Snapshot A 26-year-old, G2P1, female at 37 weeks gestation was admitted in active labor at 6-cm dilation. Spontaneous rupture of membranes occured prior to admission. Past obstetric history reveals a prior uncomplicated vaginal delivery with one living child. On physical exam, the patient's vital signs are normal and the fetal heart rate tracing is reactive. Her prenatal records reveal a positive vaginal culture for group B streptococci (GBS) at 35 weeks gestation. Intrapartum penicillin G was administered. Introduction Clinical definition gram-positive coccus that frequently colonizes the following areas: genital tract of females gastrointestinal tract upper respiratory tract Associated conditions cystitis and pyelonephritis during pregnancy neonatal sepsis in infants of colonized mothers neonatal meningitis most common cause of neonatal meningitis in developed countries Epidemiology Incidence asymptomatic cervical colonization occurs in up to 30% of women 50% of infants become colonized Presentation Symptoms can have asymptomatic bacteriuria dysuria, increased urinary frequency, and urinary urgency if cystitis is present fever, flank pain, and/or costovertebral angle tenderness if pyelonephritis is present Studies Labs vaginal and rectal culture performed 35-40 weeks gestation exceptions include women with GBS bacteriuria while currently pregnant women with who previously gave birth to their newborn with invasive GBS disease Differential Differential diagnosis of asymptomatic bacteruria Escherichia coli is the most frequently isolated organism Treatment Medical penicillin, amoxicillin, or cephalexin indication pregnant women with asymptomatic GBS bacteriuria with a colony count ≥10^5 intrapartum intravenous penicillin G indication pregnant women colonized with GBS at 35-37 weeks prior birth of an infant with GBS disease unknown status of antepartum culture alternative antibiotics intravenous clindamycin or erythromycin in patients with a penicillin-allergy Complications Complications progression to pyelonephritis associated with untreated, asymptomatic GBS bacteriuria infants of colonized women are at increased risk of GBS sepsis incidence only 1-2% of neonates develop actual disease treatment intravenous penicillin G indicated when GBS is identified as the sole organism Prognosis IIntrapartum prophylaxis has reduced the incidence of neonatal sepsis Mortality rates are higher in preterm infants neonates with meningitis