Compliance with a risk factor-based intrapartum prophylaxis program for neonatal group B streptococcal disease.
OBJECTIVE
The US Centre for Disease Control (CDC) recently amended their guidelines for the prevention of early-onset group B streptococcal disease (EOGBSD) of the newborn to recommend bacteriological screening, rather than risk factor-based screening, as the preferred method of identifying 'at risk' mother-infant pairs. This recommendation was derived from population data suggesting that the effectiveness of bacteriological screening was superior to a risk-factor approach because antibiotic compliance was better with the former. Whether poor compliance and therefore impaired prevention is inherent in risk-factor screening has not been widely tested.


METHODS
For a 6-month period we audited compliance with an established risk-factor EOGBSD prophylaxis program.


RESULTS
During the audit period, 1243 women delivered, of whom 287 (23%) had at least one risk factor. Of these women, 193 (67%), representing 15% of all women giving birth, received antibiotics. Thus, there were 94 women who were eligible for antibiotics but did not receive prophylaxis. There were sound clinical reasons for withholding antibiotics in 68 of these. Therefore, the corrected compliance rate within our program was 73%.


CONCLUSIONS
This compares favourably with published compliance rates with bacteriological-based programs, but we have suggested mechanisms to improve compliance further.
McIlwaine
Kate
K
Maternal-Fetal Medicine Unit, Southern Health, Clayton, Victoria, Australia.
Kneebone
Kim
K
Barkehall-Thomas
Andrea
A
Wallace
Euan M
EM
D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008499:Medical Records; D018743:Perinatal Care / Q000592:standards*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000635:transmission; D013292:Streptococcus agalactiae; D014739:Victoria / Q000453:epidemiology