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Updated: May 24 2020

Group B Streptococcus Colonization

  • 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
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