GBS - stupid question

Posted

If a pt is GBS positive are they a just considered "carrier" or are they actually "infected". I had OB last semester and should remember this, but don't! :banghead:

jenrninmi, MSN, RN

Specializes in L&D. Has 11 years experience. 1,975 Posts

It means GBS has been found when they did the vaginal swab.

CEG

862 Posts

If a pt is GBS positive are they a just considered "carrier" or are they actually "infected". I had OB last semester and should remember this, but don't! :banghead:

It's not an infection, just a colonization of bacteria. It is present in 25-40% of the US population.

dawngloves, BSN, RN

2,399 Posts

Yes, but once you have it, you always will carry it. Correct?

CEG

862 Posts

Yes, but once you have it, you always will carry it. Correct?

No, it is transient. So in fact you can have it at 36 weeks when you are tested and not have it at delivery and vice versa. You can also test positive in one pregnancy and negative in another. There is no effective rapid test for GBS so it has to be done weeks before delivery. Our system of treatment is pretty imperfect as a result. Even if you are treated with one child you may still be colonized with the next- leading me to believe we are creating a next generation of antibiotic resistant strains of GBS resulting in a huge problem for our children's babies when GBS was a statistically small problem for us.

gemba1970

Specializes in ob/gyn. Has 38 years experience. 14 Posts

so far testing and giving antibiotics seems to be decreasing the rate of babies ending up in ICU for respiratory problems due to GBS...it is worth it to keep these babies from dying...

CEG

862 Posts

so far testing and giving antibiotics seems to be decreasing the rate of babies ending up in ICU for respiratory problems due to GBS...it is worth it to keep these babies from dying...

Right, but it was relatively rare. Now we are most likely creating common antibiotic-resistant GBS and causing big problems for future generations. Even the CDC says our current solution is only a temporary bandaid approach.

Jolie, BSN

Specializes in Maternal - Child Health. Has 36 years experience. 6,375 Posts

Right, but it was relatively rare. Now we are most likely creating common antibiotic-resistant GBS and causing big problems for future generations. Even the CDC says our current solution is only a temporary bandaid approach.

I understand your point, but I worked in NICU over 20 years ago and have vivid memories of babies who died of GBS sepsis for lack of early detection and prophylactic treatment. What alternatives do we have now that won't put our future moms and babies at risk of resistant strains?

dawngloves, BSN, RN

2,399 Posts

Right, but it was relatively rare. Now we are most likely creating common antibiotic-resistant GBS and causing big problems for future generations. Even the CDC says our current solution is only a temporary bandaid approach.

Do you think this is due to the fact that we only treat up until delivery, which may mean only one dose of amp?

CEG

862 Posts

I understand your point, but I worked in NICU over 20 years ago and have vivid memories of babies who died of GBS sepsis for lack of early detection and prophylactic treatment. What alternatives do we have now that won't put our future moms and babies at risk of resistant strains?

Cases have declined from 2-3/1000 before universal screening to .5/1000 now. I am not saying that we shouldn't be treating, only that our treatment is not the greatest. There are many other things we can do to reduce incidence of GBS infection including limiting vag exams after ROM, not using FSEs or IUPCs, and avoiding membrane stripping. I can't speak for other facilities but mine does not practice this way. The risk-based treatment method is not as effective as the screening-based method but does reduce risks and reduces antibiotic exposure and potential resistance.

I do know some midwives who use prophylactic treatments such as garlic, certain vaginal douches, and vitamin C to reduce colonizations prior to testing and continue to birth. This reduces their overall number of positive screenings without an increase in infection.

I wish I had a good answer for a better way, I am sure no one does or we would be doing it that way;) But I think it's important to keep in mind the future ramifications of our actions.

Here is an interesting publication from the CDC regarding these issues: http://www.cdc.gov/MMWR/preview/mmwrhtml/rr5111a1.htm

Jolie, BSN

Specializes in Maternal - Child Health. Has 36 years experience. 6,375 Posts

If a pt is GBS positive are they a just considered "carrier" or are they actually "infected". I had OB last semester and should remember this, but don't! :banghead:

An interesting statement from the CDC publication CEG noted above:

In pregnant women, GBS can cause clinical infections, but most women have no symptoms associated with genital tract colonization. Urinary tract infections caused by GBS complicate 2%--4% of pregnancies (12,13). During pregnancy or the postpartum period, women can contract amnionitis, endometritis, sepsis, or rarely, meningitis caused by GBS (14--19). Fatalities among women with pregnancy-associated GBS disease are extremely rare.

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