Advertisement
JOGC

Management of Group B Streptococcal Bacteriuria in Pregnancy

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective

      To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care.

      Outcomes

      The outcomes considered were neonatal GBS disease, preterm birth, pyelonephritis, chorioamnionitis, and recurrence of GBS colonization.

      Evidence

      Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). Low colony counts refer to < 100 000 CFU/mL, and high (significant) colony counts refer to ≥ 100 000 CFU/mL. Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Searches were updated on a regular basis and incorporated in the guideline to February 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.

      Values

      Recommendations were quantified using the evaluation of evidence guidelines developed by the Canadian Task Force on Preventive Health Care (Table).

      Benefits, Harms, and Costs

      The recommendations in this guideline are designed to help clinicians identify pregnancies in which it is appropriate to treat GBS bacteriuria to optimize maternal and perinatal outcomes, to reduce the occurrences of antibiotic anaphylaxis, and to prevent increases in antibiotic resistance to GBS and non-GBS pathogens. No cost-benefit analysis is provided.

      Recommendations

      • 1.
        Treatment of any bacteriuria with colony counts ≥ 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. (II-2A)
      • 2.
        Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the time of labour or rupture of membranes with appropriate intravenous antibiotics for the prevention of early-onset neonatal group B streptococcal disease. (II-2A)
      • 3.
        Asymptomatic women with urinary group B streptococcal colony counts < 100 000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth. (II-2E)
      • 4.
        Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. (II-2D)

      Key Words

      ABBREVIATIONS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Obstetrics and Gynaecology Canada
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Valkenburg-van den Berg A.W.
        • Sprij A.J.
        • Oostvogel P.M.
        • Mutsaers J.A.
        • Renes W.B.
        • Rosendaal D.R.
        • et al.
        Prevalence of colonisation with group B streptococcus in pregnant women of a multi-ethnic population in the Netherlands.
        Eur J Obstet Gynecol Reprod Biol. 2006; 124: 178-183
        • Barcaite E.
        • Bartusevicius A.
        • Tameliene R.
        • Kliucinskas M.
        • Malackiene L.
        • Nadiasauskiene R.
        Prevalence of maternal group B streptococcal colonization in European countries.
        Acta Obstet Gynecol Scand. 2008; 87: 260-271
        • Verani J.R.
        • McGee L.
        • Schrag S.J.
        Prevention of perinatal group B streptococcal disease: revised guidelines from CDC.
        MMWR Recomm Rep. 2010; 59: 1-36
      1. American College of Obstetricians and Gynecologists. ACOG committee opinion. Prevention of early-onset group B streptococcal disease in newborns. No. 279.
        Obstet Gynecol. 2002; 100 (December): 1405-1412
        • Money D.M.
        • Dobson S.
        The prevention of early-onset neonatal group B streptococcal disease: SOGC Clinical Practice Guideline no. 149.
        J Obstet Gynaecol Can. 2004; 26 (September): 826-832
        • Millar L.K.
        • Cox S.M.
        Urinary tract infections complicating pregnancy.
        Infect Dis Clin North Am. 1997; 11: 13-26
        • Smaill F.M.
        • Vazquez J.C.
        Antibiotics for asymptomatic bacteriuria in pregnancy.
        Cochrane Database Syst Rev. 2007; : 490https://doi.org/10.002/1461858
        • Mignini L.
        • Carroli G.
        • Abalos E.
        • Widmer M.
        • Amigot S.
        • Nardin J.M.
        • et al.
        Accuracy of diagnostic tests to detect asymptomatic bacteriuria during pregnancy.
        Obstet Gynecol. 2009; 113: 346-352
        • Sheiner E.
        • Maxor-Drey E.
        • Levy A.
        Asymptomatic bacteriuria during pregnancy.
        J Matern Fetal Neonat Med. 2009; 22: 423-427
        • Nicolle L.E.
        • Bradley S.
        • Colgan R.
        • Rice J.C.
        • Schaeffner A.
        • Hooton T.M.
        Infectious Diseases Society of America Guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.
        Clin Infect Dis. 2005; 40: 643-654
        • Lumbiganon P.
        • Laopaiboon M.
        • Thinkhamrop J.
        Screening and treating asymptomatic bacteriuria in pregnancy.
        Curr Opin Obstet Gynecol. 2010; 22: 95-99
        • Valkenburg-van denBerg A.W.
        • Sprij A.J.
        • Dekker F.W.
        • Dörr P.J.
        • Kanhai H.H.H.
        Association between colonization with group B Streptococcus and preterm delivery: a systematic review.
        Acta Obstet Gynecol. 2009; 88: 958-967
        • Regan J.A.
        • Klebanoff M.A.
        • Nugent R.P.
        The epidemiology of group B streptococcal colonization in pregnancy. Vaginal Infections and Prematurity Study Group.
        Obstet Gynecol. 1991; 77: 604-610
        • Persson K.
        • Christensen K.K.
        • Christensen P.
        • Forsgren A.
        • Jorgensen C.
        • Persson P.
        Asymptomatic bacteriuria in pregnancy with special reference to group B streptococci.
        Scand J Infect Dis. 1985; 17: 195-199
        • Alvarez J.R.
        • Fechner A.J.
        • Williams S.F.
        • Ganesh V.L.
        • Apuzzio J.J.
        Asymptomatic bacteriuria in pregestational diabetic pregnancies and the role of group B streptococcus.
        Am J Perinatol. 2010; 27: 231-234
        • Moller M.
        • Thomsen A.
        • Borch K.
        • Dinsesen K.
        • Zdravkovic M.
        Rupture of membranes and premature delivery associated with group B streptococci in urine of pregnant women.
        Lancet. 1984; 2: 69-70
        • Muller A.E.
        • Oostvogel P.M.
        • Steegers E.A.P.
        • Dörr P.J.
        Morbidity related to maternal group B streptococcal infections.
        Acta Obstet Gynecol. 2006; 85: 1027-1037
        • Guinto V.T.
        • De Guia B.
        • Festin M.R.
        • Dowswell T.
        Different antibiotic regimens for treating asymptomatic bacteriuria in pregnancy.
        Cochrane Database Syst Rev. 2010; (CD007855)https://doi.org/10.1002/14651858
        • Anderson B.L.
        • Simhan H.S.
        • Simons K.M.
        • Wiesenfeld H.C.
        Untreated asymptomatic group B streptococcal bacteriuria early in pregnancy and chorioamnionitis at delivery.
        Am J Obstet Gynecol. 2007; 196: 524-534
        • McKenna D.S.
        • Matson S.
        • Northern I.
        Maternal group B streptococcal (GBS) genital tract colonization at term in women who have asymptomatic GBS bacteriuria.
        Inf Dis Obstet Gynecol. 2003; 11: 203-207
        • Edwards R.K.
        • Clark P.
        • Duff P.
        Intrapartum antibiotic prophylaxis 2: positive predictive value of antenatal group B streptococci cultures and antibiotic susceptibility of clinical isolates.
        Obstet Gynecol. 2002; 100: 540-544
        • Aungst M.
        • King J.
        • Steele A.
        • Gordon M.
        Low colony counts of asymptomatic group B streptococcus bacteriuria: a survey of practice patterns.
        Am J Perinatol. 2004; 21: 403-407
        • Gardner S.E.
        • Yow M.D.
        • Leeds L.J.
        • Thompson P.K.
        • Mason E.O.
        • Clark D.J.
        Failure of penicillin to eradicate group B streptococcal colonization in the pregnant woman.
        Am J Obstet Gynecol. 1979; 135: 1062-1065
        • Thomsen A.C.
        • Mørup L.
        • Hansen K.B.
        Antibiotic elimination of group-B streptococci in urine in the prevention of preterm labour.
        Lancet. 1987; 1: 591-593
        • Chen K.T.
        • Puopolo K.M.
        • Eichenwald E.C.
        • Onderdonk A.B.
        • Lieberman E.
        No increase in rates of early-onset neonatal sepsis by antibiotic-resistant group B Streptococcus in the era of intrapartum antibiotic prophylaxis.
        Am J Obstet Gynecol. 2005; 192: 1167-1171
        • Woolf S.H.
        • Battista R.N.
        • Angerson G.M.
        • Logan A.G.
        • Eel W.
        Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care.
        CMAJ. 2003; 169: 207-208

      Linked Article

      • ERRATA
        Journal of Obstetrics and Gynaecology Canada Vol. 37Issue 6
        • Preview
          Allen VM, Yudin MH, Bouchard C, Boucher M, Caddy S, Castillo E, et al.; Society of Obstetricians and Gynaecologists of Canada Infectious Diseases Committee. Management of Group B Streptococcal Bacteriuria in Pregnancy. SOGC Clinical Practice Guideline, No. 276, May 2012. J Obstet Gynaecol Can 2012;34(5):482–6.
        • Full-Text
        • PDF