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Intrapartum group B streptococci prophylaxis in patients reporting a penicillin allergy

Kristen A Matteson1, Stacey P Lievense, Bethany Catanzaro

  • 1Department of Obstetrics and Gynecology, Women and Infants Hospital, the Warren Alpert Medical School at Brown University, Providence, Rhode Island 02905, USA. KMatteson@wihri.org

Obstetrics and Gynecology
|February 2, 2008
PubMed

Insights

Adherence to group B streptococci (GBS) prophylaxis guidelines for penicillin-allergic women is suboptimal. Most received antibiotics, but few received appropriate GBS treatment, highlighting a need for better antimicrobial sensitivity testing and antibiotic selection.

Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Clinical Pharmacy

Background:

  • Group B Streptococcus (GBS) poses risks during pregnancy and childbirth.
  • Penicillin allergy is common in obstetric patients requiring GBS prophylaxis.
  • Adherence to Centers for Disease Control and Prevention (CDC) guidelines is crucial for effective GBS prevention.

Purpose of the Study:

  • To evaluate the adherence to 2002 CDC guidelines for GBS prophylaxis in obstetric patients with a reported penicillin allergy.
  • To assess the appropriateness of antibiotic selection and the utilization of antimicrobial sensitivity testing in this patient group.

Main Methods:

  • Retrospective cohort study of 233 GBS-positive, penicillin-allergic obstetric patients delivering between 2004-2005.
  • Analysis of medical records for delivery type, gestational age, antimicrobial sensitivity testing, and administered antibiotics.
  • Definition of "appropriate antibiotic choice" based on 2002 CDC GBS prophylaxis guidelines.

Main Results:

  • 95% of patients received antibiotic prophylaxis, but only 16% received an appropriate antibiotic according to CDC guidelines.
  • Clindamycin was the most common antibiotic (83%), despite antimicrobial sensitivity testing being performed in only 11% of cases.
  • Appropriate antibiotic administration increased from 11% in 2004 to 20% in 2005, but remained suboptimal.

Conclusions:

  • Adherence to 2002 CDC guidelines for GBS prophylaxis in penicillin-allergic women is significantly below optimal levels.
  • There is a critical need to improve the performance of antimicrobial sensitivity testing and the selection of appropriate antibiotics.
  • Enhanced strategies are required to ensure effective GBS prophylaxis in this vulnerable obstetric population.
Abstract

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