Reduced colonization of newborns with group B streptococci following washing of the birth canal with chlorhexidine

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Abstract
Possible measures for prevention of neonatal group B streptococcal (GBS) septicemia include active or passive immunoprophylaxis and administration of penicillin to mothers and infants. In a previous study we have found GBS to be extremely sensitive to chlorhexidine. Furthermore vaginal washing with chlorhexidine diminished the recovery of GBS from parturients. In order to study the effect of chlorhexidine washing upon the colonization of newborns, a study group of chronic GBS carriers, i.e. women who were GBS positive in the 32-36 gestational week as well as during labor was selected. In 18 of these females chlorhexidine washing was performed prior to delivery while 33 chronic carriers served as controls. Screening during labor was performed in 945 consecutive patients. Cultures were collected from the external ear, throat and umbilicus of all infants within 5 minutes of birth and at day 4 of life. At birth 22% of the infants of the chlorhexidine washed mothers were colonized with GBS, in contrast to 52% of the infants from the chornic GBS carriers (p < 0.05). The proportion of infants harboring GBS at day 4 were similar in the two groups (Tab. I). Among the 945 consecutively screened women, 164 harbored GBS and 54 (33%) of their 164 infants were colonized at birth. The colonization rate of the infants from chronic GBS carriers was significantly higher, 17 of 33 infants (p < 0.05). This may reflect that the risk of contracting GBS by infants increases with the quantity of GBS in the birth channel. Vaginal washing with chlorhexidine suppressed the transfer of GBS from mother to infant among the chronic GBS carriers. No side-effects of the washing procedure were noted. The present results raise hope for the design of a simple measure for control of early onset neonatal GBS disease.