"Real World" compliance with strategies to prevent early-onset group B streptococcal disease. Academic Article uri icon

Overview

abstract

  • OBJECTIVE: To assess the "real-world" compliance with risk- and culture-based strategies to prevent early-onset group B streptococcal disease. STUDY DESIGN: We retrospectively reviewed the medical records of consecutive term pregnancies delivered at three institutions (a subset of practices at an academic hospital using the culture-based strategy, an academic hospital using the risk-based strategy, and a community hospital using both) between January and March 1998. We abstracted demographic data and risk factors for group B streptococcus, group B streptococcal culture information, documentation of intrapartum antibiotic prophylaxis, and adverse drug reactions. We compared intrapartum compliance with the intended strategy. RESULTS: There were a total of 505 women managed with the risk-based strategy. Of those, 79 had a risk factor for group B streptococcal disease and 72/79 (91.1%) received intrapartum antibiotic prophylaxis. There were a total of 428 women managed with the culture-based strategy. Of those, 70 had positive cultures and 67 (95.7%) received intrapartum antibiotic prophylaxis. An additional 39 women in the culture-based group had no documentation that cultures had been done. Of those, eight (20.5%) had risk factors and all eight received intrapartum antibiotic prophylaxis. Compliance with the risk-based strategy was 91.1 versus 96.2% with the culture-based strategy (p=0.3). Among women managed using the risk-based strategy, 5/426 (1.2%) received intrapartum antibiotic prophylaxis without an identifiable risk factor. Among women in the culture-based strategy, 5/359 (1.4%) received intrapartum antibiotic prophylaxis with documented negative group B streptococcal cultures (p=0.5). When examined by site, compliance with the intended strategy was 91.2% at the academic hospital using the risk-based strategy, 100% at the academic hospital using the culture-based strategy, 90.9% at the community practices using the risk-based strategy, and 82.4% at the community practices using the culture-based strategy. CONCLUSION: Overall, intrapartum compliance with the risk-based approach was similar to the culture-based approach. However, there were more cultures not done and cultures done at inappropriate gestations at the community hospital practice.

authors

  • Riley, Laura
  • Appollon, Kataia
  • Haider, Sadia
  • Chan-Flynn, Stella
  • Cohen, Amy
  • Ecker, Jeffrey
  • Rein, Mitchell
  • Lieberman, Ellice

publication date

  • June 1, 2003

Research

keywords

  • Antibiotic Prophylaxis
  • Guideline Adherence
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Streptococcal Infections
  • Streptococcus agalactiae

Identity

Scopus Document Identifier

  • 0037628981

Digital Object Identifier (DOI)

  • 10.1038/sj.jp.7210895

PubMed ID

  • 12774132

Additional Document Info

volume

  • 23

issue

  • 4