Practice Guidelines

Group B Streptococcus Disease: AAP Updates Guidelines for the Management of At-Risk Infants


Am Fam Physician. 2020 Mar 15;101(6):378-380.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Maternal screening for GBS and intrapartum antibiotics for positive screening are important for reducing early-onset GBS disease risk.

• For well-appearing infants born at 35 weeks' gestation or later, determining treatment with a risk calculator and clinical monitoring for 36 to 48 hours are alternatives to empiric antibiotics, even with maternal intrapartum fever.

• Infants born before 35 weeks' gestation because of cervical insufficiency, preterm labor, premature rupture of membranes, intra-amniotic infection, or acute or unexplained nonreassuring fetal status should receive empiric antibiotics because of the high risk of GBS disease.

• Infants born before 35 weeks' gestation because of other causes should receive empiric antibiotics for insufficient intrapartum antibiotics, maternal intrapartum fever, or newborn signs of illness.

From the AFP Editors

The American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG) have updated guidelines for management of early- and late-onset group B streptococcus (GBS) disease in infants. GBS disease is the most common cause of newborn early-onset sepsis and a significant cause of late-onset sepsis in infants. This guideline replaces the Centers for Disease Control and Prevention 2010 guideline for GBS and is based on evolving epidemiology, new data, and changing practice standards.

Early-Onset GBS

Early-onset GBS disease is defined as isolation of GBS from a normally sterile site within six days of birth, although it typically presents by 12 to 24 hours after delivery. Infants born earlier than 37 weeks' gestation make up 28% of all GBS cases, but have a 19% case fatality rate compared with 2% in term infants. Because maternal colonization leads to early GBS disease, testing and intrapartum antibiotics are responsible for reductions in early-onset GBS. Early-onset GBS incidence decreased from 0.37 cases per 1,000 live births in 2006 to 0.23 in 2015. Meningitis was diagnosed in 10% of infants with early-onset GBS, with 9% of these cases occurring in the absence of bacteremia.

Late-Onset GBS

Late-onset GBS disease is defined as identification of GBS from a normally sterile site within one week to less than three months of age. Average incidence of late-onset GBS disease did not change from 2006 to 2015, demonstrating that maternal colonization at birth is less responsible for late-onset GBS. Acquisition of group B streptococci from nonmaternal caregivers may also be associated with late-onset GBS. Bacteremia was found in 93% of infants diagnosed with late-onset GBS disease, and meningitis was diagnosed in 31%. Preterm birth, positive maternal GBS screening at delivery, and positive maternal screening at diagnosis of late-onset disease are all strongly associated with late-onset GBS disease.


ACOG recommends that all pregnant women have antenatal testing for GBS colonization with a vaginal-rectal culture at 36 to 37 weeks' gestation. Screening is also recommended for any woman with preterm labor or premature rupture of membranes before 37 weeks' gestation. Vaginalrectal culture is not needed if antenatal urine culture has already confirmed GBS colonization. Nucleic acid amplification tests at point-of-care are not recommended for determining maternal colonization status because of reported variable sensitivity and lack of information about antibiotic sens

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of Practice Guidelines published in AFP is available at



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