PrintDownload PDFGet Adobe ReaderDownload to WordDownload as HTMLDownload as XMLCitation Manager
Save to Favorites
Guideline Summary
Guideline Title
Prevention of perinatal group B streptococcal disease. Revised guidelines from CDC, 2010.
Bibliographic Source(s)
Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010 Nov 19;59(RR-10):1-36. [264 references] PubMed External Web Site Policy
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR Recomm Rep 2002 Aug 16;51(RR-11):1-22.

Scope

Disease/Condition(s)

Perinatal group B streptococcal (GBS) disease (early-onset)

Guideline Category
Diagnosis
Management
Prevention
Risk Assessment
Screening
Clinical Specialty
Infectious Diseases
Obstetrics and Gynecology
Pathology
Pediatrics
Preventive Medicine
Intended Users
Advanced Practice Nurses
Clinical Laboratory Personnel
Health Care Providers
Health Plans
Hospitals
Managed Care Organizations
Nurses
Patients
Physician Assistants
Physicians
Public Health Departments
Guideline Objective(s)

To update recommendations and guidelines for the prevention of perinatal group B streptococcal (GBS) disease

Target Population
  • Pregnant women
  • All newborn infants
Interventions and Practices Considered
  1. Identification of candidates for intrapartum antibiotic prophylaxis
    • Universal screening for group B Streptococcus (GBS)
    • Screening of women with threatened preterm delivery
  2. Procedures for GBS specimen collection and processing
    • Collection of both anal and vaginal specimens
    • Antimicrobial susceptibility testing on antenatal GBS isolates from penicillin-allergic women at high risk for anaphylaxis
  3. Intrapartum antibiotic prophylaxis
    • Intravenous (IV) penicillin G or ampicillin
    • IV cefazolin for women allergic to penicillin but not at high risk for anaphylaxis
    • IV clindamycin or IV vancomycin for women allergic to penicillin and at high risk for anaphylaxis
  4. Secondary prevention for infants
    • Evaluation (limited or full)
    • Antibiotic prophylaxis
Major Outcomes Considered
  • Impact of prevention efforts on incidence of perinatal group B streptococcal (GBS) disease
  • Efficacy of intrapartum chemoprophylaxis (i.e., administration of antimicrobial agents after onset of labor or membrane rupture but before delivery) in preventing both early-onset GBS disease and maternal illness resulting from GBS
  • Adverse or unintended effects of GBS prevention efforts
  • Protective effect of prenatal GBS screening compared with the risk-based approach
  • Accuracy of prenatal screening cultures in identifying intrapartum colonization status

Methodology

Methods Used to Collect/Select the Evidence
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases
Searches of Unpublished Data
Description of Methods Used to Collect/Select the Evidence

The working group identified a subset of topics for in-depth review, including areas in which new technologies and/or evidence had become available since the publication of the 2002 guidelines, areas in which implementation of the 2002 guidelines was found to be suboptimal on the basis of published and unpublished data, and areas in which interpretation of the 2002 guidelines was found to be variable on the basis of inquiries received at the Centers for Disease Control and Prevention (CDC) and the experience of experts in the field. For these topics, a thorough review was conducted of published literature through PubMed searches, other sources (including abstracts and conference proceedings), and unpublished data from ongoing surveillance and research activities of which the working group was aware.

Number of Source Documents

Not stated

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Quality of Evidence Supporting Recommendation*

  1. Evidence from at least one well-executed randomized, controlled trial or one rigorously designed laboratory-based experimental study that has been replicated by an independent investigator
  2. Evidence from at least one well-designed clinical trial without randomization; cohort or case-controlled analytic studies (preferably from more than one center); multiple time-series studies; dramatic results from uncontrolled studies; or some evidence from laboratory experiments
  3. Evidence from opinions of respected authorities based on clinical or laboratory experience, descriptive studies, or reports of expert committees

*Adapted from LaForce FM. Immunizations, immunoprophylaxis, and chemoprophylaxis to prevent selected infections. US Preventive Services Task Force. JAMA 1987;257:2464-70.

Methods Used to Analyze the Evidence
Systematic Review with Evidence Tables
Description of the Methods Used to Analyze the Evidence

For topics on which several sources of data were available, evidence was summarized in tables. For topics on which relatively little new evidence was available, summaries of pertinent data were provided to working group members. Expert opinion was sought from working group members regarding topics on which no new evidence was available.

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

In November 2008, the Centers for Disease Control and Prevention (CDC) formed a technical working group to revise the 2002 guidelines. The group consisted of representatives from the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice, the American College of Nurse-Midwives (ACNM), the American Academy of Pediatrics (AAP) Committee on Infectious Diseases and Committee on the Fetus and Newborn, the American Academy of Family Physicians (AAFP), the Society for Healthcare Epidemiology of America, the American Society for Microbiology (ASM), and CDC's Active Bacterial Core surveillance system, as well as experts in group B streptococcus (GBS) epidemiology, clinical microbiology, and pharmacology. The group held regular telephone conference calls to identify potential areas of change in the recommendations to prevent GBS disease, and to define sources of newly available data (published and unpublished) to inform the revision of the guidelines.

In June 2009, an in-person meeting of the technical working group was held to review available data and develop updated recommendations using an evidence-based approach when possible and relying on expert scientific opinion when sufficient data were lacking.

Rating Scheme for the Strength of the Recommendations

Strength of Recommendations*

  1. Strong evidence for efficacy and substantial clinical benefit (Strongly recommended)
  2. Strong or moderate evidence for efficacy, but only limited clinical benefit (Generally recommended)
  3. Insufficient evidence for efficacy or efficacy does not outweigh possible adverse consequences (Optional)
  4. Moderate evidence against efficacy or for adverse outcome (Generally not recommended)
  5. Strong evidence against efficacy or for adverse outcome (Never recommended)

*Adapted from LaForce FM. Immunizations, immunoprophylaxis, and chemoprophylaxis to prevent selected infections. US Preventive Services Task Force. JAMA 1987;257:2464-70.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

Not stated

Recommendations

Major Recommendations

Definitions for the quality of evidence (I-III) and strength of recommendations (A-E) are provided at the end of the "Major Recommendations" field.

The key changes in the 2010 guidelines include the following:

  • Expanded recommendations on laboratory methods for the identification of group B Streptococcus (GBS)
  • Clarification of the colony-count threshold required for reporting GBS detected in the urine of pregnant women
  • Updated algorithms for GBS screening and intrapartum chemoprophylaxis for women with preterm labor or preterm premature rupture of membranes
  • A change in the recommended dose of penicillin-G for chemoprophylaxis
  • Updated prophylaxis regimens for women with penicillin allergy
  • A revised algorithm for management of newborns with respect to risk for early-onset GBS disease

The following updated recommendations for the prevention of early-onset GBS disease are based on critical appraisal of data that have become available since publication of previous Centers for Disease Control and Prevention (CDC) and American College of Obstetricians and Gynecologists (ACOG) recommendations and replace previous recommendations from CDC.

Obstetric and neonatal health-care providers, in conjunction with supporting laboratories and labor and delivery facilities, should adopt the following recommendations for the prevention of early-onset GBS disease.

Identification of Candidates for Intrapartum Antibiotic Prophylaxis

Universal Screening for GBS

Candidates to receive intrapartum antibiotic prophylaxis to prevent early-onset GBS disease should be identified according to the indications and nonindications provided (see Table 3 in the original guideline document).

The following are key components of the screening strategy:

  • Women with GBS isolated from the urine at any time during the current pregnancy or who had a previous infant with invasive GBS disease should receive intrapartum antibiotic prophylaxis and do not need third trimester screening for GBS colonization (AII). Women with symptomatic or asymptomatic GBS urinary tract infection detected during pregnancy should be treated according to current standards of care for urinary tract infection during pregnancy and should receive intrapartum antibiotic prophylaxis to prevent early-onset GBS disease (AIII).
  • All other pregnant women should be screened at 35–37 weeks' gestation for vaginal and rectal GBS colonization (AII).
  • At the time of labor or rupture of membranes, intrapartum antibiotic prophylaxis should be given to all pregnant women who tested positive for GBS colonization (AII), except in the instance of cesarean delivery performed before onset of labor on a woman with intact amniotic membranes.
  • For circumstances in which screening results are not available at the time of labor and delivery, intrapartum antibiotic prophylaxis should be given to women who are <37 weeks and 0 days' gestation, have a duration of membrane rupture ≥18 hours, or have a temperature of ≥100.4° F (≥38.0°C) (AII).
  • In the absence of GBS urinary tract infection, antimicrobial agents should not be used before the intrapartum period to eradicate GBS genitorectal colonization, because such treatment is not effective in eliminating carriage or preventing neonatal disease and can cause adverse consequences (DI).
  • Intrapartum antibiotic prophylaxis to prevent early-onset GBS disease is not recommended as a routine practice for cesarean deliveries performed before labor onset on women with intact amniotic membranes, regardless of the GBS colonization status of the woman or the gestational age of the pregnancy (CIII). The use of perioperative prophylactic antibiotics to prevent infectious complications of cesarean delivery should not be altered or affected by GBS status. Women expected to undergo cesarean deliveries should undergo routine vaginal and rectal screening for GBS at 35–37 weeks' gestation because onset of labor or rupture of membranes can occur before the planned cesarean delivery, and under those circumstances GBS-colonized women should receive intrapartum antibiotic prophylaxis (AII).
  • Health-care providers should inform women of their GBS screening test result and the recommended interventions (BIII).

The following key changes were made from the 2002 guidelines:

  • Guidance regarding cesarean deliveries performed before onset of labor on a woman with intact amniotic membranes is clarified as applying to cesarean deliveries performed at any gestational age (CIII).
  • In settings in which nucleic acid amplification test (NAAT) for GBS is available, obstetric providers can choose to perform intrapartum testing of vaginal-rectal samples from women with unknown GBS colonization status and no intrapartum risk factors (temperature of ≥100.4° F [≥38.0°C] or rupture of amniotic membranes ≥18 hours) at the time of testing and who are delivering at term (CII). If an intrapartum risk factor subsequently develops, antibiotic prophylaxis should be administered regardless of the intrapartum testing results (AIII).
  • Women with positive intrapartum NAAT results for GBS should receive antibiotic prophylaxis (AII). NAAT testing is optional and might not be available in all settings.

Threatened Preterm Delivery

Women admitted with signs and symptoms of preterm labor (before 37 weeks and 0 days' gestation) should be managed according to the algorithm provided (see Figure 5 in the original guideline document). Women with rupture of membranes at <37 weeks and 0 days' gestation should be managed according to the algorithm provided (see Figure 6 in the original guideline document).

The following are key components of threatened preterm delivery GBS management:

  • Women admitted with signs and symptoms of labor or with rupture of membranes at <37 weeks and 0 days' gestation should be screened for GBS colonization at hospital admission unless a vaginal-rectal GBS screen was performed within the preceding 5 weeks (AII).
  • Women admitted with signs and symptoms of preterm labor who have unknown GBS colonization status at admission or a positive GBS screen within the preceding 5 weeks should receive GBS prophylaxis at hospital admission (AII).
  • Antibiotics given for GBS prophylaxis to a woman with preterm labor should be discontinued immediately if at any point it is determined that she is not in true labor or if the GBS culture at admission is negative (AII).
  • Negative GBS colonization status should not affect the administration of antibiotics for other indications (AIII).
  • Women with threatened preterm delivery who have a GBS screen performed that is positive and do not deliver at that time should receive GBS prophylaxis when true labor begins (AII).
  • Women with threatened preterm delivery who have a GBS screen performed that is negative but do not deliver at that time should undergo repeat screening at 35–37 weeks' gestation. If such women are re-admitted at a later date with threatened preterm delivery, they should undergo repeat screening if the previous culture was performed >5 weeks prior (AIII).

The following key changes were made from the 2002 guidelines:

  • Separate algorithms are presented for GBS prophylaxis in the setting of threatened preterm delivery, one for spontaneous preterm labor (see Figure 5 in the original guideline document) and one for preterm premature rupture of membranes (see Figure 6 in the original guideline document).
  • GBS prophylaxis provided to women with signs and symptoms of preterm labor should be discontinued if it is determined that the patient is not in true labor (AI).
  • Antibiotics given to prolong latency for preterm premature rupture of membranes with adequate GBS coverage (specifically 2 g ampicillin administered intravenously followed by 1 g administered intravenously every 6 hours for 48 hours) are sufficient for GBS prophylaxis if delivery occurs while the patient is receiving that antibiotic regime (CIII). Oral antibiotics alone are not adequate for GBS prophylaxis (DII).
  • Women with preterm premature rupture of membranes who are not in labor and are receiving antibiotics to prolong latency with adequate GBS coverage should be managed according to standard of care for preterm premature rupture of membranes; GBS testing results should not affect the duration of antibiotics (BIII).
  • Women with preterm premature rupture of membranes who are not in labor and are not receiving antibiotics to prolong latency (or are receiving antibiotics that do not have adequate GBS coverage) should receive GBS prophylaxis for 48 hours, unless a GBS screen performed within the preceding 5 weeks was negative (CIII). If the results from a GBS screen performed on admission become available during that 48-hour period and are negative, then GBS prophylaxis should be discontinued at that time.

GBS Specimen Collection and Processing

GBS specimen collection and processing should be conducted according to the recommendations provided (see Boxes 1–3 and Figure 7 in the original guideline document).

The following are key components of specimen collection and processing:

  • GBS colonization status should be determined by collecting both vaginal and rectal specimens at 35–37 weeks' gestation. A single combined vaginal-rectal specimen can be collected (AII).
  • Specimens should undergo 18–24 hour incubation at 35°–37°C in an appropriate enrichment broth medium to enhance the recovery of GBS (AI).
  • Accurate results are more important than rapid turnaround time for antenatal screening (AIII).
  • To ensure proper testing of specimens, clinicians must inform laboratories when submitted urine specimens are from pregnant women (AIII).
  • Antimicrobial susceptibility testing should be performed on antenatal GBS isolates from penicillin-allergic women at high risk for anaphylaxis because of a history of anaphylaxis, angioedema, respiratory distress, or urticaria following administration of a penicillin or a cephalosporin (AII) (see Box 3 in the original guideline document).

The following key changes were made from the 2002 guidelines:

  • Specimen transport options and timing until processing are clarified.
  • GBS identification options are expanded to include a positive identification from chromogenic media and identification directly from enriched broth. NAAT, such as commercially available polymerase chain reaction (PCR) assays, can also be used after enrichment, if laboratories have validated NAAT performance and instituted appropriate quality controls (CII).
  • A direct plating option can be included in addition to enriched culture (CII). Direct plating has a lower sensitivity than enriched culture and should not be used as sole means to identify GBS.
  • Testing for inducible clindamycin resistance should be performed on antenatal GBS isolates that are susceptible to clindamycin, resistant to erythromycin, and are from penicillin-allergic women at high risk for anaphylaxis (CIII).
  • Laboratories should report GBS in urine culture specimens when present at concentrations of ≥104 colony-forming units/ml in pure culture or mixed with a second microorganism (AII) (see Box 4 in the original guideline document).

Intrapartum Antibiotic Prophylaxis

Intrapartum antibiotic prophylaxis agents and dosing should be administered according to the recommendations provided (see Figure 8 in the original guideline document).

The following are key components of intrapartum antibiotic prophylaxis agents and dosing:

  • Penicillin remains the agent of choice for intrapartum antibiotic prophylaxis, with ampicillin as an acceptable alternative (AI).
  • Penicillin-allergic women who do not have a history of anaphylaxis, angioedema, respiratory distress or urticaria following administration of a penicillin or a cephalosporin should receive cefazolin (BII).
  • Antimicrobial susceptibility testing should be ordered for antenatal GBS cultures performed on penicillin-allergic women at high risk for anaphylaxis because of a history of anaphylaxis, angioedema, respiratory distress or urticaria following administration of a penicillin or a cephalosporin (AII). To ensure proper testing, clinicians must inform laboratories of the need for antimicrobial susceptibility testing in such cases (AIII).
  • Penicillin-allergic women at high risk for anaphylaxis should receive clindamycin if their GBS isolate is susceptible to clindamycin and erythromycin, as determined by antimicrobial susceptibility testing; if the isolate is sensitive to clindamycin but resistant to erythromycin, clindamycin may be used if testing for inducible clindamycin resistance is negative (CIII). Penicillin-allergic women at high risk for anaphylaxis should receive vancomycin if their isolate is intrinsically resistant to clindamycin as determined by antimicrobial susceptibility testing, if the isolate demonstrates inducible resistance to clindamycin, or if susceptibility to both agents is unknown (CIII) (see Box 3 in the original guideline document).

The following key changes were made from the 2002 guidelines:

  • The definition of high risk for anaphylaxis is clarified as a history of anaphylaxis, angioedema, respiratory distress or urticaria following administration of a penicillin or a cephalosporin.
  • The recommended dosing regimen of penicillin G is 5 million units intravenously, followed by 2.5–3.0 million units intravenously every 4 hours (AII). The range of 2.5–3.0 million units is recommended to achieve adequate drug levels in the fetal circulation and amniotic fluid while avoiding neurotoxicity. The choice of dose within that range should be guided by which formulations of penicillin G are readily available in order to reduce the need for pharmacies to specially prepare doses.
  • Erythromycin is no longer an acceptable alternative for intrapartum GBS prophylaxis for penicillin-allergic women at high risk for anaphylaxis.

Other Obstetric Management Issues

  • Available data are not sufficient to suggest that GBS colonization should differentially affect the use of obstetric procedures for monitoring, cervical ripening or labor induction. These procedures should be reserved for appropriate indications and not altered for GBS-colonized women (CIII).
  • Data are not sufficient to make recommendations regarding the timing of procedures intended to facilitate progression of labor, such as amniotomy, in GBS-colonized women. Intrapartum antibiotic prophylaxis is optimal if administered for at least 4 hours before delivery; therefore, such procedures should be timed accordingly, if possible (CIII).
  • No medically necessary obstetric procedure should be delayed in order to achieve 4 hours of GBS prophylaxis before delivery (AIII).

Secondary Prevention among Infants

To detect potential sepsis cases in newborns as early as possible, newborns should be managed according to the algorithm provided (see Figure 9 in the original guideline document). The following are key components of the neonatal management algorithm:

  • Any newborn with signs of sepsis should receive a full diagnostic evaluation and receive antibiotic therapy pending the results of the evaluation. The evaluation should include a blood culture; a complete blood count (CBC) including white blood cell differential and platelet count; a chest radiograph if any abnormal respiratory signs are present; and a lumbar puncture if the newborn is stable enough to tolerate the procedure and sepsis is suspected. Therapy for the infant should include antimicrobial agents active against GBS (including intravenous ampicillin) as well as other organisms that might cause neonatal sepsis, such as Escherichia coli (AII).
  • Well-appearing newborns whose mothers had suspected chorioamnionitis should undergo a limited evaluation and receive antibiotic therapy pending culture results (AII). The evaluation should include a blood culture and a CBC including white blood cell differential and platelet count; no chest radiograph or lumbar puncture is needed. Consultation with obstetric providers to assess whether chorioamnionitis was suspected is important to determine neonatal management (CIII).
  • Well-appearing infants whose mothers had no chorioamnionitis and no indication for GBS prophylaxis should be managed according to routine clinical care (CIII).
  • Well-appearing infants of any gestational age whose mothers received adequate intrapartum GBS prophylaxis (≥4 hours of penicillin, ampicillin, or cefazolin before delivery) should be observed for ≥48 hours, and no routine diagnostic testing is recommended (BIII). Such infants can be discharged home as early as 24 hours after delivery, assuming that other discharge criteria have been met, ready access to medical care exists, and that a person able to comply fully with instructions for home observation will be present (CIII).
  • For well-appearing infants born to mothers who had an indication for GBS prophylaxis but received no or inadequate prophylaxis, if the infant is well-appearing and ≥37 weeks and 0 days' gestational age and the duration of membrane rupture before delivery was <18 hours, then the infant should be observed for ≥48 hours, and no routine diagnostic testing is recommended (BIII). If the infant is well-appearing and either <37 weeks and 0 days' gestational age or the duration of membrane rupture before delivery was ≥18 hours, then the infant should undergo a limited evaluation and observation for ≥48 hours (BIII).

The following key changes were made from the 2002 guidelines:

  • The algorithm now applies to all newborns.
  • The definition of adequate intrapartum antibiotic prophylaxis is clarified as ≥4 hours of IV penicillin, ampicillin, or cefazolin before delivery (AII). All other agents or durations are considered inadequate for purposes of neonatal management.
  • Well-appearing infants whose mothers had an indication for GBS prophylaxis but received no or inadequate intrapartum antibiotics can be managed with observation for ≥48 hours, unless the infant is <37 weeks and 0 days' gestational age or membranes were ruptured ≥18 hours before delivery, in which case a limited evaluation and observation for ≥48 hours is recommended (BIII).
  • Well-appearing infants with a gestational age of 35–36 weeks whose mothers received adequate intrapartum antibiotic prophylaxis do not routinely require diagnostic evaluations (CIII).

Monitoring Implementation and Impact of Guidelines

  • Local and state public health agencies, in conjunction with appropriate groups of hospitals, are encouraged to establish surveillance for early-onset GBS disease and to take other steps to promote perinatal GBS disease prevention and education to reduce the incidence of early-onset GBS disease in their states (CIII).
  • Efforts to monitor the emergence of perinatal infections caused by other organisms are also encouraged (CIII).

Definitions:

Quality of Evidence Supporting Recommendations*

  1. Evidence from at least one well-executed randomized, controlled trial or one rigorously designed laboratory-based experimental study that has been replicated by an independent investigator
  2. Evidence from at least one well-designed clinical trial without randomization; cohort or case-controlled analytic studies (preferably from more than one center); multiple time-series studies; dramatic results from uncontrolled studies; or some evidence from laboratory experiments
  3. Evidence from opinions of respected authorities based on clinical or laboratory experience, descriptive studies, or reports of expert committees

Strength of Recommendations*

  1. Strong evidence for efficacy and substantial clinical benefit (Strongly recommended)
  2. Strong or moderate evidence for efficacy, but only limited clinical benefit (Generally recommended)
  3. Insufficient evidence for efficacy; or efficacy does not outweigh possible adverse consequences. (Optional)
  4. Moderate evidence against efficacy or for adverse outcome. (Generally not recommended)
  5. Strong evidence against efficacy or for adverse outcome. (Never recommended)

*Adapted from LaForce FM. Immunizations, immunoprophylaxis, and chemoprophylaxis to prevent selected infections. US Preventive Services Task Force. JAMA 1987;257:2464-70.

Clinical Algorithm(s)

The following algorithms are provided in the original guideline document:

  • Algorithm for screening for group B streptococcal (GBS) colonization and use of intrapartum prophylaxis for women with preterm labor (PTL)
  • Algorithm for screening for group B streptococcal (GBS) colonization and use of intrapartum prophylaxis for women with preterm premature rupture of membranes (pPROM)
  • Algorithm for recommended laboratory testing for prenatal screening for group B streptococcal (GBS) colonization
  • Recommended regimens for intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal (GBS) disease
  • Algorithm for secondary prevention of early-onset group B streptococcal (GBS) disease among newborns

Evidence Supporting the Recommendations

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits
  • A large population-based study conducted during 1998–1999 demonstrated the superiority of culture-based screening over the risk-based approach to prevention of early-onset group B streptococcal (GBS) disease. The study found that culture-based screening resulted in the identification of a greater proportion of women at risk for transmitting GBS to their newborns. Furthermore, women with a positive antenatal GBS culture were more likely to receive intrapartum antibiotic prophylaxis than those women with a risk-based indication for chemoprophylaxis.
  • As a result of prevention efforts, incidence of GBS has declined dramatically over the past 15 years, from 1.7 cases per 1,000 live births in the early 1990s to 0.34–0.37 cases per 1,000 live births in recent years. Early trials suggested an efficacy of 100% for intrapartum antibiotic prophylaxis to prevent early-onset disease among infants born to women with GBS colonization. Subsequent observational studies have found the effectiveness to be 86%–89% among infants born to women who received intrapartum GBS prophylaxis.
  • Appropriate use of antibiotic prophylaxis for women with threatened preterm delivery is critical. For women remote from term with premature rupture of membranes, clinical trials have demonstrated that certain antibiotic regimens prolong latency.

Subgroups Most Likely to Benefit

  • Pregnant women who are colonized with group B Streptococcus in the genital or rectal areas and who experience either a long duration of membrane rupture, premature delivery, or intrapartum fever
  • Pregnant women who previously delivered an infant who had GBS disease
Potential Harms
  • Potential adverse or unintended effects of group B streptococcal (GBS) prevention efforts that have raised concern include allergic or anaphylactic reactions to agents used for intrapartum antibiotic prophylaxis, emergence of GBS strains resistant to standard therapies, and increasing incidence of serious neonatal infections caused by pathogens other than GBS, including antimicrobial-resistant strains.
  • Some false-negative screening results are expected because culture is not perfectly sensitive and GBS can be acquired by the mother during the period between screening and delivery.

Qualifying Statements

Qualifying Statements
  • Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.
  • References to non-Centers for Disease Control and Prevention (CDC) sites on the Internet are provided as a service to Morbidity and Mortality Weekly Report (MMWR) readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of these sites. URL addresses listed in MMWR were current as of the date of publication.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools
Chart Documentation/Checklists/Forms
Clinical Algorithm
Foreign Language Translations
Patient Resources
Resources
Slide Presentation
Staff Training/Competency Material
For information about availability, see the Availability of Companion Documents and Patient Resources fields below.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Staying Healthy
IOM Domain
Effectiveness
Patient-centeredness

Identifying Information and Availability

Bibliographic Source(s)
Verani JR, McGee L, Schrag SJ, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010 Nov 19;59(RR-10):1-36. [264 references] PubMed External Web Site Policy
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
1996 May 31 (revised 2010 Nov 19)
Guideline Developer(s)
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]
Source(s) of Funding

United States Government

Guideline Committee

Group B Streptococcus Technical Working Group

Composition of Group That Authored the Guideline

Report Prepared by: Jennifer R. Verani, MD; Lesley McGee, PhD; Stephanie J. Schrag, DPhil, of the Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases

Working Group Members: Kathryn Arnold, MD, Georgia Division of Public Health, Barbara Stoll, MD, Yun Wang, MD, PhD, Emory University School of Medicine, Atlanta, Georgia; Carol Baker, MD, Baylor College of Medicine, Houston, Texas; Carrie Byington, MD, American Academy of Pediatrics/Committee on Infectious Diseases, Richard Polin, MD, American Academy of Pediatrics/Committee on Fetus and Newborn, Elk Grove Village, Illinois; Ronald Gibbs, MD, University of Colorado School of Medicine, Denver, Colorado; Jeanne Jordan, PhD, George Washington University School of Public Health and Health Services, Sarah Kilpatrick, MD, PhD, American College of Obstetricians and Gynecologists, District of Columbia; Geraldine Hall, PhD, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio; Tekoa King, MPH, American College of Nurse Midwives, Silver Spring, Maryland; Ruth Lynfield, MD, Minnesota Department of Health, Minneapolis, Minnesota; Marti Perhach, Group B Strep International, Pomona, California; Laura Riley, MD, Massachusetts General Hospital, Boston, Massachusetts; Pablo Sanchez, MD, Society for Healthcare Epidemiology of America, Arlington, Virginia; Pamela Simms, PhD, PharmD, Samford University McWhorter School of Pharmacy, Birmingham, Alabama; Julie Wood, MD, American Academy of Family Physicians, Leawood, Kansas; Rex Astles, PhD, Bernard Beall, PhD, Roberta Carey, PhD, Janine Corey, MPH, Lee Hampton, MD, Denise Jamieson, MD, Melissa Lewis, MPH, Michael Miller, PhD, Christine Olson, MD, Alison Patti, MPH, Emily Weston, MPH, Cynthia Whitney, MD, Elizabeth Zell, MStat, CDC, Atlanta, Georgia

Financial Disclosures/Conflicts of Interest
  • The Centers for Disease Control and Prevention (CDC), their planners, and their content experts wish to disclose they have no financial interests or other relationships with the manufacturers of commercial products, suppliers of commercial services, or commercial supporters. Presentations will not include any discussion of the unlabeled use of a product or a product under investigational use.
  • All working group members were asked to disclose any potential conflict of interest. Ronald Gibbs disclosed receiving a consulting fee from Novartis for consulting on potential vaccine complications (unrelated to group B Streptococcus [GBS]); Lee Hampton disclosed owning shares in General Electric; and Laura Riley disclosed receiving an honorarium from Up To Date for services as a writer.
Guideline Endorser(s)
American Academy of Family Physicians - Medical Specialty Society
American Academy of Pediatrics - Medical Specialty Society
American College of Nurse-Midwives - Professional Association
American College of Obstetricians and Gynecologists - Medical Specialty Society
American Society for Microbiology - Professional Association
Guideline Status

This is the current release of the guideline.

This guideline updates a previous version: Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. MMWR Recomm Rep 2002 Aug 16;51(RR-11):1-22.

Guideline Availability

Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.

Print copies: Available from the Centers for Disease Control and Prevention, MMWR, Atlanta, GA 30333. Additional copies can be purchased from the Superintendent of Documents, U.S. Government Printing Office, Washington, DC 20402-9325; (202) 783-3238.

Availability of Companion Documents

The following are available:

  • Early-onset group B streptococcal disease prevention: for clinicians. Slide set. Atlanta (GA): Centers for Disease Control and Prevention; 2010. Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy.
  • Early-onset group B streptococcal disease prevention: procedures for laboratories. Slide set. Atlanta (GA): Centers for Disease Control and Prevention; 2010. Electronic copies: Available from the CDC Web site External Web Site Policy.
  • Q&As about implementing the 2010 guidelines for obstetric providers. Atlanta (GA): Centers for Disease Control and Prevention; 2010. Electronic copies: Available from the CDC Web site External Web Site Policy.
  • Q&As about implementing the 2010 guidelines for neonatal providers. Atlanta (GA): Centers for Disease Control and Prevention; 2010. Electronic copies: Available from the CDC Web site External Web Site Policy.

A variety of other educational group B streptococcal (GBS) materials are available through the CDC Group B Streptococcal Disease Web site External Web Site Policy.

In addition, a continuing medical education (CME) examination is available from the CDC Web site External Web Site Policy.

Patient Resources

The following are available:

  • Are you pregnant? Protect your baby from group B strep. Brochure. Atlanta (GA): Centers for Disease Control and Prevention; 2002. 2 p. Electronic copies: Available from the Centers for Disease Control and Prevention (CDC) Web site External Web Site Policy. Also available in Spanish External Web Site Policy.
  • Group B strep. What you need to know. Patient handout. Atlanta (GA): Centers for Disease Control and Prevention. 2 p. Electronic copies: Available from the CDC Web site External Web Site Policy.

A variety of other patient-related group B streptococcal (GBS) materials, including prenatal testing cards for patients, are available through the CDC Group B Streptococcal Disease Web site External Web Site Policy.

Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information, it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.

NGC Status

This NGC summary was completed by ECRI on January 15, 1998. The information was verified by the guideline developer as of March 1, 1999. The summary was updated by ECRI on October 21, 2002. This NGC summary was updated by ECRI Institute on February 17, 2011.

Copyright Statement

No copyright restrictions apply.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

Read full disclaimer...