"Real World" compliance with strategies to prevent early-onset group B streptococcal disease.
OBJECTIVE
To assess the "real-world" compliance with risk- and culture-based strategies to prevent early-onset group B streptococcal disease.


METHODS
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.


CONCLUSIONS
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.
Riley
Laura
L
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA.
Appollon
Kataia
K
Haider
Sadia
S
Chan-Flynn
Stella
S
Cohen
Amy
A
Ecker
Jeffrey
J
Rein
Mitchell
M
Lieberman
Ellice
E
D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D013292:Streptococcus agalactiae / Q000302:isolation & purification / Q000472:pathogenicity*; D013997:Time Factors