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New report shows widespread NHS testing for group B Strep carriage in pregnant women

14 March 2015 One Comment

Lilee developed Group B Strep infection at birthMORE than half of the UK’s NHS maternity units are testing pregnant women for potentially life-threatening bacteria, against national recommendations.
The bacteria, group B Strep, is the UK’s most common cause of severe infections in newborn  and of meningitis in babies in the first three months of their lives, sometimes leading to death and disability.

With correct screening, most group B Strep infections can be prevented if antibiotics (usually penicillin) are given in labour to women who have been found to carry the bacteria.

A new audit1, published by the Royal College of Obstetricians & Gynaecologists (RCOG), shows shortcomings, variations and inconsistencies within the NHS in the implementation of its current national guidance on group B Strep prevention.

The RCOG does not support universal antenatal screening for group B Strep carriage.  Instead, a risk-based approach2 has been in place since 2003. This recommends  giving women antibiotics in labour against these infections in newborns only when a woman has previously had a baby with group B Strep; group B Strep has been detected during the woman’s current pregnancy (from a urine sample or vaginal swab); or the woman has a fever or symptoms of chorioamnionitis – inflammation of the membranes – in labour.

Despite this it has been found that 55.9% of obstetric units are offering testing to some or all pregnant women for group B Strep carriage, with 76% of these units doing so at the mother’s request.

Jane Plumb MBE, chief executive of national charity Group B Strep Support welcomes these findings. She said: “Obstetricians and midwives recognise the usefulness of testing pregnant women for group B Strep carriage – they know the RCOG’s guidelines have failed to reduce group B Strep infections in newborn babies

The audit reported support for universal screening and shows units are offering testing to pregnant women. Women want it, obstetricians and midwives are already offering it. It’s time the UK’s guidelines caught up.”

As well as additional testing, the report identified 13 situations where units offered women antibiotics in labour, against the RCOG recommendations.

For those following the recommendations, between 92-99% offered antibiotics to women in labour who had risk factors defined by RCOG and identified before labour. Between 63-76% offered them to those with risk factors that would only be identified around the time of labour.

The audit also discovered most units do not use sensitive tests to detect group B Strep carriage. It discovered 61.5% of them are not using the gold standard Enriched Culture Medium (ECM) method for testing for group B Strep carriage, described by Public Health England’s UK Standard3. Plus almost a third (32.5%) of units reported that the testing method used was unknown.

Jane Plumb said:  “Why is the NHS still using a test to detect group B Strep carriage which we know misses up to half of all carriers?

“The ECM test is not expensive – Public Health England estimated the cost at £11 a test. There can be huge consequences from a false-negative test result in a woman carrying group B Strep. If she is not offered antibiotics in labour because of that false-negative result, her baby could develop preventable group B Strep infection.

Why we aren’t giving our busy health professionals the right tool for the job?”

Another audit highlight revealed the most common source of written information received by women about the bacteria is from Group B Strep Support, used by 37.5% of obstetric units.

Emeritus Professor Philip Steer, chairman of Group B Strep Support’s Medical Advisory Panel said: ”The fact that the most common source of written patient information used by professionals is provided by Group B Strep Support highlights their confidence in the accuracy and reliability of that information. It should be given to all pregnant women, not just those who ask or who are lucky enough to meet an informed professional.”

The number of group B Strep infections in newborn babies has risen by 21% in England, Wales and Northern Ireland since the RCOG’s risk-based group B Strep prevention guidelines were introduced 4.
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This is because the risk-factors recommended by RCOG to select women for antibiotics in labour are poor at predicting group B Strep carriage – less than three out of every ten women who have a risk factor carry group B Strep5.

Almost one in every five women who have no known risk factors carries group B Strep5.

Using risk factors to select for the offer of antibiotics means many women who are not carrying group B Strep are offered them, and most who are carrying group B Strep are not.

The widely available test for group B Strep carriage is also poor at detecting the bacteria. Standard (non-ECM) tests fail to detect group B Strep in up to 50% of the women who are carrying the bacteria at the time the samples are taken. Many group B Strep carriers are falsely given a negative result from a standard test. Despite this, the ECM test is not available in most NHS trusts, not even through Public Health England’s own regional laboratories.

Jane Plumb believes the UK needs is a more effective group B Strep prevention strategy in order for things to change. She said: “The RCOG’s guidelines have failed to reduce group B Strep infection in newborn babies since their introduction in 2003.

“Many families, health professionals, charities and many decision makers believe it is time to change the UK’s prevention strategy. Standard practice in most developed countries with a group B Strep prevention strategy is to offer women sensitive testing for group B Strep late in pregnancy. This is both safe and effective.

“The RCOG’s guidelines are due for review in 2015/6, as is the UK National Screening Committee’s group B Strep policy. This will be an ideal opportunity to make a change. We can reduce the unnecessary heartbreak that preventable group B Strep infection can bring.” 

Sources:
1 Royal College of Obstetricians and Gynaecologists, London School of Hygiene and Tropical Medicine. Audit of current practice in preventing early-onset neonatal group B streptococcal disease in the UK. Commissioned by the National Screening Committee. London: RCOG; 2015.
2 Royal College of Obstetricians and Gynaecologists. The Prevention of Early-onset Neonatal Group B Streptococcal Disease. Green-top Guideline No. 36. 2003; updated  2012.
3 3 Public Health England. UK Standards for Microbiology Investigations. Processing Swabs for Group B Streptococcal Carriage. B 58 Issue 2.3. Under review. London: PHE; 2014.
4 Data series online:
Pyogenic & non-pyogenic streptococcal bacteraemia, England, Wales & Northern Ireland: 2003. CDR Wkly 2004; 13(16): Bacteraemia
Voluntary surveillance of pyogenic & non-pyogenic streptococcal bacteraemia in England, Wales & Northern Ireland: 2013
5 Daniels JP1, Gray J, Pattison HM, Gray R, Hills RK, Khan KS; GBS Collaborative Group. Intrapartum tests for group B streptococcus: accuracy and acceptability of screening. BJOG. 2011 Jan;118(2):257-65

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