Compliance with group B streptococcal disease prevention guidelines.

PURPOSE: This study assessed the degree of clinician compliance with nationally recommended guidelines for the prevention of early onset Group B Streptococcal (GBS) disease in infants. A secondary objective was to identify areas for specific educational interventions to enhance clinician compliance.

STUDY DESIGN AND

METHODS

A hospital-based retrospective cohort study was undertaken at a tertiary medical center. Mothers (N = 515) with any known risk factor for GBS sepsis who delivered live infants (N = 537) in a 9-month study period participated. No interventions were done. Compliance of obstetric and pediatric clinicians with nationally recommended management algorithms for pregnant women and infants at risk for GBS disease was evaluated.

RESULTS

In the combined risk factor and culture-based algorithm for maternal management, clinician compliance with administration of intrapartum antibiotic prophylaxis (when indicated) ranged from 75% to 84%. Unindicated antibiotics were administered in 22% of the women. Among the women for whom antenatal cultures were indicated, 65% received them. Only 9% of the cultures were performed from the anogenital site, as recommended. In the risk factor-based maternal management algorithm, indicated antibiotics were administered to 76% of the women and unindicated antibiotics to 15% of the women. Use of penicillin, the recommended antibiotic, ranged from 0% to 9%. Among the infants, between 14% to 75% received recommended evaluations and 61% to 94% were observed for at least 48 hrs postdischarge.

CLINICAL IMPLICATIONS: Clinician compliance with current GBS disease prevention guidelines for mothers and infants is less than ideal. Targeted education efforts are warranted.