20: Use of cefazolin for group b streptococcus prophylaxis in women allergic to penicillin without anaphylaxis

Abstract

* Sepsis within 72 hours, Pneumonia, Meningitis, Need for supplemental oxygen, Intubation, Hypoglycemia, Death. Use of cefazolin for group b streptococcus prophylaxis in women allergic to penicillin without anaphylaxis V. Briody, C. Albright, B. Hughes Brown University, Providence, RI, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University/Women & Infants Hospital, Providence, RI OBJECTIVES: To estimate the proportion of GBS-positive women with a history of penicillin allergy without anaphylaxis receiving appropriate intrapartum antibiotic prophylaxis. METHODS: Retrospective cohort of GBS-positive, penicillin-allergic women with singleton pregnancies delivering at term at a tertiary care academic center receiving intrapartum antibiotic prophylaxis during labor. Those with a scheduled cesarean delivery were excluded. Primary outcome was the proportion of women who received appropriate antibiotic coverage, defined as Penicillin or Cefazolin. Secondary outcomes included performance of antibiotic sensitivity testing on vaginal and urinary GBS cultures and neonatal outcomes such as APGAR score, blood draws, antibiotic usage, length of hospital stay, and composite morbidity. RESULTS: Of 165 women reporting a penicillin allergy without anaphylaxis, 73 (44.2%) received an appropriate antibiotic (95% confidence interval, 36.9-51.9%) and 92 (55.8%) received an inappropriate antibiotic. Of those receiving an inappropriate antibiotic, 60.9% were given Clindamycin, 1.1% Erythromycin, and 38.0% Vancomycin. Women reporting rash as a penicillin reaction were more likely to receive Cefazolin than another antibiotic (60.3 versus 26.1%, respectively; p<0.001), while women whose reaction was not documented were less likely to receive Cefazolin (23.3 versus 65.2%, respectively; p<0.001). 20.7% of those who had GBS bacteriuria had sensitivity testing performed, compared to 61.7% of those who had vaginal colonization (p<0.001). Of 57 women receiving Clindamycin or Erythromycin, 35.1% (20) did not have sensitivities performed. In those who had sensitivity testing (n1⁄437), 18.9% (7) were not sensitive to both Clindamycin and Erythromycin. Among neonates whose mothers received appropriate versus inappropriate antibiotics, there was no difference in APGAR score, number of blood draws, antibiotic usage, length of hospital stay, or composite morbidity (Table). While not statistically significant, it is notable that 9.9% of neonates born to mothers who did not receive appropriate antibiotics underwent blood cultures versus 2.7% of neonates who were born to mothers who did receive appropriate antibiotics (p1⁄40.11). CONCLUSIONS:More than half of women allergic to penicillin without anaphylaxis inappropriately received an antibiotic other than Penicillin or Cefazolin as intrapartum prophylaxis, indicating poor adherence to national guidelines.