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OB Guideline 13: Prevention of Neonatal Sepsis Due to Group B Streptococci

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OB Guideline 13: Prevention of Neonatal Sepsis Due to Group B Streptococci

Related to: Clinical Guidelines, Communication, Diagnosis, Documentation, Nursing, Obstetrics

The CDC has recommended that all obstetrical clinicians adhere to a screening culture-based obstetrical protocol for prevention of neonatal sepsis due to Group B Strep.1  This protocol requires that GBS-specific cultures be universally performed during the antepartum period and that intrapartum antibiotics be administered to women based on culture data. If culture results are not available, intrapartum antibiotics should be administered according to defined risk factors.

Adherence to this culture-based protocol requires the following:

  1. Antepartum GBS-specific cultures according to the methodology specified by the CDC are performed between 35 and 37 weeks gestation. Women with positive screening cultures during a previous pregnancy should be recultured during subsequent pregnancies and managed on the basis of the current culture. Women who have had GBS cultures performed prior to 35 weeks (whether positive or negative) should have a repeat screening culture performed between 35 and 37 weeks gestation if it is anticipated that delivery may occur more than five weeks after the prior culture.
  2. Intrapartum antibiotics are administered according to results of these cultures.
  3. If results of cultures are not available, intrapartum antibiotics should be administered to all women with any of the following risk factors:
    • preterm labor (<37 weeks gestation)
    • rupture of membranes ≥18 hours, or
    • intrapartum temperature ≥100.4° F orally (100° F axillary).
  4. Intrapartum antibiotics should be administered to women with either of the following (regardless of culture results):
    •  previous GBS infected neonate, or
    • GBS bacteriuria (of any magnitude of colony count) at any time during the current pregnancy.
  5. If a woman at term with a positive GBS culture ruptures her membranes without signs of labor, no more than 12 hours should pass prior to consideration of steps to effect delivery and antibiotic administration.
  6. Women with negative cultures within five weeks of delivery do not require intrapartum antibiotic prophylaxis for GBS even if obstetrical risk factors develop. Intrapartum temperature ≥100.4° F orally (100° F axillary) should prompt consideration for use of intrapartum antibiotics regardless of concerns regarding GBS prophylaxis.
  7. Women undergoing a planned cesarean delivery prior to the onset of labor and membrane rupture do not require intrapartum antibiotic prophylaxis for GBS.
  8. Penicillin is the first line antibiotic recommended for this purpose; ampicillin is also acceptable. For penicillin-allergic individuals, acceptable antibiotics include:
    • Cefazolin: (preferred alternative except for patients at high risk for anaphylaxis);2
    • Clindamycin and erythromycin: (for patients at high risk for anaphylaxis, and whose susceptibility is known);3 and
    • Vancomycin: (for patients at high risk for anaphylaxis, and whose susceptibility is unknown).



  1. Verani JR, L McGee, and SJ Schrag. Division of Bacterial Diseases. National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Prevention of perinatal Group B streptococcal disease: revised guidelines from CDC (2010): 1–36.
  2. Women who are at high risk for anaphylaxis include those with a history of immediate hypersensitivity reaction to penicillin and those with concomitant conditions that may make anaphylaxis more difficult to treat, including active asthma and current treatment with beta-adrenergic blocking agents.
  3. Susceptibility testing to clindamycin and erythromycin should be performed on all positive GBS cultures obtained from women at high risk for anaphylaxis.

 

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May 1, 2014
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