From the Guidelines
Women with Group B Streptococcus (GBS) urinary tract infection detected during pregnancy should be treated according to current standards of care for urinary tract infection during pregnancy. The treatment of GBS urinary tract infections is crucial to prevent complications such as preterm labor and neonatal sepsis. According to the guidelines from the CDC, as stated in 1 and updated in 1, women with GBS isolated from the urine in any concentration during their current pregnancy should receive intrapartum chemoprophylaxis because such women usually are heavily colonized with GBS and are at increased risk of delivering an infant with early-onset GBS disease.
Key Considerations for Treatment
- The choice of antibiotic should be based on the severity of the infection and the patient's allergy history.
- For patients without penicillin allergies, penicillin or ampicillin are recommended as first-line options.
- For patients with penicillin allergies, alternatives such as ceftriaxone, vancomycin, or clindamycin may be used.
- It is essential to complete the full course of antibiotics even if symptoms improve and to follow up with the healthcare provider to ensure the infection has cleared completely.
Importance of Screening and Intrapartum Chemoprophylaxis
- Universal screening at 35–37 weeks’ gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns, as noted in 1.
- Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease.
- The guidelines emphasize the importance of monitoring for potential adverse consequences of intrapartum antibiotic prophylaxis, such as the emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens.
Management of Newborns
- Routine use of antimicrobial prophylaxis for newborns whose mothers received intrapartum chemoprophylaxis for GBS infection is not recommended, as stated in 1.
- However, therapeutic use of these agents is appropriate for infants with clinically suspected sepsis.
- An updated algorithm for management of infants born to mothers who received intrapartum chemoprophylaxis for GBS infection is provided, which takes into account the risk for early-onset GBS disease.
From the Research
Group B Strep Urinary Tract Infection
- Group B Streptococcus (GBS) is a significant source of morbidity and mortality in high-risk populations, including pregnant women, neonates, and the elderly 2.
- GBS remains the most common culture-confirmed neonatal bacterial infection in the United States and is a significant source of neonatal morbidity globally 2.
- Intrapartum antibiotic prophylaxis has reduced the incidence of early-onset neonatal disease without a notable impact on the incidence of late-onset neonatal disease 2.
Antibiotic Susceptibility
- Penicillin G remains the mainstay of therapy for GBS, although reduced penicillin susceptibility has been observed in select isolates 2.
- Increased frequency of resistance to non-beta-lactam antibiotics, including clindamycin, erythromycin, and fluoroquinolones, has been observed, with some isolates demonstrating resistance to vancomycin 2.
- A study found that all colonizing strains of GBS were susceptible or moderately susceptible to ampicillin and penicillin G, while resistance was noted to other antibiotics, including erythromycin, clindamycin, and gentamicin 3.
- Another study found that a high proportion of GBS isolates from urinary tract infections were multidrug-resistant, with high rates of resistance to azithromycin, clindamycin, erythromycin, and tetracycline 4.
Multidrug Resistance
- Multidrug resistance has been reported in GBS from various origins, including urinary tract infections 4.
- A study found that exposure of multidrug-resistant GBS to erythromycin can partially counteract the severe growth inhibitory effect of hydrogen peroxide, signifying a partial rescue effect of the antibiotic 4.
- The same study found that the growth of multidrug-resistant GBS was attenuated and severely inhibited by exposure to erythromycin and hydrogen peroxide, respectively 4.