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

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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.

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Acknowledgements

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

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Authors and Affiliations

  1. School of Medicine, University College Dublin, Dublin 4, Ireland

    Enya F. Fullston & Michael J. Doyle

  2. UCD Perinatal Research Centre, University College Dublin, National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Mary F. Higgins

  3. Department of Microbiology, National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Susan J. Knowles

  4. Department of Microbiology, Royal Victoria Eye and Ear Hospital, Dublin 2, Ireland

    Susan J. Knowles

  5. National Maternity Hospital, Holles Street, Dublin 2, Ireland

    Susan J. Knowles

Authors
  1. Enya F. Fullston
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  2. Michael J. Doyle
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  3. Mary F. Higgins
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  4. Susan J. Knowles
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Contributions

All four authors meet all the criteria for authorship.

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Correspondence to Susan J. Knowles.

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Fullston, E.F., Doyle, M.J., Higgins, M.F. et al. Clinical impact of rapid polymerase chain reaction (PCR) test for group B Streptococcus (GBS) in term women with ruptured membranes. Ir J Med Sci 188, 1269–1274 (2019). https://doi.org/10.1007/s11845-019-01977-x

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  • DOI: https://doi.org/10.1007/s11845-019-01977-x

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