Group B Streptococcal Sepsis

1. See also
   1. Neonatal Sepsis
   2. Group B Streptococcus Prophylaxis
2. Epidemiology
   1. Most common US cause of Neonatal Sepsis and Meningitis
   2. Incidence
      1. Overall: 2 to 4 per 1000 live births
      2. Invasive: 1.8 per 1000 live births
   3. Primarily occurs in newborns
      1. Very rare after 5 months of age
3. Risk Factors
   1. Gestational age <37 weeks
   2. Maternal GBS colonization isolated from mother's vagina, Rectum or urine
   3. Inadequate GBS Prophylaxis (if indicated)
   4. Prolonged Rupture of Membranes >18 hours
   5. Maternal Chorioamnionitis
   6. Adair (2003) CMAJ 169(3):198-203 [PubMed]
4. Pathophysiology
   1. Group B Beta-hemolytic Streptococcus infection
   2. Perinatal transmission
      1. Delivery via a birth canal colonized with GBS
      2. Incidence of U.S. vaginal GBS colonization: 15-20%
   3. Onset of infection (Mean onset 20 hours of life)
      1. Early onset neonatal disease
         1. Presentations
            1. Sepsis
            2. Pneumonia
         2. Clinical infection signs in 95% within 24 hours
            1. Maternal prophylaxis does not delay diagnosis
            2. Bromberger (2000) Pediatrics 106:244-50 [PubMed]
      2. Late onset neonatal disease
         1. Sepsis
         2. Meningitis
5. Signs
   1. See Neonatal Sepsis
6. Labs
   1. Newborn
      1. See Neonatal Sepsis for lab evaluation
   2. Maternal Screening
      1. GBS Culture in all pregnant women at 35-37 weeks
7. Management: Initial
   1. See Group B Streptococcus Prophylaxis
      1. Includes guidelines for neonatal evaluation
   2. See Neonatal Sepsis for initial antibiotic management
      1. Convert to antibiotics below when organism identified
8. Management: Group B Streptococcus based on culture
   1. Sepsis (treat for 10-14 days)
      1. Penicillin G 200,000 units/kg/day divided q4-6 hours
   2. Meningitis (treat for 14-21 days)
      1. Penicillin G 400,000 units/kg/day divided q2-4 hours
9. Prevention
   1. Perinatal Group B Streptococcus Prophylaxis
10. Prognosis
    1. Mortality 10-40%
11. References
    1. Cagno (2012) Am Fam Physician 86(1): 59-65 [PubMed]