GBS Flashcards
what is early onset GBS
infection from the first week of life
what is late onset
infection from the first week of life to the first 3 months of life
how to teach moms about late onset
ensure the mother has a good knowledge of basic hygiene measures and how to recognize a sick baby
understanding late onset GBS
GBS can be transmitted by skin-to-skin contact or via the respiratory system. The risk of a baby developing a GBS infection decreases with age. It is rare after 1 month and virtually unknown after 3 months
clinical features of GBS
Streptococci are divided into at least 20 different types, called Lancefield groups. the main Lancefield group types of beta-hematolytic streptococci are group A, group B, and groups C-G
how typical is GBS in adults
in both men and women the normal reservoir for GBS is the gastrointestinal tract, and it is carried by up to 30 percent of adults
how GBS moves in the body
in women colonization of the gut commonly leads to transient colonization of the vagina and urinary tract. Vaginal–rectal colonization with GBS may be intermittent, transitory, or persistent.
what can GBS cause even though is primarily asymptomatic
UTIs, more rarely amnionitis, endometritis, sepsis or meningitis.
when can GBS cause the majority of infections
GBS can cross intact membranes, most infections occur during labor and/or after membrane rupture
who are most at risk for GBS infection
premature babies most risk of infection and dying or sustaining long-term damage because of their relatively undeveloped immune system
prevention and management of GBS for the neonate
begins with the treatment of the GBS-positive mother and may include
- antenatal identification of risk factors
- antenatal screening
- identification of risk factors in labor
- antibiotic treatment in labor
- monitoring and care of the neonate
what are some examples of ‘high risk’ when it comes to risk factors for GBS infection
- a woman who has ha a GBS- infected baby previously will usually be offered IV antibiotics in labor, whether or not she has screened positive herself during the current pregnancy
- Urinalysis revels GBS indicating heavy maternal vaginal–rectal colonization
what is the importance of screening
many babies who develop early onset- GBS infection are born to women who had no risk factors at delivery apart from carrying GBS and if screening is not undertaken, neither they nor their caregivers will be aware of the risk
understanding the swab
both rectal and vaginal swabs are recommended. a rectal swab will be more likely to show the presence of GBS as this is a normal site for colonization. a low vaginal swab is recommended, as a high vaginal swab is likely to test negative, even when there is GBS present in the lower vagina. To maximize the likelihood of GBS recovery, a single swab is used to obtain the culture specimen first from the lower vagina (near the introitus) and then from the rectum (through the anal sphincter) without use of a speculum. A culture of the lower vagina and rectum increases the culture yield substantially compared with either sampling the cervix alone or sampling the vagina without a rectal culture
why test if GBS is intermittent
when teste between 35-37 wga it is demonstrated that a positive result will indicate around 87 percent chance she sill be positive at delivery
what could a client present with undiagnosed GBS
preterm pre-labor rupture of membranes or pre-labor rupture of membranes
what is a potential risk factor for antibiotics in labor
antibiotic use of any kind increase the risk of yeast infection
what are possible signs of neonatal GBS infection
- inability to maintain body temperature
- inability to maintain blood sugar
- abnormally high or low temperature, respiratory rate and/or heart rate
- lethargy
- poor feeding
- seizure activity
Role of the midwife with GBS
- maintain an up-to-date knowledge of GBS, a frequently changing field to ensure that all questions from clients can be accurately and comprehensively answered
- sustain a good working protocol
- ensure the ability to effectively monitor all newborns, recognize the signs and symptoms of infection, and refer as necessary
Teach women about general assessment of well-being of newborn
which antibiotics for GBS
Intravenous penicillin remains the agent of choice for intrapartum prophylaxis, with intravenous ampicillin as an acceptable alternative. First-generation cephalosporins (i.e., cefazolin) are recommended for women whose reported penicillin allergy indicates a low risk of anaphylaxis or is of uncertain severity. For women with a high risk of anaphylaxis, clindamycin is the recommended alternative to penicillin only if the GBS isolate is known to be susceptible to clindamycin.
For women who are at high risk of anaphylaxis after exposure to penicillin, what should the laboratory requisitions for ordering antepartum GBS screening cultures (whether on paper or online in electronic medical records) indicate
the presence of penicillin allergy. intended to ensure that the need to test GBS isolates for clindamycin susceptibility is recognized and performed by laboratory personnel, and that the health care provider understands the importance of reviewing such a test result.
what important when labeling the sample
incorrect specimen collection—most typically vaginal cultures obtained without concomitant rectal sampling—is the most commonly identified GBS prenatal screening error among health care providers
bacteria count for antibiotic and GBS positive
In asymptomatic women, treatment of GBS bacteriuria, as with bacteriuria due to other organisms, is recommended only if test results indicate a level of 105 CFU/mL or higher
Intrapartum antibiotic prophylaxis to reduce the risk of GBS EOD is based on what two-pronged approach
1) decreasing the incidence of neonatal GBS colonization, which requires adequate maternal drug levels
2) reducing the risk of neonatal sepsis, which requires adequate antibiotic levels in the fetus and newborn.