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Perinatal antibiotic usage and changes in colonization and resistance rates of group B streptococcus and other
Renee Spaetgens1, Kim DeBella, Doreen Ma
1Child Health Research Unit, Alberta Children's Hospital, University of Calgary, Canada.
Insights
Over half of pregnant women received antibiotics during the perinatal period, with ampicillin being most common. This usage did not increase antibiotic resistance in vaginal-rectal organisms like group B Streptococcus.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic use during pregnancy and childbirth is common.
- Understanding the impact of perinatal antibiotic exposure on maternal vaginal-rectal microbiota is crucial.
- Group B Streptococcus (GBS) is a key focus for intrapartum antibiotic prophylaxis.
Purpose of the Study:
- To quantify antibiotic usage in the perinatal period.
- To assess the impact of this usage on vaginal-rectal colonizing organism resistance rates.
- To evaluate current GBS prevention practices.
Main Methods:
- Culture and antibiotic sensitivity testing of vaginal-rectal swabs from 1207 pregnant women.
- Comparison of cultures from antepartum, intrapartum, and 6-week postpartum periods.
- Analysis of antibiotic administration data, including GBS prophylaxis and treatment of GBS-negative women.
Main Results:
- 19.5% of women were GBS positive antepartum; 51% received antibiotics overall (31.4% intrapartum).
- Ampicillin, cefazolin, and penicillin were most frequent. GBS resistance to erythromycin (5.6%) and clindamycin (3.0%) was observed.
- No significant increase in resistance rates for GBS or other organisms was found in antibiotic recipients.
Conclusions:
- Perinatal antibiotic administration affects over half of pregnant women in the studied region.
- While ampicillin is common, current practices, including treating GBS-negative women, were not associated with increased maternal vaginal-rectal organism resistance.
- Further research may be needed to optimize antibiotic stewardship in perinatal care.
Objective:
To quantify current antibiotic usage during the perinatal period and impact on vaginal-rectal colonizing organism resistance rates.
Methods:
Swabs were obtained for culture of group B streptococcus and other bacteria from a cohort of 1207 pregnant women in Calgary, Alberta, at 36 weeks' gestation. Those women who received antibiotics during labor or after pregnancy and a 10% subset who received no antibiotics had repeat cultures at 6 weeks postpartum. Cultured organisms were tested for sensitivity to several antibiotics.
Results:
Group B streptococcus was identified in 235 women (19.5%) in the antepartum period. Fifty-one percent of all participants received antibiotics (31.4% intrapartum). Group B streptococcus prophylaxis was given to 215 (17.8%), whereas 83 (6.9%) group B streptococcus-negative women without fever during labor received antibiotics. Ampicillin (49%), cefazolin (28%), and penicillin (18%) were the most frequently used antibiotics. Resistance rates among group B streptococcus to erythromycin and clindamycin were 5.6% and 3.0%, respectively, whereas 20.6% of Escherichia coli were ampicillin resistant. Among antibiotic recipients, 6.3% of all bacteria that were initially sensitive on prenatal cultures to a specific antibiotic became resistant in the postnatal period, whereas 6.5% that were initially resistant became sensitive.
Conclusion:
Current prevention practices in our region were associated with perinatal antibiotic administration in over half of pregnant women. Ampicillin was the most common antibiotic administered. Some physicians are treating women who are group B streptococcus culture negative at term, a practice that is of no proven value. However, this was not associated with increased resistance for group B streptococcus or other organisms identified from maternal vaginal-rectal tracts.