OBJECTIVE: To examine adherence to the 2002 Centers for Disease Control and Prevention (CDC) guidelines for group B streptococci (GBS) prophylaxis in patients who reported a penicillin allergy.
METHODS: This is a retrospective cohort study of GBS-positive, penicillin-allergic obstetric patients who delivered at our institution from 2004 through 2005 (N=233). Medical records were analyzed for type of delivery, gestational age at delivery, antimicrobial sensitivity testing, and antibiotics administered. Antimicrobial sensitivity testing and appropriate prophylactic antibiotic choice were analyzed. “Appropriate antibiotic choice” was defined using the 2002 CDC guidelines for GBS prophylaxis. Women with either a scheduled cesarean delivery or a preterm delivery were excluded from analyses. Data were analyzed using Stata 9.0.
RESULTS: Overall, 95% (95% confidence interval [CI] 91–97%) of GBS-positive, penicillin-allergic women received antibiotic prophylaxis and only 16% (95% CI 11–21%) of patients received an appropriate antibiotic. The majority of women who were given antibiotics received clindamycin (83%, 95% CI 77–87%); however, antimicrobial sensitivity testing was performed in only 11% (95% CI 9–17%) of patients. More women received an appropriate antibiotic in 2005 than in 2004 (20% compared with 11%, P=0.11). Although the study was underpowered to evaluate the magnitude of increase, the overall prevalence of appropriate antibiotic administration in 2005 was still only 20% (95% CI 13–28%).
CONCLUSION: Adherence to the 2002 CDC guidelines for GBS prophylaxis in penicillin-allergic women is far from optimal. Improvements are necessary in obtaining antimicrobial sensitivity testing and choosing an appropriate antibiotic for GBS-positive women with a reported penicillin allergy.
LEVEL OF EVIDENCE: II
The management of group B streptococci-positive, penicillin-allergic patients must be improved to adhere to the 2002 Centers for Disease Control and Prevention guidelines.
From the 1Department of Obstetrics and Gynecology, Women and Infants Hospital, the Warren Alpert Medical School at Brown University, Providence, Rhode Island.
Supported by the T32 HD 040673-03 Women and Infants Hospital/Brown Epidemiology/Clinical Trials Training Program from the National Institutes of Child Health and Human Development.
The authors thank Christina Raker, ScD, for her statistical support for the revised version of the manuscript.
Presented at the American College of Obstetricians and Gynecologists Annual Clinical Meeting, San Diego, California, May 5–9, 2007.
Corresponding author: Kristen A. Matteson MD, MPH, Department of Obstetrics and Gynecology, Women and Infants Hospital, 101 Dudley Street, Providence, Rhode Island 02905; e-mail: KMatteson@wihri.org.
Financial Disclosure The authors have no potential conflicts of interest to disclose.