Gbs 2010

Group B Strep 2010 CDC GBS REVISION of 2002 guidelines What’s new 2010 CDC COPY & PASTE MMWR November 19, 2010 / 59(RR10);1-32

WHATS NEW FOR THE LAB ,[object Object],[object Object],[object Object]

GBS BACTERURIA LAB CRITERIA Identification of group B Streptococcus (GBS) Bacteriuria in pregnant women ,[object Object],[object Object]

NO CHANGE IN OB MANAGEMENT FOR GBS BACTERIURIA ,[object Object],[object Object]

GBS BACTERIURIA TREATED EARLIER WITH NEGATIVE F/U CULTURE ,[object Object],[object Object]

WHATS NEW FOR PEDIATRICS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

WHATS NEW FOR OB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

GBS IPA INDICATED ,[object Object],[object Object],[object Object]

GBS IPA INDICATED Unknown GBS status at the onset of labor (culture not done, incomplete, or unknown) ,[object Object],[object Object],[object Object]

WHAT DOES THE CDC CONSIDER HIGH RISK FOR ANAPHYLACTIC ALLERGY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ANAPHYLACTIC RISK ,[object Object],[object Object]

HOW IMPORTANT IS IT TO USE ANCEF vs CLINDA OR VANCO ,[object Object],[object Object]

WHAT IS APPROPRIATE SUSCEPITIBILITY TESTING ,[object Object],[object Object]

VANCOMYCIN ,[object Object],[object Object]

PEDS DILEMMAS GBS IPA PROPHYLAXIS IN UTERO DURATION OF < 4 HRS & CLINDA / VANCO NOT CONSIDERED “ ADEQUATE “ ,[object Object],[object Object],[object Object],[object Object],Pediatrics 2000;106:256 Obstet Gynecol 2006;108:1254 Pediatrics 2000;106:244 Obstet Gynecol 2008;112:265 Pediatr Infect Dis J 2003;22:430 Obstet Gynecol 1998;91:112

KP DATA Escobar & Bromberger ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

HOW TO CULTURE ,[object Object],[object Object]

? WHEN TO CULTURE ? @ 35-37 WEEKS ,[object Object],[object Object]

GBS culture 5 VS 6 WEEKS ,[object Object],[object Object],[object Object]

Dr Montgomery prefers GBS CULTURE @ 36 wks to ensure all deliveries occur within 5 weeks of the culture because ~ 10 % may not be delivered until 42 0/7 ,[object Object],[object Object]

EFFICAY FOR < 37 0/7 WEEKS ,[object Object]

PTL INTACT MEMBRANES < 37 0/7 WEEKS ,[object Object],[object Object],[object Object],[object Object],[object Object]

PpROM / PROM GBS IPA PROPHYLAXIS ONLY IF NO culture within 5wk ,[object Object],[object Object],[object Object],[object Object]

GBS CULTURES FOR R C/S PATIENTS ,[object Object],[object Object],[object Object]

AMNIOTOMY ,[object Object],[object Object]

Chorioamnionitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Obstet Gynecol 2010;116:387–92 Meta Analysis JAMA 2000; 284:1417 JAMA 2003: 290:2677

CHORIOAMNIONITIS CDC & EPIDEMIOLOGICAL DATA ,[object Object],[object Object],[object Object]

Chorioamnionitis Dx with 100.4 “UpToDate” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Original GBS Risk Factor Identification Cohort with > 30,000 patients ,[object Object],[object Object],[object Object],J Infect Dis. 1983 Nov;148(5):795-801

If a patient is going to manifest an elevated temperature from an epidural the literature has demonstrated it typically occurs within the first 4 hours after epidural Results closely resemble the findings of Camann who demonstrated a maternal temperature increase of 1.3ºF versus 1.1ºF (0.33ºF/hr in the first 4 hours). Br J Anaesth 1991;67:565–8. Obstet Gynecol 2007;109:687–90

PEDIATRIC IMPLICATIONS OF DIAGNOSING CHORIOAMNIONITIS ,[object Object],[object Object]

REGIONAL GUIDANCE ,[object Object],[object Object],[object Object],[object Object]

WHAT DOES THE CDC CONSIDER HIGH RISK FOR ANAPHYLACTIC ALLERGY ,[object Object],[object Object],[object Object],[object Object],[object Object]

History for an Allergic Reaction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ANGIODEMA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

WHAT IS URTICARIA ,[object Object],[object Object]

Confirmation that the lesions are urticaria ,[object Object],[object Object]

Sx / Sx associated with ANAPHYLAXIS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gbs 2010

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Gbs 2010