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Group B Streptococcal Sepsis

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Group B Streptococcal Sepsis, Group B Streptococcus, GBS Sepsis, Neonatal Sepsis from GBS, Group B Streptococcal Pneumonia

  • See also
  1. Neonatal Sepsis
  2. Group B Streptococcus Prophylaxis
  • 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
  • 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]
  • 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
  • Signs
  1. See Neonatal Sepsis
  • Labs
  1. Newborn
    1. See Neonatal Sepsis for lab evaluation
  2. Maternal Screening
    1. GBS Culture in all pregnant women at 35-37 weeks
  • 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
  • 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
  • Prevention
  1. Perinatal Group B Streptococcus Prophylaxis
  • Prognosis
  1. Mortality 10-40%
  • References
  1. Cagno (2012) Am Fam Physician 86(1): 59-65 [PubMed]