a screening strategy would mean that the antibiotics in labour