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Abstract
GBS colonization is an important risk factor for maternal and neonatal infection morbidity and mortality. Intrapartum antibiotics may prevent vertical transmission of GBS from colonized mothers to their babies. The objective of this study was to evaluate the effectiveness of cefazolin prophylactic regimen for GBS disease, comparing it to the established penicillin-based protocols, given the opportunity provided by the temporary unavailability of first-choice antibiotics in Brazil. A retrospective analysis was conducted at the Hospital Femina Obstetrics Service between January and December 2015. Ninety-eight pregnant women received standard penicillin (70 patients) or ampicillin (28 patients) antibiotic prophylaxis, and 251 pregnant women received an alternative prophylaxis with cefazolin during the study period. Risk factor, Maternal and neonatal outcomes were evaluated and compared between groups. No significant difference was found in maternal (RR = 0.71; IC 95%:0.30-1.68; p = 0.709) and neonatal (RR = 0.84; IC 95%:0.61-1.15; p = 0.271) outcomes between those patients using the alternative antibiotic prophylaxis in comparison to the standard antibiotics, with the dependent variable of maternal and neonatal outcomes grouped and controlled for potential confounding variables. The antibiotics used as alternatives to penicillin and ampicillin for the prevention of maternal-fetal GBS disease are poorly studied, and this study indicate that cefazolin can be an optimal choice, offering safety in the use of this antibiotic in situations where penicillins are contraindicated or unavailable.
Highlights
Group B Streptococcus (GBS) colonization is an important risk factor for maternal and neonatal infection morbidity and mortality
Antimicrobial prophylaxis to prevent maternal-fetal GBS infection is recommended for pregnant women in situations such as follows: with GBS positive anal and vaginal cultures collected up to five weeks before delivery, with GBS bacteriuria in any trimester of the current pregnancy, or for those whose previous newborn was affected by invasive GBS disease
This study was performed during a period of penicillin depletion in the Brazilian Unified Health System in 2015, when cefazolin was used as an alternative to penicillins for the prevention of maternal-fetal GBS infection due to its low-cost, wide availability and theoretical efficacy [12,13,14,15]
Summary
GBS colonization is an important risk factor for maternal and neonatal infection morbidity and mortality. Conclusions: The antibiotics used as alternatives to penicillin and ampicillin for the prevention of maternal-fetal GBS disease are poorly studied, and this study indicate that cefazolin can be an optimal choice, offering safety in the use of this antibiotic in situations where penicillins are contraindicated or unavailable. Group B Streptococcus (GBS) is a bacterium that causes maternal infections during pregnancy and the neonatal period [1,2], and is responsible for colonization of the gastrointestinal and genitourinary tracts in about 20% of pregnant women [3]. Antimicrobial prophylaxis to prevent maternal-fetal GBS infection is recommended for pregnant women in situations such as follows: with GBS positive anal and vaginal cultures collected up to five weeks before delivery, with GBS bacteriuria in any trimester of the current pregnancy, or for those whose previous newborn was affected by invasive GBS disease. For patients allergic to penicillins with a history of severe reactions, such as anaphylaxis, angioedema, respiratory distress and urticaria after administration, anal and vaginal cultures with
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