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Background: Early-onset group B streptococcal (EOGBS) disease (including sepsis, meningitis, and pneumonia) causes significant morbidity and mortality in newborn infants worldwide. Antibiotic prophylaxis can prevent vertical streptococcal transmission, yet no uniform criteria to identify eligible women for prophylaxis exist. Some guidelines recommend universal GBS screening to pregnant women in their third trimester (screening-based protocol), while others employ risk-based protocols.
Search strategy: Key words for the database searches included GBS, Streptococcus agalactiae, pregnancy, screening, culture-based, risk-based.
Data collection and analysis: : Risk ratios (RR) and 95% confidence intervals (CI) were determined using Mantel-Haenszel analyses with random effects.
Main results:: 17 eligible studies were included. In this meta-analysis , screening was associated with a reduced risk against EOGBS disease compared either with risk-based protocols (10 studies, RR 0.43, 95% CI 0.32-0.56), or with no policy (4 studies, RR 0.31 95% CI 0.11-0.84). Meta-analysis could not demonstrate a significant effect of risk-based protocols vs. no policy (7 studies, RR 0.86, 95% CI 0.61-1.20). In studies reporting on the use of antibiotics, screening was not associated with higher antibiotic administration rates (31% vs 29%).
Conclusions: Screening-based protocols were associated with lower incidences of EOGBS disease compared to risk-based protocols, while not clearly overexposing women to antibiotics. This information is of relevance for future policymaking.
GF Hasperhoven,S Al-Nasiry,V Bekker,E Villamor,BWW Kramer