Risk-based approach versus culture-based screening for identification of group B streptococci among women in labor

Mohammed R Khalil*, Niels Uldbjerg, Poul B Thorsen, Jens K Møller

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

OBJECTIVE: To compare a risk-based and culture-based screening approach for identification of group B streptococci (GBS) vaginal colonization using an intrapartum rectovaginal culture as the reference standard.

METHODS: Pregnant women attending the prenatal clinic at Lillebaelt Hospital, Kolding, Denmark, between April 1, 2013, and June 30, 2014, were invited to participate in a prospective observational study. For prepartum culture-based screening, vaginal and rectal culture samples were obtained and, for reference, standard, paired vaginal and rectal culture samples were collected during labor. Risk factors for risk-based screening were previous early-onset GBS, GBS bacteriuria during pregnancy, maternal temperature ≥38.0°C intrapartum, and rupture of membranes for more than 18 hours.

RESULTS: The intrapartum rectovaginal GBS colonization rate was 30% (32/108) among participants with risk factors and 15% (123/794) among participants without risk factors. Culture-based screening demonstrated a sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio in predicting intrapartum GBS carriage of 78% (95% confidence interval [CI] 71-84), 95% (94-97), 78% (70-84), 95% (94-97), and 17 (12-23), respectively; for risk-based screening, these values were 21% (15-28), 90% (87-92), 30% (22-38), 85% (83-86), and 2 (1-3), respectively.

CONCLUSIONS: Culture-based screening performed considerably better than a risk-based approach in identifying intrapartum GBS colonization.

Original languageEnglish
JournalInternational Journal of Gynecology & Obstetrics
Volume144
Issue number2
Pages (from-to)187-191
ISSN0020-7292
DOIs
Publication statusPublished - 1. Feb 2019

Keywords

  • Antibiotic prophylaxis
  • Culture-screening strategy
  • Early-onset neonatal infection
  • Group B streptococci
  • Intrapartum colonization
  • Risk-based approach

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