Reduction of the use of antimicrobial drugs following the rapid detection of Streptococcus agalactiae in the vagina at delivery by real-time PCR assay

Authors

  • E Poncelet-Jasserand,

    1. Department of Obstetrics, Gynaecology and Reproductive Medicine, University-Hospital of Saint-Etienne, France
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    • These authors contributed equally to the work.

  • F Forges,

    1. Unit of Clinical Research, Innovation and Pharmacology, INSERM CIE3, University-Hospital of Saint-Etienne, France
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    • These authors contributed equally to the work.

  • M-N Varlet,

    1. Department of Obstetrics, Gynaecology and Reproductive Medicine, University-Hospital of Saint-Etienne, France
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  • C Chauleur,

    1. Department of Obstetrics, Gynaecology and Reproductive Medicine, University-Hospital of Saint-Etienne, France
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  • P Seffert,

    1. Department of Obstetrics, Gynaecology and Reproductive Medicine, University-Hospital of Saint-Etienne, France
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  • C Siani,

    1. Research Laboratory in Knowledge Engineering (ERIC), University of Lyon, Institute of Pharmaceutical and Biological Sciences (ISPB) of Lyon, France
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  • B Pozzetto,

    Corresponding author
    1. Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Faculty of Medicine of Saint-Etienne, University of Lyon, France
    2. Department of Microbiology, Hôpital Nord, University-Hospital of Saint-Etienne, France
    • Department of Obstetrics, Gynaecology and Reproductive Medicine, University-Hospital of Saint-Etienne, France
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  • A Ros

    1. Department of Microbiology, Hôpital Nord, University-Hospital of Saint-Etienne, France
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Correspondence: Prof Bruno Pozzetto, GIMAP EA 3064, Faculté de Médecine J. Lisfranc, 15 rue Ambroise Paré, 42023 Saint-Etienne Cedex 02, France. Email bruno.pozzetto@univ-st-etienne.fr

Abstract

Objective

To assess whether the determination of the presence of group B streptococci (GBS) in the vagina using a rapid polymerase chain reaction (PCR) assay at delivery was able to spare useless antimicrobial treatments, as compared with conventional culture at 34–38 weeks of gestation.

Design

Practical evaluation and prospective cost-effectiveness analysis.

Setting

A university hospital in France.

Population

A cohort of 225 women in labour at the University-Hospital of Saint-Etienne.

Methods

Each woman had a conventional culture performed at 34–38 weeks of gestation. At the beginning of labour, two vaginal swabs were sampled for rapid PCR testing and culture. The decision to prescribe a prophylactic antimicrobial treatment or not was taken according to the result of the PCR test. A comparative cost-effectiveness analysis of the two diagnostic strategies was carried out.

Main outcome measures

Number of women receiving inadequate prophylactic antimicrobial drugs following each testing strategy, costs of PCR testing and culture, frequency of vaginal GBS, and diagnostic performance of the PCR test at delivery.

Results

The percentage of unnecessarily treated women was significantly reduced using the rapid test versus conventional culture (4.5 and 13.6%, respectively; P < 0.001). The rate of vaginal GBS at delivery was 12.5%. The incremental cost-effectiveness ratio (ICER) for each inadequate management avoided was €36 and €173 from the point of view of the healthcare system and hospital, respectively.

Conclusions

The PCR assay reduced the number of inadequate antimicrobial treatments aimed to prevent the early onset of GBS disease. However, this strategy generates extra costs that must be put into balance with its clinical benefits.

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