Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin.
OBJECTIVE
To determine both the frequency of reported penicillin allergy in parturients and the frequency of resistance in vitro of clinical isolates of group B streptococci to clindamycin and erythromycin.


METHODS
One hundred clinical isolates of group B streptococci were tested to determine the frequency of resistance to clindamycin, erythromycin, penicillin G, vancomycin, and cefazolin. The frequency of beta-lactam allergy and reported allergic reaction also were recorded for all consecutive laboring women during the 4-month study.


RESULTS
The frequency of group B streptococcal resistance to clindamycin was 15% and to erythromycin was 16%. No isolates were resistant to penicillin G, vancomycin, or cefazolin. Twelve percent of the 963 women who delivered during the study reported a penicillin allergy, but only 30% of those could describe their allergic reaction.


CONCLUSIONS
In vitro resistance of group B streptococci to clindamycin and erythromycin occurred frequently in this population. Whereas the importance of this finding in vivo is uncertain, it raises concern about the possibility of inadequate prophylaxis using currently recommended alternatives in penicillin-allergic patients. Artful questioning of women reporting penicillin allergy may lessen the likelihood of using these less desirable agents in the setting of intrapartum antimicrobial prophylaxis.
Department of Obstetrics and Gynecology, The University of Michigan Health System, Ann Arbor 48109-0276, USA. pearlman@umich.edu
M D
MD
Pearlman
C L
CL
Pierson
R G
RG
Faix
D000328:Adult; D002437:Cefazolin / Q000627:therapeutic use; D002981:Clindamycin / Q000627:therapeutic use*; D004342:Drug Hypersensitivity / Q000453:epidemiology*; D004352:Drug Resistance, Microbial; D004917:Erythromycin / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D010400:Penicillin G / Q000627:therapeutic use; D010406:Penicillins / Q000009:adverse effects*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D013292:Streptococcus agalactiae / Q000187:drug effects* / Q000302:isolation & purification; D014640:Vancomycin / Q000627:therapeutic use
D010406:Penicillins; D002981:Clindamycin; D004917:Erythromycin; D014640:Vancomycin; D002437:Cefazolin; D010400:Penicillin G