prevention of perinatal group b streptococcal disease

Most screen vaginal and rectal specimens at 34–37 weeks of gestation. Opportunities for prevention of perinatal group B streptococcal disease: a multistate surveillance analysis. Women who have had severe reactions to penicillin or a cephalosporin should be tested for erythromycin and clindamycin resistance. Am Fam Physician. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Swab the vaginal introitus, followed by the rectum (insert swab through the anal sphincter) using the same swab or two different swabs. Group B streptococci (GBS) emerged as the leading cause of invasive bacterial infections in newborns in the United States in the 1970s. Perinatal group B streptococcal disease after universal screening recommendations--United States, 2003-2005. Group B streptococci at delivery: high count in urine increases risk for neonatal colonization. RR-11]). Setting: All hospitals that undertook deliveries in public patients in the State of Victoria, November 1997 to January 1998. N Engl J Med. Although one recent study showed that perianal and rectal cultures yield similar results,6 the current guideline recommends obtaining cultures from the vagina and rectum with cotton swabs, with the rectal swab passed through the anal sphincter.6 Specimens are sent to the laboratory in a transport medium, incubated in enrichment broth, and then plated for culture. This report presents CDC's updated guidelines, which have been endorsed by the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, the American College of Nurse-Midwives, the American Academy of Family Physicians, and the American Society for Microbiology. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Schrag S, MMWR Recomm Rep. 2010;59(RR-10):21. McGee L, Screening and treating GBS colonized women has been very successful in decreasing the incidence of … Neonatal Group B Streptococcal Disease Study Group Obstet Gynecol , … In contrast with the previous algorithm for secondary prevention of early-onset disease in newborns, which applied only to those at risk of infection, the algorithm in the new guideline applies to all newborns (Figure 5).1 The need for evaluation, observation, or treatment depends on whether the infant appears ill, and whether risk factors are present. Schuchat A, Plikaytis BD, Scand J Infect Dis. Revised guidelines from CDC. Committee on Obstetric Practice, American College of … This is a corrected version of the article that appeared in print. Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the . MMWR Recomm Rep 2010;59(RR-10):1–36. In 2002, all Minnesota providers surveyed reported using a prevention policy. MMWR 1996:45(no. The only change from the previous CDC guideline is the inclusion of a dose range for penicillin, which facilitates dosing because formulations vary. Evaluation of universal antenatal screening for group B streptococcus. Kowalsky L, Oddie S, Schrag SJ; The disease emerged as a leading infectious cause of neonatal morbidity and mortality in the United States in the 1970s for reasons that remain unclear. De Rose DU, Perri A, Auriti C, Gallini F, Maggio L, Fiori B, D'Inzeo T, Spanu T, Vento G. Antibiotics (Basel). In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. 3. About 25% of pregnant women unknowingly carry group B strep in the rectum or vagina. Group B streptococci at delivery: high count in urine increases risk for neonatal colonization. 8. Continued efforts are needed to sustain and improve on the progress achieved in the prevention of GBS disease. Group B streptococcus (GBS) remains a leading cause of serious neonatal infection despite great progress in perinatal GBS disease prevention in the 1990s. Both regimens aim to maintain adequate drug levels in the fetal circulation and amniotic fluid while avoiding maternal neurotoxicity. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Group B strep disease in newborns most commonly causes infection of the blood, pneumonia, and sometimes meningitis. MMWR Morb Mortal Wkly Rep. 2007 Jul 20;56(28):701-5. Prevention of perinatal group B streptococcal disease: a public health perspective. Third, the new guideline presents separate algorithms for management of preterm labor and preterm premature rupture of membranes, rather than a single algorithm for both conditions. If a negative culture result from the preceding five-week period is not available in a woman with threatened preterm labor or PPROM, a specimen should be obtained for culture or rapid nucleic acid amplification testing, and intrapartum antibiotics should be initiated and continued until results are available. Gotoff SP. 101, Tucson, AZ 85750 (e-mail: colleen. 2010 Jun;37(2):375-92. doi: 10.1016/j.clp.2010.02.002. 2021 Jan;10(1):64-72. doi: 10.21037/tp-20-255. Prevention of peri - natal group B streptococcal disease—revised guidelines from CDC, 2010. 1. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC, 2010. 4. et al. MMWR Recomm Rep. 2010;59(RR-10):16. Embleton ND. Verani JR, Prevention of perinatal group B streptococcal disease. MMWR Recomm Rep. 2010;59(RR-10):1-36. Fultz-Butts K, Highlights We reviewed intrapartum prophylaxis impact on newborn group B streptococcal disease. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml. Prevention of Perinatal Group B Streptococcal Disease: A Public Health Perspective Summary Group B streptococcus is a leading cause of serious neonatal infection. Matson S, Prevention of perinatal group B streptococcal disease. Modified from Verani JR, McGee L, Schrag SJ. J Perinat Neonatal Nurs. 2000;105(1 pt 1):21–26. The new guideline offers separate, more detailed algorithms for each of these situations, including recommendations for antibiotic regimens to prolong latency while also providing adequate coverage against GBS (Figures 2 and 3).1 These algorithms specify that if a culture has been obtained within the past five weeks, results of that culture should guide intrapartum antibiotic prophylaxis. Centers for Disease Control and Prevention. Burd LI, Urine cultures are considered positive and warrant prophylaxis when GBS is present at concentrations of at least 104 colony-forming units per mL, whether as a single isolate or with other microorganisms. In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. Lin K, The new guideline defines inadequate intrapartum chemoprophylaxis as failure to receive at least four hours of intravenous penicillin, ampicillin, or cefazolin before delivery. CDC - Morbidity and Mortality Weekly Report. Prevention of Perinatal Group B Streptococcal (GBS) Disease . Multistate case-control study of maternal risk factors for neonatal group B streptococcal disease. Universal screening at 35-37 weeks' gestation for maternal GBS colonization and use of intrapartum antibiotic prophylaxis has resulted in substantial reductions in the burden of early-onset GBS disease among newborns. MMWR Recomm Rep. 2010;59(RR-10):17. Wenger JD; 2021 Mar 1. doi: 10.1038/s41372-021-00981-3. In June 2009, a meeting of clinical and public health representatives was held to reevaluate prevention strategies on the basis of data collected after the issuance of the 2002 guidelines. The new guideline clarifies that women who are allergic to penicillin are at risk of anaphylaxis if they have a history of anaphylaxis, angioedema, respiratory distress, or urticaria after administration of penicillin or a cephalosporin. Well-appearing term infants whose mother had an indication for intrapartum chemoprophylaxis but did not receive antibiotics or received inadequate prophylaxis can be observed for at least 48 hours without treatment or further evaluation. Intrapartum antibiotic prophylaxis for the prevention of perinatal group B streptococcal disease: experience in the United States and implications for a potential group B streptococcal vaccine. Van Dyke MK, Clin Perinatol. leading cause of early-onset neonatal sepsis in the United States. Algorithm for the secondary prevention of early-onset GBS disease among newborns. Quon H, The algorithm clarifies the extent of evaluation and duration of observation required for infants in different risk categories. et al. Author disclosure: No relevant financial affiliations to disclose. 14. Centers for Disease Control and Prevention. All rights Reserved. Screening for group B streptococcus (GBS) and use of intrapartum chemoprophylaxis for women with preterm labor. et al. In 1996, CDC, in collaboration with relevant professional societies, published guidelines for the prevention … / afp Pediatr Infect Dis J. Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. Farley MM, Recommended laboratory testing for prenatal screening for group B streptococcus (GBS). Deaver-Robinson K, Despite substantial progress in prevention of perinatal group B streptococcal (GBS) disease since the 1990s, GBS remains the leading cause of early-onset neonatal sepsis in the United States. Elfström L, US uptake of prenatal screening and intrapartum antibiotics was rapid and widespread. Bethesda, MD 20894, Copyright Nandyal RR. Multistate case-control study of maternal risk factors for neonatal group B streptococcal disease. 2021 Feb 16;21(1):141. doi: 10.1186/s12884-021-03624-9. U.S. Preventive Services Task Force. Exceptions to the recommendation for observation without evaluation are infants delivered at less than 37 weeks’ gestation or when membranes had been ruptured for 18 hours or more. Jordan HT, Gotoff SP. 4. Phares CR, / MMWR Recomm Rep. 1996;45(RR-7):1–24. Fajardo K. Current prevention limitations might … 2012 Jul 1;86(1):59-65. Table 2. Lynfield R, Trappe KL, Sign up for the free AFP email table of contents. RR-7]); those guidelines were updated and republished in 2002 (CDC. Gorwitz R, Fajardo K. Group B streptococcus (GBS) is the leading cause of early-onset neonatal sepsis in the United States.1 From 1992 to 2010, implementation of screening for GBS during pregnancy reduced the incidence of early-onset sepsis,2–4 and universal screening for GBS at 35 to 37 weeks’ gestation is now recommended in all pregnant women.5, Enlarge / Journals 13. Jordan HT, Mohle-Boetani J, Screening for group B streptococcus (GBS) and use of intrapartum chemoprophylaxis for women with preterm premature rupture of membranes. Persson K, Fultz-Butts K, McKenna DS, 2008;22(3):230–237. Deaver-Robinson K, The American Academy of Pediatrics (AAP) also published a policy statement on this topic in 1997. Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. McKenna DS, Gorwitz R, Trappe KL, An improved clinical prediction rule for identifying neonatal bacterial meningitis: a multicenter cohort study. MMWR Recomm Rep. 1996 May 31;45(RR-7):1-24. 5. Previous: Summary of the NIAID-Sponsored Food Allergy Guidelines, Next: Reducing Adverse Effects of Proton Pump Inhibitors, Home Routine screening for asymptomatic bacteriuria is recommended during pregnancy,7 and group B streptococcal bacteriuria is found in 2 to 7 percent of pregnant women.8 The presence of group B streptococcal bacteriuria indicates concomitant genital tract colonization and an increased risk of early-onset neonatal disease. eCollection 2020. Elfström L, Fourth, there are minor changes in the recommended dose of penicillin G for intrapartum chemoprophylaxis. Group B streptococcus (GBS), or Streptococcus agalactiae, is a gram-positive bacterium that can colonize the human gastrointestinal and genitourinary tracts asymptomatically and is a leading cause of morbidity and mortality in newborn infants.Neonatal infection results from vertical transmission of maternal colonization of the anal, perineal, and/or vaginal regions. Patients who are allergic to penicillin should be evaluated for anaphylaxis risk. Dinsmoor MJ, Second, the colony count required to consider a urine specimen positive is at least 104 colony-forming units per mL. Shaffer LE, Choose a single article, issue, or full-access subscription. Introduction. Most neonatal GBS infections can be prevented through the use of intrapartum antimicrobial prophylaxis in women who are at increased risk for transmitting the infection to their newborns. et al. Clindamycin (900 mg intravenously every eight hours until delivery) is the drug of choice if the GBS isolate is susceptible to clindamycin and erythromycin, and if there is no inducible clindamycin resistance. In 2002, all Minnesota providers surveyed reported using a prevention policy. afpserv@aafp.org for copyright questions and/or permission requests. Prevention of perinatal group B streptococcal disease: a public health perspective. ; 1(July 1, 2012) For information about the SORT evidence rating system, go to, Adapted from Verani JR, McGee L, Schrag SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention recently updated its guideline for the prevention of early-onset neonatal group B streptococcal disease. From 1994 to 2010 over 70,000 cases of newborn invasive GBS disease were prevented. The 2002 Prevention of Perinatal Group B Streptococcal Disease guidelines from the Center for Disease Control (CDC) represents a revision of a prior set of guidelines represented by the CDC in 1996. The Centers for Disease Control and Prevention (CDC) have recently published new guidelines for prevention of group B streptococcal (GBS) disease.1 These new guidelines are in consensus with the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists (ACOG), who previously published their own, different, recommendations.2,3 The new CDC guidelines … If time does not permit sensitivity testing, vancomycin is the drug of choice. Privacy, Help FOIA COLLEEN K. CAGNO, MD, JESSIE M. PETTIT, MD, and BARRY D. WEISS, MD, University of Arizona College of Medicine, Tucson, Arizona. Verani JR, Group B streptococcus and pregnancy : towards an optimal prevention strategy for neonatal Group B Streptococcal Disease Doctoral Thesis Group B Streptococcus (GBS, Streptococcus agalactiae) has been recognized as an important cause of perinatal morbidity and mortality. et al. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. testing for group B streptococcus during pregnancy, Expanded Recommendations for Laboratory Detection of GBS, Colony Count Threshold for Reporting GBS in Urine, Screening and Chemoprophylaxis in Women with Preterm Labor or PPROM, Updated Prophylactic Regimens for Women with Penicillin Allergy, Revised Algorithm for Secondary Prevention of Early-Onset Disease, Summary of the NIAID-Sponsored Food Allergy Guidelines, Reducing Adverse Effects of Proton Pump Inhibitors. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Risk factors and opportunities for prevention of early-onset neonatal sepsis: a multicenter case-control study. Forsgren A. The purpose of this guideline is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early‐onset neonatal group B streptococcal (EOGBS) disease and the information to be provided to women, their partners and family. Place the swab into a nonnutritive transport medium. CMAJ. RR-11]). Burd LI, Prevention of perinatal group B streptococcal disease: a public health perspective. Prevention of perinatal group B streptococcal disease: revised guidelines from CDC. Thus, group B streptococcal bacteriuria at any point in pregnancy is an indication for intrapartum chemoprophylaxis. Reprints are not available from the authors. Address correspondence to Colleen K. Cagno, MD, University of Arizona, 707 N. Alvernon Way, Ste. 2021 Jan 28;10(2):123. doi: 10.3390/antibiotics10020123. These infants should undergo evaluation with a blood culture and a complete blood count with differential and platelet count at birth or at six to 12 hours after delivery. Update on group B streptococcal infections: perinatal and neonatal periods. If signs of sepsis are apparent, a full evaluation should be performed and antibiotic therapy should be initiated against GBS (regardless of maternal colonization) and other common pathogens (e.g., Escherichia coli). In 1996, CDC, in collaboration with other agencies, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. For infants born to mothers with chorioamnionitis, the guideline recommends a blood culture and complete blood count with differential and platelet count, followed by initiation of antibiotics, including intravenous ampicillin, for GBS and other organisms such as E. coli. MMWR 1996;45[No. The Active Surveillance Study Group. First, there is a recommendation to consider using sensitive nucleic acid amplification tests, rather than just routine cultures, for detection of group B streptococcus in rectal and vaginal specimens. Mohle-Boetani J, Centers for Disease Control and Prevention. / Vol. Fisher DE, Adair CE, Risk factors for early-onset group B streptococcal disease in neonates: a population-based case-control study. Group B streptococcus (GBS) infects two to three per 1000 newborns in the United States with a mortality of 20% to 30% (); although specific Canadian data are not known, they are likely similar.As many as 10% to 30% of pregnant women are colonized with GBS in the vagina or rectum (2,3), 1% to 2% of their newborns developing early onset disease (). Vancomycin (1 g intravenously every 12 hours until delivery) is recommended if testing shows resistance or inducible resistance to clindamycin. Rosenstein NE, Schuchat A. Obstet Gynecol, 90(6):901-906, 01 Dec 1997 Cited by: 34 articles | PMID: 9397099 A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. If erythromycin and clindamycin susceptibility tests were not performed, or if results are not available at the time of labor, vancomycin should be used in women at high risk of anaphylaxis.1 Erythromycin is no longer acceptable for empiric prophylaxis because of increasing rates of resistance. Copyright © 2012 by the American Academy of Family Physicians. Group B streptococcus is a leading cause of serious neonatal infection. Update on group B streptococcal infections: perinatal and neonatal periods. Phares CR, Adapted from Verani JR, McGee L, Schrag SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). doi: 10.1016/j.vaccine.2012.11.056. 10. Search date: February 25, 2011. editor’s note: The American Academy of Family Physicians has endorsed the 2010 CDC guideline on prevention of perinatal group B streptococcal disease, with reservations. Tano S, Ueno T, Mayama M, Yamada T, Takeda T, Uno K, Yoshihara M, Ukai M, Suzuki T, Kishigami Y, Oguchi H. BMC Pregnancy Childbirth. These infants should be observed in the hospital for at least 48 hours. Patient information: See related handout on testing for group B streptococcus during pregnancy, written by the authors of this article. COVID-19 is an emerging, rapidly evolving situation. Would you like email updates of new search results? [ Pediatr Infect Dis J. Accessibility Pediatrics. Adoption of hospital policies for the prevention of perinatal group B streptococcal dis-ease—United States, 1997. Get Permissions, Access the latest issue of American Family Physician. Oddie S, Gao K, Gao C, Huang L, Guan X, Ji W, Chang CY, McIver DJ, Deng Q, Zhong H, Xie Y, Deng L, Gao F, Zeng L, Liu H. Front Microbiol. Obstet Gynecol. Fifth, the guideline provides new recommendations about antibiotic regimens for women with penicillin allergy. Adapted from Verani JR, McGee L, Schrag SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Although rectal and vaginal specimens are still recommended, the new guideline suggests using more sensitive methods to process specimens. The recommendations were made on the basis of available evidence when such evidence was sufficient and on expert opinion when available evidence was insufficient. The new guideline contains six important changes. Ann Intern Med. Most cases of neonatal group B streptococcal disease with early onset have an intrapartum pathogenesis. ACOG’s guidance replaces the 2010 guidelines published by CDC. Discharge at 24 hours with further observation at home can be considered in cases of inadequate prophylaxis if the infant was born at more than 37 weeks’ gestation, has met other discharge criteria, has caregivers who will follow instructions, and has access to medical care. Bjerre B, 12. Ampicillin should be given as one 2-g intravenous dose, followed by 1 g every four hours until delivery. ; Abstract: Objectives: To survey clinical protocols for prevention of early-onset group B streptococcal disease (EOGBSD) of the newborn in public maternity hospitals. (CBC = complete blood count; GBS = group B streptococcus.). He is medical editor of AAFP’s FP Essentials and an associate medical editor of American Family Physician. 1,4. Polberger S, Risk factors for early onset neonatal group B streptococcal sepsis: case-control study. Design: Postal questionnaire with telephone follow-up when required. Persson K, The use of screening-based methods has increased dramatically since 1998. Farley MM, Maternal colonization is the primary risk factor for early-onset disease in infants; other risk factors include preterm labor (less than 37 weeks’ gestation) and prolonged rupture of membranes10–14  (Table 2). 1994;13(7):623–629. Prevention of perinatal group B streptococcal disease—revised guidelines from CDC, 2010. 6. Active Bacterial Core Surveillance (ABCs)/Emerging Infections Program Network, CDC. For women with penicillin allergy who have not had severe reactions, cefazolin is the recommended antibiotic.1 It should be given as one 2-g intravenous dose, followed by 1 g every eight hours until delivery. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2021 Jan 25;11:609526. doi: 10.3389/fmicb.2020.609526. Schuchat A, Cefazolin is an alternative in women with penicillin allergy who do not have a high risk of anaphylaxis. U.S. Preventive Services Task Force. Selective intrapartum chemoprophylaxis of neonatal group B streptococcal early-onset disease. Morven S Edwards, Carol J Baker, Group B Streptococcal Disease: Interim Prevention at 50 Years and Counting, Clinical Infectious Diseases, Volume 70, Issue 12, ... Prevention of invasive group B streptococcal (GBS) perinatal disease by contrast has lacked the determination of but a few. MMWR Recomm Rep. 2010;59(RR-10):20. Prevention of Perinatal Group B Streptococcal Disease: Updated CDC Guideline. Verani JR, McGee L, Schrag SJ; Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Cervical, perianal, perirectal, or perineal specimens are not acceptable, and a speculum should not be used for culture collection. Northern I. Prevention of perinatal group B streptococcal diseases: Belgian guidelines Pierrette Melin Group B streptococcal early onset disease In most industrialized countries in the 1970s, the prevalence of group B strep-tococcal (GBS) pneumonia, septicaemia and meningitis in young infants increased dramatically. There also is a need to monitor for potential adverse consequences of intrapartum antibiotic prophylaxis (e.g., emergence of bacterial antimicrobial resistance or increased incidence or severity of non-GBS neonatal pathogens). 2013 Aug 28;31 Suppl 4:D20-6. Abstract. Schuchat A. Zywicki SS, 101, Tucson, AZ 85750 (e-mail: colleen. Barriers to prevention of perinatal group B streptococcal disease. Revisiting the need for vaccine prevention of late-onset neonatal group B streptococcal disease: a multistate, population-based analysis. Stempel LE. Wang Y, Lei X, Zhao Y, Tan J, Li J, Gong X, Shan L, Zhang Q, Zhou Q, Zhang Y. Transl Pediatr. McGee L, et al. This site needs JavaScript to work properly. Prevention of perinatal group B streptococcal disease. Dinsmoor MJ, The Neonatal Group B Streptococcal Disease Study Group. Vaginal-perianal compared with vaginal-rectal cultures for detecting group B streptococci during pregnancy. Northern I. Cultures should be collected in the outpatient setting by the physician or, with appropriate instruction, by the patient. 7. The previous CDC guideline recommended that any amount of group B streptococcal bacteriuria be considered a positive culture.5 The new guideline reflects findings that only concentrations exceeding 104 colony-forming units per mL are associated with early-onset neonatal disease.9 As a result, the new guideline recommends that laboratories report a urine specimen positive for GBS when the organism is present at concentrations of at least 104 colony-forming units per mL, whether GBS is present as a single isolate or if there is another organism present.1. Selected references cited in the guideline were also reviewed. In November 2010, the Centers for Disease Control and Prevention (CDC) issued a revised guideline for the prevention of early-onset neonatal group B streptococcal disease.1 This article reviews the key changes, which include (1) expanded recommendations for laboratory detection of GBS, (2) clarification of the colony count required to consider a urine specimen positive for GBS, (3) updated algorithms for screening and intrapartum chemoprophylaxis in women with preterm labor or preterm premature rupture of membranes (PPROM), (4) a minor change in the recommended dose of penicillin G for chemoprophylaxis, (5) updated antibiotic recommendations for women with penicillin allergy, and (6) a revised algorithm for secondary prevention of early-onset sepsis in newborns. 1986;18(6):525–531. In 1996, CDC, in collaboration with relevant professional soci-eties, published guidelines for the prevention of perinatal group B streptococcal disease (CDC. Jafari HS(1), Schuchat A, Hilsdon R, Whitney CG, Toomey KE, Wenger JD. 1 Purpose and scope. 2002;325(7359):308. 2008;27(12):1057–1064. If a pregnant woman with a penicillin allergy and a high risk of anaphylaxis tests positive for GBS, further testing should be performed to determine erythromycin resistance and inducible clindamycin resistance. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement.

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