Limitations of the obstetric group B Streptococcus protocol.
OBJECTIVE
To assess compliance with the Centers for Disease Control and Prevention (CDC) screening-based protocol for obstetric group B Streptococcus (GBS) and to determine an acceptable threshold for protocol failure.


METHODS
A retrospective chart review was carried out for all deliveries performed through the resident-run community clinic from January through June 1999. Compliance with the CDC protocol was assessed by reviewing collected data from patient charts and comparing it to CDC requirements. Data were collected regarding patient demographics, antenatal GBS status, gestational age at screening, time of rupture of the membranes, time the antibiotic was given and time of delivery.


RESULTS
A total of 248 charts were reviewed. Elective cesarean deliveries were excluded (25 charts). Unknown culture status was found for 22 (9.9%) patients. Cultures were collected before 35 weeks' gestation in 39 (17.5%) patients and at > 37 weeks' gestation in 28 (12.6%) patients. Of those with known positive GBS status, 4 (7.0%) were not treated, and antibiotics were given less than four hours before delivery in 13 (24.5%) patients. Of those with unknown status, six (27.2%) were not treated. Overall, there was 70% compliance with the culture collection arm of the protocol and 87% compliance with the treatment arm.


CONCLUSIONS
Fulfillment of CDC guidelines in this community setting is imperfect. There are several areas beyond physician control, including precipitous delivery and patient non-compliance. However, perhaps an acceptable threshold for limitations of adherence to the protocol can be reached.
Nemunaitis-Keller
Jennifer
J
Department of Obstetrics and Gynecology, Aultman Health Foundation, Northeastern Ohio Universities College of Medicine, Canton, OH, USA.
Gill
Prabacharan
P
D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D009774:Obstetrics / Q000379:methods; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000188:drug therapy*; D011256:Pregnancy Outcome; D011322:Primary Prevention / Q000379:methods; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000187:drug effects* / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents