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Intrapartum Group B Streptococci Prophylaxis in Patients Reporting a Penicillin Allergy

From the ¹Department of Obstetrics and Gynecology, Women and Infants Hospital, the Warren Alpert Medical School at Brown University, Providence, Rhode Island.

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