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To the Editor: The study by Dr Phares and colleagues¹ concluded that there was an overall reduction in the incidence of group B streptococcal disease in neonates within the first 6 days of life for the period 2003 to 2005 compared with 1999 to 2001. This decrease coincided with revised disease prevention guidelines in 2002. The study shows a reduction only in the number of positive cerebrospinal fluid and blood cultures. However, the rate of positive cultures is not an accurate and exclusive measure of the incidence of invasive streptococcal disease. This study's approach is particularly problematic for assessing the epidemiology of early onset sepsis.

Using positive cultures as a required criterion is likely to underestimate the prevalence of neonatal early onset sepsis because results are affected by small sample volumes,^2-3 significant sampling errors⁴ and the presence of antibiotics.⁵ Based on this, clinicians have developed the concept of suspected sepsis, . . . [Full Text of this Article]

Ralph K. H. Nanan, PhD, FRACP
ralphn@med.usyd.edu.au

Gurvinder Singh, MBBS; Alison Poulton, MBBChir, MRCP, FRACP
Nepean Clinical School
University of Sydney
Penrith, Australia

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