Download A new audit 1 , published by the Royal College of Obstetricians

6 March 2015: For immediate release
New report shows widespread NHS testing for group B
Strep carriage in pregnant women … using the wrong test
MORE than half of the UK’s NHS maternity units are testing pregnant women for
potentially life-threatening bacteria, against national recommendations and using the
wrong test.
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 riskbased 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.”
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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 introduced4.
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.
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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.
https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/gbs-audit-firstreport.pdf
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.
https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_36.pdf
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.
https://www.gov.uk/government/publications/smi-b-58-processing-swabs-for-group-bstreptococcal-carriage
4
Data series online:
Pyogenic & non-pyogenic streptococcal bacteraemia, England, Wales & Northern Ireland:
2003. CDR Wkly 2004; 13(16): Bacteraemia
http://webarchive.nationalarchives.gov.uk/20140714084352/http://www.hpa.org.uk/cdr/ar
chives/2004/cdr1604.pdf.
Voluntary surveillance of pyogenic & non-pyogenic streptococcal bacteraemia in England,
Wales & Northern Ireland: 2013 https://www.gov.uk/government/publications/pyogenicand-non-pyogenic-streptococcal-bacteraemia-annual-data-from-voluntary-surveillance
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 http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02725.x/epdf
Group B Strep: Key Facts
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At least 500 babies a year in the UK develop group B Strep infection.
One in 10 of these babies will die and a further one in 20 will suffer long-term physical or
mental disabilities, such as cerebral palsy, deafness, blindness and learning difficulties.
20-30% of women carry group B Strep, usually without harm or symptoms.
The rate of group B Strep infections in newborn babies per live birth has not fallen since
2003, when the Royal College of Obstetricians and Gynaecologists introduced their riskbased prevention guidelines. The number of babies affected has risen by 21%. The guidelines
had been expected to reduce the rate by 50-60%.
Carrying group B Strep at birth is the key risk factor for group B Strep infection in babies.
ENDS
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For comment or greater detail:
Jane Plumb MBE, Chief Executive, Group B Strep Support
01444 416176
mobile 07986 745387
[email protected]
Sarah Fiedosiuk, Media and Awareness, Group B Strep Support
01444 416176
mobile 07984 649898
[email protected]
Website: www.gbss.org.uk
Notes:
Group B Strep Support is a UK charity dedicated to preventing life-threatening group B Strep
infection in newborn babies. It provides information and support to families affected by group B
Strep, and their health professionals. It is calling for every pregnant woman to be informed about
group B Strep and offered a sensitive test for group B Strep carriage to prevent unnecessary
tragedies. An independent Medical Advisory Panel supports the charity http://gbss.org.uk/who-weare/people-involved/medical-advisory-panel/.
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