Compliance with a risk factor-based intrapartum prophylaxis program for neonatal group B streptococcal disease

Area of Science:

• Obstetrics and Gynecology
• Neonatal Health
• Infectious Disease Prevention

Background:

• The US CDC updated guidelines for preventing early-onset group B streptococcal disease (EOGBSD) in newborns.
• Current guidelines favor bacteriological screening over risk-factor screening for identifying at-risk mother-infant pairs.
• Population data suggests bacteriological screening is more effective due to better antibiotic compliance.

Purpose of the Study:

• To audit compliance with an established risk-factor-based EOGBSD prophylaxis program.
• To assess the effectiveness of risk-factor screening in identifying mothers requiring intrapartum antibiotics.
• To determine if poor compliance is an inherent limitation of risk-factor screening.

Main Methods:

• A 6-month audit of an existing risk-factor EOGBSD prophylaxis program.
• Analysis of antibiotic administration records for women with identified risk factors.
• Calculation of compliance rates based on eligible and treated patients.

Main Results:

• Out of 1243 deliveries, 287 women (23%) had at least one risk factor for EOGBSD.
• 193 women (67% of those with risk factors) received antibiotics, representing 15% of all births.
• A corrected compliance rate of 73% was achieved after excluding cases with valid clinical reasons for withholding antibiotics.

Conclusions:

• The 73% compliance rate with risk-factor screening is favorable compared to published rates for bacteriological screening.
• Risk-factor screening demonstrates potential for effective EOGBSD prevention.
• Mechanisms to further enhance compliance with risk-factor screening protocols were identified.