Clinician compliance to intrapartum antibiotics prophylaxis for minimising neonatal group B streptococcal infection risk.

Abstract

Intrapartum antibiotic prophylaxis (IAP) administration to group B streptococcal (GBS) positive pregnant women and other pregnant women with risk factors may reduce the rate of neonatal early-onset GBS infection (EOGBSI). Our aims were estimating the current indications for IAP among women presenting in labour, evaluating compliance to the current local IAP guidelines and to provide recommendations for improving clinician compliance. We retrospectively analysed IAP data at our tertiary perinatal centre over a 16-month period. Our cohort included women, positive for GBS (± risk factors for EOGBSI), and a comparable number of randomly selected women with risk factors and GBS status negative or unknown. A total of 424 mother-baby pairs were included in this study. Forty-seven percent of the study cohort had IAP indication (n = 202/424). Of these, 72% (n = 145/202) received some form of IAP and 61% (n = 123/202) received 'adequate' IAP. IAP was adequately administered in 67% (n = 99/148) of women positive for GBS, 27% (n = 9/33) of women with unknown GBS status and 71% (n = 15/21) of women negative for GBS with IAP indication. Most frequent reason (30%, n = 125/424) for 'inadequate' IAP was less than four hours from birth for women positive for GBS despite spending more than 60 min in the hospital before birthing. A substantial number of IAP were administered less than four hours before birth and were therefore 'inadequate' according to the current recommendations. These high rates could be reduced if those administered at least two hours prior to birth were redefined as 'adequate'.