[Decrease in Group B Streptococcal Infections in Neonates: Analysis of Health Insurance Data 2005 to 2017].

Abstract:

BACKGROUND:In the German guidelines for prophylaxis of group B streptococcal (GBS) early onset sepsis in neonates (EOS), GBS screening of all pregnant women has been recommended, but is not yet included in the Maternity Directives. Aim of the study was to identify temporal trends in incidence of EOS and their association to GBS Screening. METHODS:The analysis based on health insurance data of the statutory health insurance provider Barmer from 2005 to 2017 of 313,385 mother-child pairs. Annual frequency of GBS infections in newborns was determined by ICD-10 P36.0. The frequency of maternal GBS colonization was indicated by ICD-10 B95.1, which was used as surrogate for GBS screening. Temporal trends of the risk of EOS in neonates were assessed in logistic regression models. Pearson's correlation coefficient of EOS incidence and the surrogate marker for maternal GBS colonization was calculated. RESULTS:The risk of EOS in neonates caused by GBS has decreased annually by 9.3%, resulting in an overall decrease in the observation period of 72.0%. There was no statistical significant change in the risk for LOS (Late Onset Sepsis). The decrease of EOS could not be explained by temporal changes in Caesarian section, risk factors or preterm delivery. The 3.5 fold increase in the proportion of mothers with documented positive GBS colonization in the same period correlated inversely with the incidence of EOS (r=- 0.75; p=0.002). CONCLUSION:The decrease of EOS in neonates caused by GBS in Germany and the unchanged risk of LOS in neonates may be explained by the increasing application of the GBS Screening in pregnant women. HINTERGRUND:In der Leitlinie zur Prophylaxe der frühen Form (Early Onset Sepsis, EOS) der Neugeborenensepsis durch Streptokokken der Gruppe B (GBS) wird ein GBS Screening aller Schwangeren empfohlen. Dieses ist jedoch nicht Bestandteil der Mutterschaftsrichtlinien. Studienziel war die Überprüfung des zeitlichen Verlaufs der Infektionsrate im Zusammenhang mit dem GBS Screening. METHODIK:Krankenversicherungsdaten der Jahre 2005 bis 2017 von 313 385 BARMER versicherten Mutter-Kind Paaren wurden analysiert. Über die ICD-10 P36.0 wurde die jährliche Häufigkeit von GBS Infektionen bei Neugeborenen ermittelt. Als Surrogat für das GBS Screening wurde die ICD-10 B95.1 verwendet, welche bekannte positive mütterliche GBS Besiedelung beschreibt. Durch logistische Regressionsmodelle wurden die zeitliche Veränderungen des Erkrankungsrisikos von EOS bei Neugeborenen untersucht. Pearson-Korrelationskoeffizient wurde zur Bewertung des Zusammenhangs zwischen der zeitlichen Veränderung der Häufigkeit an EOS und dem Surrogatmarker für GBS Besiedelung verwendet. ERGEBNISSE:Das Erkrankungsrisiko der EOS bei Neugeborenen hat jährlich um 9,3% abgenommen, gesamt über die Beobachtungsjahre um 72,0%, während für die Spätform LOS (Late Onset Sepsis) keine statistisch signifikante Veränderung beobachtet wurde. Diese Abnahme konnte nicht durch zeitliche Veränderungen bei Kaiserschnitten, Risikofaktoren oder Frühgeburten erklärt werden. Eine gleichzeitige Erhöhung des Anteils der Mütter mit bekanntem positivem GBS Status um den Faktor 3,5 korrelierte invers (r=− 0,75; p=0,002) mit der Inzidenz von EOS. SCHLUSSFOLGERUNG:Die starke Abnahme der EOS in Deutschland bei unveränderter Inzidenz von LOS könnte durch eine zunehmende Umsetzung des Schwangerenscreenings erklärt werden.

journal_name

Klin Padiatr

journal_title

Klinische Padiatrie

authors

Sorg AL,Obermeier V,Armann J,Klemme M,von Kries R

doi

10.1055/a-1202-1758

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

17-23

issue

1

eissn

0300-8630

issn

1439-3824

journal_volume

233

pub_type

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  • [Treatment of hepatitis B virus-associated membranous glomerulonephritis with interferon alfa in a 7 year old boy].

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