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Delivering the 2010 Perinatal Group B Streptococcal Disease Prevention Guidelines

Categories: Healthcare-associated infections

Denise J. Jamieson, M.D.

Denise J. Jamieson, M.D.

Author — Denise J. Jamieson, M.D.
Medical Officer
CDC’s Division of Reproductive Health

As an obstetrician-gynecologist who practices at Grady, a large urban teaching hospital in Atlanta, I often have the opportunity to witness how guidance developed at CDC is translated into clinical practice.  For example, in my role as a CDC medical officer, I participated in the CDC workgroup that helped develop the 2010 revised guidelines for the prevention of perinatal Group B Streptococcal (GBS) disease.  Following the release of the new guidelines, I was able to see how the recommendations were interpreted and used in my role as a practicing obstetrician-gynecologist at Grady.

Shorty after the release of the revised GBS guidelines, Dr. Catherine Hudson, one of the Emory residents, presented the new recommendations on morning rounds while I was the attending physician on labor and delivery.  To me, one of the many delightful (and humbling!) things about being at a teaching hospital is how much you can learn from the residents!  Dr. Hudson was able to distill the essential points of the 32-page document concisely and accurately while integrating her own clinical perspective. 

One of the issues that Dr. Hudson chose to highlight was how to manage GBS prophylaxis in a pregnant patient who reports a penicillin allergy, a common clinical situation in our patient population.  If the patient reports a history of a penicillin allergy, it is critical to take a detailed history and find out what symptoms she had after receiving penicillin.  If she reports a history of anaphylaxis, angioedema, respiratory distress, or urticaria, then antimicrobial susceptibility testing should be ordered at the time the third trimester vaginal-rectal swab is collected.  If she is not at high risk for anaphylaxis (no history of anaphylaxis, angioedema, respiratory distress, or urticaria), then she should receive cefazolin if GBS prophylaxis is indicated.  I realize that even in this circumstance of a patient who is at low risk of anaphylaxis to penicillin we are sometimes hesitant to give a cephalosporin to those with penicillin allergies, but beta-lactam-cephalosporin cross reactivity is relatively uncommon for such women, and cefazolin is more effective for GBS prevention than clindamycin or vancomycin. In addition, GBS resistance to clindamycin is increasing, so antimicrobial susceptibility testing is necessary if clindamycin is going to be used. If susceptibility testing has not been performed, then vancomycin is the preferred agent for penicillin-allergic women at high risk for anaphylaxis. It is sometimes challenging in our patient population because a relatively high proportion of patients do not receive regular prenatal care and therefore may present in labor without GBS screening.  In these cases, it is critical to obtain a careful history, including any prior penicillin allergy, to give women the most effective prophylaxis agent and also to avoid the overuse of vancomycin.

What are some of the challenges you have found in translating the new CDC guidance “Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines from CDC, 2010” into your clinical practice?

Related Link:

Updated Guidelines for Prevention of Perinatal Group B Strep Disease, an expert commentary from CDC in partnership with Medscape

Public Comments

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  1. April 5, 2011 at 12:00 am ET  -   Ruby Osorio

    Thank you for your valuable post.

    We have decided to share it with our global physician audience at PhysicianNexus.com: http://physiciannexus.com/forum/topics/delivering-the-2010-perinatal

    Ruby
    Team Member
    http://www.PhysicianNexus.com
    Physicians connecting worldwide

    Link to this comment

  2. February 21, 2011 at 7:19 pm ET  -   Stephanie Harris

    Hello,
    I am not in a medical field. I am a parent who lost her teenage daughter due to undetected Group B strep. However, your website speaks primarily to perinatal GBS. Last June my 16 year old daughter contracted Group B strep, which went undetected despite 2 trips to pediatrican, and a trip to the emergency room and a trip to the infirmary. Because of the infection she developed endocarditis, which caused blood clots, which subsequently caused 2 massive strokes. She was a healthy child with no diagnosed illnesses except asthma (went away at age 9). All this to say is there ANY other information regarding how Group B strep is contracted. She developed a fever and in less than 10 days she had 2 strokes and passed away. Very scary, please, please help me find more information on how this disease could move so rapidly without detection. I don’t know where else to turn.
    Respectfully,
    Stephanie Harris

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  3. February 13, 2011 at 1:59 am ET  -   Michael E. Bailey

    I also think that a detailed, careful medical history and assessment are two of the most critical steps to be taken at the time a pregnant woman presents herself at the hospital, especially if she has not been seen on a regular basis during the 9 months of pregnancy. Communication between the patient and doctor is crucial. After a detailed medical history and assessment has been done, it can more easily be determined which medication should be given.

    Today, unlike in the past, women who have developmental disabilities now can marry, be pregnant and have children; and they are a special case. The same detailed medical history and assessment should be given but the patient’s independent living or supported living staff person should also be present to help in interpreting what is being said and help in answering the questions. The patient may not be able to understand what is going on, may not read or not read well, and/or may have communications and speech problems making it hard to understand what she is telling the doctor. The independent living or supported living program should have a written record of all the patient’s doctor and hospital visits for the entire time she has been with the program and covering the reason for each vist, the treatment, the doctor’s name, and the facilitiy’s name and address. Information to such a patient needs to be as simple and easy to understand as possible including using pictures to describe complex ideas; and it should be available in different formats such as Braille, Large Print, and vedio sign language translation.

    For women who don’t speak English that well, the collecting of the medical history should be done in the language the patient feels most comfortable in. Information needs to be avalible in different languages. But the first step should always be the detailed medical history and assessment and next the medication (s) the patient will get. Best wishes, Michael E. Bailey.

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  4. January 12, 2011 at 5:24 am ET  -   Stefanie Bill

    Is these already tested? or is it effective? I think the most important here is a critical history and careful history assessment. And always see to it that dose and home treatment are thought to the client.

    I would be pleased if you would check my website.

    Link to this comment

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