Incidence of Group B Streptococcus early onset sepsis in term neonates with second-line prophylaxis maternal intrapartum antibiotics: A multicenter retrospective study

Abstract

Background: The difference in incidence of early onset sepsis (EOS) caused by Group B Streptococcus (GBS) among term neonates whose mothers receive first versus second-line intrapartum prophylaxis is poorly described.

Objective: To compare the incidence of GBS EOS in term neonates born to mothers who receive first, second-line or no intrapartum antibiotics, and describe the short term and survival outcomes of neonates who developed GBS EOS stratified by maternal antepartum prophylaxis.

Study design: This was a retrospective review of electronic medical records. We queried the Pediatrix Medical Group Clinical Data Warehouse to evaluate the outcomes of term neonates born to GBS positive mothers between 2003 - 2020, and compared the incidence and outcomes of neonates with GBS EOS whose mothers received first versus second-line/no intrapartum prophylaxis.

Results: Among 496,180 neonates, 104,196 (21%) were born to GBS positive mothers. Out of 97,983 GBS positive mothers with adequate prenatal antibiotic documentation, 49,234 (50%), 12,679 (13%) and 36,070 (37%) received first-line, second-line and no intrapartum prophylaxis, respectively. Incidence of GBS EOS among all neonates with maternal GBS carriage was 0.22% (231/104,196). Neonates whose mothers received second-line intrapartum antibiotics and no antibiotics had higher risk of GBS EOS infection compared to first-line intrapartum antibiotics [adjusted odds ratio (aOR) 4.12, 95% confidence interval (CI): 2.66 - 6.38 and aOR 3.80, 95% CI: 2.66 - 5.44, respectively]. No statistically significant difference in the risk of GBS EOS in neonates born to mothers who received second-line versus no antibiotics (aOR 0.92, 95% CI: 0.64 - 1.33).

Conclusion: Neonates exposed to second-line maternal GBS prophylaxis had increased risk of GBS EOS compared to those exposed to first-line maternal GBS prophylaxis. There was no statistically significant difference in GBS EOS incidence between second-line versus no antibiotics in mothers with GBS carriage.