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Clinical impact of rapid polymerase chain reaction (PCR) test for group B Streptococcus (GBS) in term women with ruptured membranes

  • Enya F. Fullston
  • Michael J. Doyle
  • Mary F. Higgins
  • Susan J. KnowlesEmail author
Original Article

Abstract

Background

Early-onset group B Streptococcus (EOGBS/GBS) infection remains a significant cause of neonatal morbidity and mortality.

Aims

Aiming to improve antimicrobial stewardship and reduce unnecessary maternal and infant exposure to intrapartum antibiotic prophylaxis (IAP), this study assessed the clinical use of a commercially available GBS polymerase chain reaction (PCR) assay for term women with pre-labour rupture of membranes.

Methods

This was a retrospective study in a tertiary level maternity unit of term women with pre-labour rupture of membranes (ROM), without any clinical suspicion of infection performed between November and December 2017. GBS PCR tests were cross-referenced with patient clinical data. PCR test results, the impact of testing on antibiotic administration, pyrexia in labour, induction, interventional delivery rates and neonatal outcomes were analysed.

Results

Of 200 patients included in the study, 29 were positive (14.5%) and 166 were negative (83%), with five invalid results (2.5%). One hundred and twenty three women had > 18-h ruptured membranes and 86 women (70%) who would have been eligible for IAP based on risk factors avoided antibiotic therapy following a negative PCR test. There were no significant differences in induction or interventional delivery rates between GBS-positive and GBS-negative women following PCR testing. During the study period, there were no cases of EOGBS.

Conclusions

In a centre adhering to a risk-factor-based GBS policy, the introduction of limited rapid GBS screening for term women with pre-labour rupture of membranes resulted in a clinically significant reduction in prophylactic antibiotic use.

Keywords

GBS GeneXpert® PCR Term pre-labour ROM 

Notes

Acknowledgements

The authors wish to acknowledge the staff of the National Maternity Hospital and the women attending the hospital.

Author contribution

All four authors meet all the criteria for authorship.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  • Enya F. Fullston
    • 1
  • Michael J. Doyle
    • 1
  • Mary F. Higgins
    • 2
  • Susan J. Knowles
    • 3
    • 4
    • 5
    Email author
  1. 1.School of MedicineUniversity College DublinDublin 4Ireland
  2. 2.UCD Perinatal Research CentreUniversity College Dublin, National Maternity HospitalDublin 2Ireland
  3. 3.Department of MicrobiologyNational Maternity HospitalDublin 2Ireland
  4. 4.Department of MicrobiologyRoyal Victoria Eye and Ear HospitalDublin 2Ireland
  5. 5.National Maternity HospitalDublin 2Ireland

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