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Compliance with protocols for prevention of neonatal group B streptococcal sepsis: practicalities and limitations
Gwendolyn L Gilbert1, Moira C Hewitt, Catherine M Turner
1Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, University of Sydney, Westmead Hospital, New South Wales, Australia. lyng@jcpmr.wsahs.nsw.gov.au
Insights
Intrapartum antibiotic prophylaxis (IAP) protocols for preventing neonatal group B streptococcal (GBS) sepsis show variable staff compliance. Improved implementation and GBS vaccines are needed for better outcomes.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Infectious Disease Prevention
Background:
- Neonatal group B streptococcal (GBS) sepsis remains a significant concern.
- Intrapartum antibiotic prophylaxis (IAP) is a key strategy to prevent neonatal GBS sepsis.
- Current protocols for IAP have varying levels of staff compliance and effectiveness.
Purpose of the Study:
- To compare the staff compliance of two intrapartum antibiotic prophylaxis (IAP) protocols for preventing neonatal GBS sepsis.
- To evaluate compliance in community and university teaching hospital settings.
- To assess compliance based on GBS carriage and clinical risk factors.
Main Methods:
- A prospective cohort study involving 1096 women across two hospitals.
- Eligibility for IAP was based on GBS carrier status (26-32 weeks gestation) or intrapartum clinical risk factors (CRF).
- Compliance was audited via case records and compared between hospitals and indications.
Main Results:
- Overall, 39% of women were eligible for IAP.
- Compliance for GBS carriers was similar (78% Hospital A vs. 76% Hospital B).
- Compliance was lower for women with CRF only at Hospital B (56%) compared to Hospital A (75%), p=0.03. Only 65% of intrapartum GBS carriers received IAP due to screening limitations.
Conclusions:
- Current IAP protocols deem approximately one-third of women eligible for antibiotics.
- Inefficient antibiotic use is observed due to poor compliance and selection criteria.
- Enhanced implementation strategies and development of GBS vaccines are crucial to improve prevention and reduce antibiotic-associated disadvantages.
Objective:
To compare two protocols for intrapartum antibiotic prophylaxis (IAP) against neonatal group B streptococcal (GBS) sepsis, with respect to staff compliance, in a prospective cohort study in the obstetric units of a community hospital (A) and a university teaching hospital (B).
Methods:
Cohorts comprised about 500 women attending antenatal clinics at each hospital (total 1096). Women identified as GBS carriers at 26-32 weeks' gestation and those who had intrapartum clinical risk factors (CRF) were eligible for IAP. Compliance was defined as the proportion of women eligible for IAP who received it according to protocol - as determined by audit of case records - and compared between hospitals and according to indication.
Results:
Overall, 39% of women were eligible for IAP. Indications were GBS carriage alone (21%), CRF alone (13%) and both (5%). Compliance was similar for GBS carriers at both hospitals: 78% at Hospital A and 76% at Hospital B. However, because of the poor predictive value of screening before 32 weeks, only 65% of intrapartum GBS carriers actually received IAP. For women with CRF only, compliance was significantly lower at Hospital B than Hospital A (56 vs. 75%; p = 0.03).
Conclusions:
According to currently recommended protocols, about one-third of healthy women are eligible for intrapartum antibiotics to prevent neonatal GBS sepsis. In practice, antibiotics are often used inefficiently because of poor compliance with protocols and poor predictive values of selection criteria. Better implementation strategies should improve compliance, but GBS vaccines are needed to replace prophylactic antibiotic use, with its associated disadvantages.