UpToDate This is rare and happens to 1 or 2 babies out of 100 when the mother does not receive treatment with antibiotics during labor. 4 0 obj
only receive treatment if fever occurs. The only exception is when Group B Strep is found in asymptomatic pregnant women. ;F2XylDaK)ld{#,6e,n1KgCY%VQ["kD,k8bNE T- j0%/9*v``2Jl*)w9^TX GBS bacteriuria is diagnosed at any stage of pregnancy, a peripartum antibiotic prophylaxis is recommended, even in patients with negative results of the control vaginal and rectal swab tests, if carried out [7, 8]. Early Onset Neonatal Sepsis is covered in this issue of Clinics in Perinatology, guest edited by Drs. Karen Fairchild and Richard Polin. This new edition also features hundreds step-by-step procedures, updated visuals, new case studies, and new material on the latest trends and equipment in clinical microbiology including automation, automated streaking, MALDI-TOF, and Searches were updated on a regular basis and incorporated in the guideline to February 2011. About 1 in 4 pregnant women carry GBS in their rectum or vagina. During pregnancy, the mother can pass the infection to the baby. Found inside Page 1133INTRAPARTUMANTIBIOTIC PROPHYLAXIS TO PREVENT EARLY-ONSET GROUP B Positive GBS vaginal-rectal screening culture in late gestation (35 to 37 weeks optimally) during the GBS bacteriuria during a previous pregnancy Unknown GBS status endobj
Without treatment, as many as 20 to 35 percent of pregnant women with asymptomatic bacteriuria will develop a symptomatic urinary tract infection (UTI), including pyelonephritis, during pregnancy [ 7,8 ]. The contributors are internationally recognized for their expertise, making this book invaluable for infectious disease physicians, (internists, pediatricians, and family physicians, microbiologists, epidemiologists, and basic scientists [10] GBS Positive or Any GBS bacteriuria or Previous child with GBS infection Bacteriuria in pregnancy is associated with increased risk of anaemia, pre-eclampsia, chorioamnionitis, Found inside Page 76If pregnancy otherwise uncomplicated, continue midwifery-led care Inform paediatricians when in labour After complete treatment of GBS bacteriuria during pregnancy, if an elective Caesarean section is planned for any other obstetric Nevertheless, the NICE guideline " Neonatal . Immediate obstetrical delivery (such as induction . Universal screening and management of GBS bacteriuria in pregnancy are standards of care in the United States; however, some women may decline guideline-based recommendations for screening, treatment, or intrapartum antibiotic prophylaxis. CDC Recommendations Group B Streptococcus Prophylaxis. In June 2019, the American College of Obstetricians and Gynecologists (ACOG) published a new Committee OpinionPrevention of Group B Streptococcal Early-Onset Disease in Newborns external icon external icon which all obstetric care providers should now be following. Prior infant with GBS disease 4. It can cause asymptomatic bacteriuria, UTI, and pyelonephritis. GBS bacteriuria during current pregnancy 3. Found inside Page 1453Any woman with a positive prenatal screening culture, GBS bacteriuria during pregnancy, or a previous infant with invasive GBS disease should receive intrapartum antibiotics. Women whose culture status is unknown (culture not done, In the United States of America, GBS is known to be the most common infectious cause of morbidity and mortality in neonates [2] [3] [2]. Women who have had an incidental finding of GBS on a vaginal swab earlier in pregnancy need to have this repeated between 35-37 weeks. To provide information regarding the management of group B streptococcal (GBS) bacteriuria to midwives, nurses, and physicians who are providing obstetrical care. Bacteriuria is defined in this clinical practice guideline as the presence of bacteria in urine, regardless of the number of colony-forming units per mL (CFU/mL). 8 Antibiotic prophylaxis also is recommended for pregnant women who are GBS unknown presenting in labor with risk factors for GBS (GBS bacteriuria earlier in pregnancy, preterm labor, history of a . This book is a new clinically oriented reference book for the management of such infections in the emergency room and focuses on all diagnostic protocols and treatment strategies that emergency room physicians need to be proficient in when Found inside Page 312Intrapartum antibiotics should be given to women found to have GBS bacteriuria or GBS identified on low vaginal and/or (UTI). Urinary tract infections (UTIs) are commonly encountered in pregnancy. Treatment for asymptomatic A: Antibiotic prophylaxis may be considered in women with 2 urinary tract infections in 6 months or 3 urinary tract infections in 12 months. pregnancy* GBS bacteriuria during previous pregnancy (unless an indication for GBS prophylaxis exists for current pregnancy) Positive GBS vaginal-rectal screening culture in late gestation during current pregnancy* Negative vaginal and rectal GBS screening culture in late gestation during the current pregnancy, regardless of intrapartum risk . Screening for asymptomatic bacteriuria in pregnancy Refer to NF for further advice on appropriate antimicrobials during All women should be screened once for asymptomatic bacteriuria at the 1st antenatal (booking) appointment (NIE recommendation). Your Pregnancy and Childbirth: Month to Month is a resource for informational purposes. If untreated leads If left untreated, up to 30% of mothers will develop acute pyelonephritis. College Statement C-Obs 19. UTI during pregnancy should be treated as per culture sensitivities. ACUTE CYSTITIS Acute cystitis occurs in 1-4% of pregnant women [3]. The early studies supported antibiotic treatment of asymptomatic GBS bacteriuria to reduce the incidence of maternal and neonatal morbidity and mortality.13,14,17 Newer retrospective and prospective studies have not demonstrated a higher risk of preterm birth in individuals with GBS bacteriuria.23,24,28,30 In more recent studies that controlled .
**If amnionitis is suspected, broad-spectrum antibiotic therapy that includes an agent known to be active . DIAGNOSIS FOR ASYMPTOMATIC BACTERIURIA AND LOWER UTI: Diagnosis of infection: >105 colonies of a single pathogen/ml clean catch urine. GBS BACTERIURIA OR GBS URINE INFECTION DURING PREGNANCY . If treating GBS bacteriuria during pregnancy with 500 mg of amoxicillin, this dose should be administered . Treatment of any bacteriuria with colony counts 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. The AAP's authoritative guide on preventing, recognizing, and treating more than 200 childhood infectious diseases. (II-2D). Pregnant women, however, are different story. Women with asymptomatic bacteriuria during pregnancy are more likely to deliver premature or low-birth-weight infants and have a 20- to 30-fold increased risk of developing pyelonephritis during . Group B streptococcus (GBS; Streptococcus agalactiae) is a gram-positive coccus that frequently colonizes the human genital and gastrointestinal tracts, and less frequently, the upper respiratory tract of children and adults [].It is an important cause of illness in neonates, young infants, pregnant women, and adults with underlying medical conditions []. Group B Strep in Pregnancy GBS Algorithm for Term Pregnancies posi Positive deliv GBS bacteriuria (104 CFU)1* / Previous child with GBS infection1 Planned cesarean in absence of labor or rupture of membranes1 No GBS prophylaxis needed Do vaginal / rectal GBS culture with selective media at 35-37 weeks1 and check sensitivities if PCN allergy1** Journal of Obstetrics and Gynaecology Canada, https://doi.org/10.1016/S1701-2163(16)35246-X. The Centers for Disease Control and Prevention (CDC) recommends that pregnant women with GBS bacteriuria be treated at the time of diagnosis and during labor. - - - - Adequate prophylaxis is defined as . Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Indications for Intrapartum Antibiotic Prophylaxis Bacteriuria If GBS bacteriuria at any colony count is detected during pregnancy, the woman is at increased risk of GBS colonization during labor. GBS is a transient bacterium that is commonly found in the gastrointestinal tract, vagina and urethra in 15-25% of pregnant women (asymptomatic carriers of GBS). They compared this group to pregnant women with negative urine cultures to determine whether antibiotic treatment early in pregnancy is associated with improved pregnancy outcomes specifically, decreased risk for chorioamnionitis. In women, GBS most often is found in the vagina and rectum.This means that GBS can pass from a pregnant woman to her fetus during labor.
Allen VM, Yudin MH, Bouchrad C et al (2012) Management of group B streptococcal bacteriuria in pregnancy. Group B Streptococcus also known as Group B Strep Infection (GBS) is a type of bacterial infection that can be found in a pregnant woman's vagina or rectum. <>>> If you would like to order paper copies of this leaflet, please contact GBSS on 0330 120 0796 or info@gbss.org.uk.. With a GBS-positive screening result in the current . The fetus can get GBS during pregnancy. This book is a guide to labour and delivery management for trainees in obstetrics and gynaecology, and midwives. (see GBS Algorithm for Term Pregnancies if allergies) Negative GBS culture at 48 hrs. When women with penicillin and cephalosporin allergy are screened for GBS during pregnancy, culture and sensitivity must also be included on the request form as there is stream (II-2E), Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. 4.2 Positive GBS bacteriuria in current pregnancy Women who have a positive urine test for GBS at any stage of pregnancy need to be treated with antibiotics at the time of diagnosis, as there is an increased risk of preterm labour and pyelonephritis. J Obstet Gynaecol Can 34(5): 482-86. GBS bacteriuria in current pregnancy - Women with GBS bacteriuria any time in the current pregnancy should routinely receive intrapartum antibiotic prophylaxis, even if bacteriuria is treated and a repeat urine culture is negative; therefore, they can be excluded from culture-based screening later in pregnancy. %PDF-1.5 Treatment of any bacteriuria with colony counts 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. IAP is not indicated solely for the reason of colonization by GBS in a previous pregnancy or GBS bacteriuria in a previous pregnancy. (II-2E) 4 . <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R 12 0 R 16 0 R 17 0 R 19 0 R 20 0 R 22 0 R 23 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Copyright 2012 Society of Obstetricians and Gynaecologists of Canada. In pregnancy, you'll undergo a variety of routine scans and lab work, from anatomy scans to the oral glucose test, to ensure everything is progressing normally.Toward the end of your pregnancy (week 36 through week 37), your obstetrics provider will recommend a screening for group B streptococcus (GBS), aka the group B strep test. Objective To systematically review screening and treatment effectiveness, and patient preferences, to inform recommendations by the Canadian Task Force on Preventive Health Care on screening for asymptomatic bacteriuria in pregnancy. <> RANZCOG (2016) Screening and Treatment for Group B Streptococcus in Pregnancy. The chance of a newborn getting sick is much lower when the mother receives treatment. Group B streptococcus (GBS) Practice points. of PTL or cessation of PTL Stop GBS prophylaxis Intrapartum GBS prophylaxis For PPROM <37 wks., obtain GBS culture. GBS bacteriuria during current pregnancy Positive Screening culture at 35-37 weeks during current pregnancy GBS unknown and any of Preterm labour (<37 weeks) - - - - ROM > 18 hours Maternal fever > 38 (treat for chorioamnionitis with broad spectrum antibiotics) No method prevents all GBS disease. Women who do not have bacteriuria in the first screen (i.e. GBS recolonized within 3 weeks. No cost-benefit analysis is provided. 8 Antibiotic prophylaxis also is recommended for pregnant women who are GBS unknown presenting in labor with risk factors for GBS (GBS bacteriuria earlier in pregnancy, preterm labor, history of a . Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. GBS is known to cause both early onset and late onset . Half of the 122 women with GBS bacteriuria received antibiotics antenatally, and half did not. appropriate antibiotic regimen is recommended according to the sensitivities as Importantly, adhering to this principle helps with antibiotic stewardship. College Statement C-Obs 19. The chance of a newborn getting sick is much lower when the mother receives treatment. Endorsed by the United Nations Secretary-General, this is a comprehensive WHO guideline on routine antenatal care for pregnant women and adolescent girls. Newborns can get it from the mother's genital tract during delivery. Indications for Intrapartum Antibiotic Prophylaxis Bacteriuria If GBS bacteriuria at any colony count is detected during pregnancy, the woman is at increased risk of GBS colonization during labor.
Group B strep, or GBS, is a type of bacteria that can live in your digestive tract and vagina. GBS bacteriuria during a previous pregnancy (unless an indication for GBS prophylaxis is present for current pregnancy) Positive vaginal-rectal GBS screening culture in late gestation during . be treated at time of diagnosis. Management of Group B Streptococcal Bacteriuria in Pregnancy 3 . None of these contents may be reproduced in any form without prior written permission of the SOGC. GBS bacteriuria in the current pregnancy GBS-positive screening result in the current pregnancy Unknown GBS status with delivery at less than 37 weeks' gestation, an intrapartum temperature of 100.4F or greater, or rupture of membranes for 18 hours or longer. Disclosure statements have been received from all members of the committee. 1 0 obj RANZCOG (2016) Screening and Treatment for Group B Streptococcus in Pregnancy. Medical Problems During Pregnancy outlines key points to consider when prescribing medication and additionally offers a range of practical suggestions that can greatly improve the physician-patient interaction. (II-2E) 4 . Asymptomatic women with urinary group B streptococcal colony counts < 100 000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth . Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Treat with one of antibiotics used to treat cystitis in pregnancy listed above. While acting as a stand-alone text on obstetric care, this volume also forms part of a three-volume set - all authored by leading authorities - on the entirety of obstetric and gynecologic practice. They should be well documented if modified at the local level. review found that antibiotics for asymptomatic bacteriuria Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the . Developed by the AAP (American Academy of Pediatrics) Committee on Infectious Diseases in conjunction with the CDC (Centers for disease control), the FDA (Food and drug administration), and other leading institutions with contributions from Established almost 30 years ago, Methods in Microbiology is the most prestigious series devoted to techniques and methodology in the field. a) a previous GBS-infected baby b) GBS bacteriuria of any count during the current pregnancy c) preterm (<37 weeks) labour and imminent birth d) intrapartum fever > 38 0 C e) membrane rupture > 18 hours 2. The decision The decision must take into consideration frequency and severity of UTI versus adverse effects, such as adverse drug reactions, C. difficile colitis, and antibiotic resistance. 1. Antibiotic treatment of GBS bacteriuria during pregnancy does not eliminate GBS from the genitourinary and gastrointestinal tracts, and recolonization after a course of antibiotics is typical, so this does not offset the recommendation that pregnant women with GBS in their urine receive antibiotics in labor.
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**If amnionitis is suspected, broad-spectrum antibiotic therapy that includes an agent known to be active . DIAGNOSIS FOR ASYMPTOMATIC BACTERIURIA AND LOWER UTI: Diagnosis of infection: >105 colonies of a single pathogen/ml clean catch urine. GBS BACTERIURIA OR GBS URINE INFECTION DURING PREGNANCY . If treating GBS bacteriuria during pregnancy with 500 mg of amoxicillin, this dose should be administered . Treatment of any bacteriuria with colony counts 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. The AAP's authoritative guide on preventing, recognizing, and treating more than 200 childhood infectious diseases. (II-2D). Pregnant women, however, are different story. Women with asymptomatic bacteriuria during pregnancy are more likely to deliver premature or low-birth-weight infants and have a 20- to 30-fold increased risk of developing pyelonephritis during . Group B streptococcus (GBS; Streptococcus agalactiae) is a gram-positive coccus that frequently colonizes the human genital and gastrointestinal tracts, and less frequently, the upper respiratory tract of children and adults [].It is an important cause of illness in neonates, young infants, pregnant women, and adults with underlying medical conditions []. Group B Strep in Pregnancy GBS Algorithm for Term Pregnancies posi Positive deliv GBS bacteriuria (104 CFU)1* / Previous child with GBS infection1 Planned cesarean in absence of labor or rupture of membranes1 No GBS prophylaxis needed Do vaginal / rectal GBS culture with selective media at 35-37 weeks1 and check sensitivities if PCN allergy1** Journal of Obstetrics and Gynaecology Canada, https://doi.org/10.1016/S1701-2163(16)35246-X. The Centers for Disease Control and Prevention (CDC) recommends that pregnant women with GBS bacteriuria be treated at the time of diagnosis and during labor. - - - - Adequate prophylaxis is defined as . Results were restricted to systematic reviews, randomized controlled trials, and relevant observational studies. Indications for Intrapartum Antibiotic Prophylaxis Bacteriuria If GBS bacteriuria at any colony count is detected during pregnancy, the woman is at increased risk of GBS colonization during labor. GBS is a transient bacterium that is commonly found in the gastrointestinal tract, vagina and urethra in 15-25% of pregnant women (asymptomatic carriers of GBS). They compared this group to pregnant women with negative urine cultures to determine whether antibiotic treatment early in pregnancy is associated with improved pregnancy outcomes specifically, decreased risk for chorioamnionitis. In women, GBS most often is found in the vagina and rectum.This means that GBS can pass from a pregnant woman to her fetus during labor.
Allen VM, Yudin MH, Bouchrad C et al (2012) Management of group B streptococcal bacteriuria in pregnancy. Group B Streptococcus also known as Group B Strep Infection (GBS) is a type of bacterial infection that can be found in a pregnant woman's vagina or rectum. <>>> If you would like to order paper copies of this leaflet, please contact GBSS on 0330 120 0796 or info@gbss.org.uk.. With a GBS-positive screening result in the current . The fetus can get GBS during pregnancy. This book is a guide to labour and delivery management for trainees in obstetrics and gynaecology, and midwives. (see GBS Algorithm for Term Pregnancies if allergies) Negative GBS culture at 48 hrs. When women with penicillin and cephalosporin allergy are screened for GBS during pregnancy, culture and sensitivity must also be included on the request form as there is stream (II-2E), Women with documented group B streptococcal bacteriuria should not be re-screened by genital tract culture or urinary culture in the third trimester, as they are presumed to be group B streptococcal colonized. 4.2 Positive GBS bacteriuria in current pregnancy Women who have a positive urine test for GBS at any stage of pregnancy need to be treated with antibiotics at the time of diagnosis, as there is an increased risk of preterm labour and pyelonephritis. J Obstet Gynaecol Can 34(5): 482-86. GBS bacteriuria in current pregnancy - Women with GBS bacteriuria any time in the current pregnancy should routinely receive intrapartum antibiotic prophylaxis, even if bacteriuria is treated and a repeat urine culture is negative; therefore, they can be excluded from culture-based screening later in pregnancy. %PDF-1.5 Treatment of any bacteriuria with colony counts 100 000 CFU/mL in pregnancy is an accepted and recommended strategy and includes treatment with appropriate antibiotics. IAP is not indicated solely for the reason of colonization by GBS in a previous pregnancy or GBS bacteriuria in a previous pregnancy. (II-2E) 4 . <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 11 0 R 12 0 R 16 0 R 17 0 R 19 0 R 20 0 R 22 0 R 23 0 R 26 0 R 27 0 R 28 0 R 29 0 R 30 0 R 31 0 R 32 0 R] /MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Copyright 2012 Society of Obstetricians and Gynaecologists of Canada. In pregnancy, you'll undergo a variety of routine scans and lab work, from anatomy scans to the oral glucose test, to ensure everything is progressing normally.Toward the end of your pregnancy (week 36 through week 37), your obstetrics provider will recommend a screening for group B streptococcus (GBS), aka the group B strep test. Objective To systematically review screening and treatment effectiveness, and patient preferences, to inform recommendations by the Canadian Task Force on Preventive Health Care on screening for asymptomatic bacteriuria in pregnancy. <> RANZCOG (2016) Screening and Treatment for Group B Streptococcus in Pregnancy. The chance of a newborn getting sick is much lower when the mother receives treatment. Group B streptococcus (GBS) Practice points. of PTL or cessation of PTL Stop GBS prophylaxis Intrapartum GBS prophylaxis For PPROM <37 wks., obtain GBS culture. GBS bacteriuria during current pregnancy Positive Screening culture at 35-37 weeks during current pregnancy GBS unknown and any of Preterm labour (<37 weeks) - - - - ROM > 18 hours Maternal fever > 38 (treat for chorioamnionitis with broad spectrum antibiotics) No method prevents all GBS disease. Women who do not have bacteriuria in the first screen (i.e. GBS recolonized within 3 weeks. No cost-benefit analysis is provided. 8 Antibiotic prophylaxis also is recommended for pregnant women who are GBS unknown presenting in labor with risk factors for GBS (GBS bacteriuria earlier in pregnancy, preterm labor, history of a . Medline, PubMed, and the Cochrane database were searched for articles published in English to December 2010 on the topic of GBS bacteriuria in pregnancy. GBS is known to cause both early onset and late onset . Half of the 122 women with GBS bacteriuria received antibiotics antenatally, and half did not. appropriate antibiotic regimen is recommended according to the sensitivities as Importantly, adhering to this principle helps with antibiotic stewardship. College Statement C-Obs 19. The chance of a newborn getting sick is much lower when the mother receives treatment. Endorsed by the United Nations Secretary-General, this is a comprehensive WHO guideline on routine antenatal care for pregnant women and adolescent girls. Newborns can get it from the mother's genital tract during delivery. Indications for Intrapartum Antibiotic Prophylaxis Bacteriuria If GBS bacteriuria at any colony count is detected during pregnancy, the woman is at increased risk of GBS colonization during labor.
Group B strep, or GBS, is a type of bacteria that can live in your digestive tract and vagina. GBS bacteriuria during a previous pregnancy (unless an indication for GBS prophylaxis is present for current pregnancy) Positive vaginal-rectal GBS screening culture in late gestation during . be treated at time of diagnosis. Management of Group B Streptococcal Bacteriuria in Pregnancy 3 . None of these contents may be reproduced in any form without prior written permission of the SOGC. GBS bacteriuria in the current pregnancy GBS-positive screening result in the current pregnancy Unknown GBS status with delivery at less than 37 weeks' gestation, an intrapartum temperature of 100.4F or greater, or rupture of membranes for 18 hours or longer. Disclosure statements have been received from all members of the committee. 1 0 obj RANZCOG (2016) Screening and Treatment for Group B Streptococcus in Pregnancy. Medical Problems During Pregnancy outlines key points to consider when prescribing medication and additionally offers a range of practical suggestions that can greatly improve the physician-patient interaction. (II-2E) 4 . Asymptomatic women with urinary group B streptococcal colony counts < 100 000 CFU/mL in pregnancy should not be treated with antibiotics for the prevention of adverse maternal and perinatal outcomes such as pyelonephritis, chorioamnionitis, or preterm birth . Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Treat with one of antibiotics used to treat cystitis in pregnancy listed above. While acting as a stand-alone text on obstetric care, this volume also forms part of a three-volume set - all authored by leading authorities - on the entirety of obstetric and gynecologic practice. They should be well documented if modified at the local level. review found that antibiotics for asymptomatic bacteriuria Women with documented group B streptococcal bacteriuria (regardless of level of colony-forming units per mL) in the current pregnancy should be treated at the . Developed by the AAP (American Academy of Pediatrics) Committee on Infectious Diseases in conjunction with the CDC (Centers for disease control), the FDA (Food and drug administration), and other leading institutions with contributions from Established almost 30 years ago, Methods in Microbiology is the most prestigious series devoted to techniques and methodology in the field. a) a previous GBS-infected baby b) GBS bacteriuria of any count during the current pregnancy c) preterm (<37 weeks) labour and imminent birth d) intrapartum fever > 38 0 C e) membrane rupture > 18 hours 2. The decision The decision must take into consideration frequency and severity of UTI versus adverse effects, such as adverse drug reactions, C. difficile colitis, and antibiotic resistance. 1. Antibiotic treatment of GBS bacteriuria during pregnancy does not eliminate GBS from the genitourinary and gastrointestinal tracts, and recolonization after a course of antibiotics is typical, so this does not offset the recommendation that pregnant women with GBS in their urine receive antibiotics in labor.
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