Beyond screening - Identifying new barriers to early onset group B streptococcal disease prevention

Background: Group B streptococcal infections remain an important cause of morbidity and mortality in newborns. Methods: Neonatal group B streptococcal cases were identified by active surveillance in 4 urban Tennessee counties. Medical records of mothers of cases and a sample of other pregnant women with live births from the same population were reviewed to determine whether the screening or risk-based approach was used for prevention of early onset group B streptococcal disease and to assess other factors affecting preventability of cases. Results: During 1998 and 1999, 43\% of women underwent prenatal group B streptococcal screening. County of residence was the only factor independently associated with not being screened {[}odds ratio, 7.85; 95\% confidence interval (4.69, 13.16)]. Ten affected babies were born to screened mothers (0.40 per 1000). In 9 of these 10, problems were identified: mothers had positive screening cultures but did not receive optimal intrapartum antibiotics (n = 3 of 4); mothers bad negative screening cultures (n = 4); and mothers were screened, but the results were unknown, and intraparturn antibiotics were not given (n = 2). Conclusions: Challenges to implementation of group B streptococcal screening and prophylaxis include insufficient screening, suboptimal intrapartum antibiotics, disease despite negative screening cultures and timely communication of screening results at delivery. An awareness of such problems may lead to supplemental measures to further reduce group B streptococcal disease.