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Confirmed group B streptococcus infection: the tip of the iceberg
  1. A R BEDFORD RUSSELL,
  2. A BREATHNACH,
  3. P SENDER
  1. Neonatal Unit and Medical Microbiology
  2. and PHLS Collaborating Centre
  3. St George's Hospital, Blackshaw Rd
  4. London SW17 OQT, UK

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Editor—Beardsall and colleagues are to be congratulated on presenting further evidence that group B streptococcus gives rise to a significant burden of disease in some areas of the United Kingdom.1 Retrospective data collected at St George's Hospital is in agreement with the authors' suggestion that culture proven sepsis under represents the true burden of disease. Firstly, we conducted a retrospective search for cases of culture positive group B streptococcus (either blood or cerebrospinal fluid) amongst a cohort of consecutive births at the hospital between 1 January 1994 and 31 October 1998, and comprising 16 910 births.

Secondly, we conducted a retrospective analysis of all babies colonised with group B streptococcus (deep ear swabs taken in the first six hours of life which were positive for group B streptococcus), and who were screened and treated for suspected early onset infection in the first 72 hours of life, between 1 April 1997 and 31 March 1998. Probable early onset group B streptococcus infection was defined as: a positive deep ear swab in a baby with clinical pneumonia or sepsis (either fever >38○C on one occasion or >37.5○C on two occasions separated by at least one hour, or two or more of: poor perfusion, respiratory distress, thrombocytopenia, leucopenia <5 ×109/l, persisting glucose imbalance or abdominal distension, bilious aspirates, or blood in stool in a baby <72 hours of age).

Twelve of 16 910 babies had blood cultures positive for group B streptococcus and group B streptococcus was cultured from the cerebrospinal fluid of one baby whose blood culture was negative. This gives an infection rate of 0.77/1000.

Of 3438 deliveries from 1 April 1997 to 31 March 1998, there were nine babies with probable group B streptococcus infection, giving an incidence of 2.6/1000.

Because of the usual problems related to retrospective data analysis this figure may still under represent the true burden of disease. We are currently prospectively evaluating the incidence of probable as well as proven group B streptococcus infection in order to estimate the true burden of disease in our local population. It is only in the light of such data that we will be able to develop evidence based guidelines for the prevention and management of this disease.

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