Ausr zyxwvutsrqponml NZ J Obstet Gynaerol zyxwvutsrq 1995; zyxwvutsrqponm 35: 2: zyxwvutsrqpon 120 OCCASIONAL REVIEW Prevention of Neonatal Group B Streptococcal Sepsis: Is Routine Antenatal Screening Appropriate zyx Gwendolyn L. Gilbert’, David Isaacs2, Margaret A. Burgess3,Suzanne M. Garland‘, Keith Grimwoods, Geoffrey G. Hogg6, Peter McIntyre7 zyxwv Department zyxwvuts of Clinical Microbiologx Centre for Infectious Diseases and Microbiology, Westmead Hospital, NS W Department of Immunology and Infectious Diseases, Royal Alexandra Hospital for Children> NS W’, Department of Oncology, Royal Alexandra Hospital for Children, Camperdown, NS W3, Department of Microbiology, Royal Women’s Hospital, Victoria‘, Department of Paediatrics, Royal Children’s Hospital, Victorias,Department of Micmbiology and Infectious Diseases, Royal Children’sHospitaf, Victoria 6, Department of Paediatrics, Westmead Hospital, NS W 7and the Paediatric Infectious Disease Group of the Australasian Society for Infectious Diseases EDITORIAL COMMENT: This position paper has a senior team of authors from Departments of Microbiology and Infectious Diseases, Oncology and Paediatrics and carries the weight of the Paediatric InfectiousDiseases Group of the Australasian Society for InfectiousDisemes. Thk impressed but did not intimidate the editorialsubcommittee and other reviewers of this article, who although recommending publication, wish to ask readers to consider the following points. Firstly, the authors do not include an obstetrician, and obstetriciansdo not favour routine screening for gmup B streptococcal carriage by vaginal and rectal swabbing because women do not like rectal swabbing. The m lt of intrw‘uction of routine vaginal and rectalswabbing at 26-28 weeks’gestation in the hospital where the editor works in an antenatal clinic was that the policy failed because of the rectal swabbing, with the result that vaginal swabs are now performed in less than 50% of patients attending the clinic, although it remains hospitalpolicy for routine swabbing to be performed. Secondly, recommendations need to be dogmatic and precise if clinicians are to follow the favoured regimen. This paper has no clear statement of what constitutes ‘an epidemiologicalrisk factor for infection’ in the women for whom intrapartum prophylaxis is recommended, nor is there a statement of the antibiotic regimens favoured. Moreovec there is no recommendation about antibiotic therapy for the infant. Our third concern is that the calculations in this paper and its tables are based on the assumption that the perinatal mortality rate from neonatalsepsis due to group B streptococcus is 20% of the 2per zyxwv 1,000 with neonatal sepsis due to this organism zyxwvutsr - if. a death rate of I in 2,500 births. Table A shows the number of perinatal deaths in Victoria, 1984-1993, in which group B hoemolyticstreptococcuswas identi3ed. The rate was I in 6,283 births for the 10-year interval and I in 19,566 births for the 3 years, 1991-1993. These data include cases in which the organism was cultured but death was considered to be due to other causes. The extent to which the recent reduction in deaths from group B streptococcusis a result of I or more of the recommendations in this paper is not known. It should be noted that at least one third of the perinatal deaths associated with group B streptococcus identification in Victoria were stillbirths and so unlikely to have been prevented by intrapartum antibiotic therapy indicated by a risk factor or positive antenatal culture. Address for correspondence: Professor G.L. Gilbert, Department of Clinical Microbiology, Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW 2145.