Prevention of neonatal group B streptococcal disease: progress, challenges and dilemmas.

Significant advances in the prevention of neonatal group B streptococcal (GBS) disease have occurred in the last decade. In Australia, as well as in centres overseas, intrapartum penicillin given to carrier mothers has been shown to unequivocally decrease early onset neonatal GBS sepsis. In choosing which women should receive intrapartum chemoprophylaxis, recent data suggest that screening programmes for the detection of GBS carriage may be more effective than risk-based strategies to prevent early onset neonatal GBS sepsis. Combined vaginal and rectal swabs, collected between 35 and 37 weeks gestation, either by a health care worker or by the patient herself and inoculated onto selective media after enrichment provide the optimum conditions to detect carriage. Increasingly erythromycin and clindamycin resistance is being described overseas, which may influence the choice of antibiotics used in those allergic to penicillin. Widespread antibiotic use, particularly with broad-spectrum agents, may lead to increasing neonatal sepsis with ampicillin resistant organisms. Whilst rates of non-GBS neonatal sepsis are generally stable there is evidence suggesting that Escherichia coli sepsis in premature infants is increasing. Novel vaccination strategies for GBS are being developed that may ultimately provide broader protection for mothers and babies and eliminate the need for intrapartum antibiotics.