Fatal group B streptococcal pneumonia in neonates. Effects of antibiotics.

Prophylactic penicillin has been suggested to prevent neonatal group B streptococcal infections (GBS). However, there is a concern that the antibiotics may conceal significant bacteremia if post-treatment blood cultures were used to recover the etiologic agent. To clarify this point, the autopsy records of 111 cases of fatal neonatal pneumonias in infants less than one week of age for the period 1974–1978 were reviewed. Nineteen documented cases of group B streptococcal infections were uncovered. Review of antibiotic therapy in these infants indicate that such therapy can indeed conceal the etiologic agent of pneumonia if one uses post treatment blood (or other normally sterile body fluids) cultures as the basis of diagnosis. On the other hand, review of 41 cases with morphologic evidence of pneumonia and no identifiable etiologic agent reveal that the majority of these were referral cases from outlying hospitals who received antibiotics prior to any diagnostic work-up.