Guideline Adherence for Intrapartum Group B Streptococci Prophylaxis in Penicillin-Allergic Patients

Kimberly A Paccione,Harold C Wiesenfeld

doi:10.1155/2013/917304

Abstract

Objective. To investigate adherence to the 2002 Centers for Disease Control and Prevention (CDC) guidelines for perinatal group B streptococci (GBS) prevention in penicillin-allergic obstetric patients. Methods. This is a retrospective cohort study of penicillin-allergic obstetric patients who tested positive for GBS and delivered at our institution in 2010. Electronic medical records were reviewed for the nature of the penicillin allergy, documentation of having previously tolerated cephalosporins, gestational age at delivery, type of delivery, antimicrobial sensitivity testing, and antibiotics administered. Antimicrobial sensitivity testing and “appropriate” antibiotic choice, which was determined using 2002 CDC guidelines, were analyzed. Results. Intrapartum antibiotic prophylaxis was administered in 97.8% (95% confidence interval [CI] 93.5–99.5%) of patients, but it was considered appropriate in only 62.2% (95% CI 53.8–70.0%) of patients. Clindamycin was the most commonly used antibiotic, but 26.4% (95% CI 16.3–39.7%) of patients who received clindamycin did not have confirmation of susceptibility via antimicrobial sensitivity testing. Overall, the sensitivity testing was performed in only 65.5% (95% CI 56.2–73.7%) of patients in whom it was indicated. Conclusion. Compliance with CDC guidelines for performing antimicrobial sensitivity testing and choosing an appropriate antibiotic in GBS-positive penicillin-allergic women continues to be suboptimal. Institution of measures to increase adherence is necessary.

Highlights

Group B streptococci (GBS) is the most frequent bacterial pathogen in neonates and is the leading cause of earlyonset sepsis and meningitis in the USA [1]
In 2010, 1,586 obstetric patients tested positive for rectovaginal GBS, and the prevalence of self-reported penicillin allergy was 13.1%
Analyses completed for GBS-positive, penicillin-allergic women delivering in 2010 (Table 1) n = 138

Summary

Introduction

Group B streptococci (GBS) is the most frequent bacterial pathogen in neonates and is the leading cause of earlyonset sepsis and meningitis in the USA [1]. The universal screening for maternal GBS colonization at 35 to 37 weeks’ gestation and the use of intrapartum antibiotic prophylaxis have resulted in a nearly 80% reduction in the rate of neonatal GBS infection over the past 15 years, from 1.7 cases per 1,000 live births in the early 1990s to 0.34–0.37 cases per 1,000 live births in recent years [1]. The emergence of resistance to these antibiotics among GBS isolates resulted in revision of perinatal GBS prevention guidelines from the Centers for Disease Control and Prevention (CDC) in 2002 [6, 7]. These guidelines recommend that a history of the patient’s penicillin allergy be assessed and that women determined to be at low risk of anaphylaxis receive intrapartum cefazolin. If the isolate is resistant to clindamycin or erythromycin or the susceptibility is unknown, vancomycin should be used

Methods

Results

Conclusion