Effect of intrapartum antibiotic prophylaxis against group B streptococcal infection on comparisons of rates of endometritis and urinary tract infection in multicenter surveillance.
OBJECTIVE
To establish whether antibiotic prophylaxis against group B streptococcal infection may be a confounding factor in comparisons of rates of endometritis and urinary tract infection after vaginal delivery.


METHODS
Prospective study.


METHODS
Maternity units at 48 hospitals in a regional surveillance network in France during 2001-2004.


METHODS
The maternity units used a common protocol to establish whether antibiotic prophylaxis was indicated. Risk factors for endometritis and urinary tract infections were evaluated using multiple logistic regression.


RESULTS
We analyzed 49,786 vaginal deliveries. The percentage of women receiving antibiotic prophylaxis varied widely and significantly among the maternity units (range, 4.4%-26.0%; median, 15.8%; 25th percentile, 12.1%; 75th percentile, 19.0%) (P < .001, by Mantel-Haenszel chi(2) test). The incidence rate of endometritis was significantly reduced from 0.25% to 0.11% by antibiotic prophylaxis (P = .001). There was a decrease in the incidence of urinary tract infection from 0.37% to 0.32%, but it was not statistically significant (P = .251).


CONCLUSIONS
A reduction in the incidence of endometritis was observed when intrapartum antibiotic prophylaxis against group B streptococcal infection was used. However, the proportion of women considered to be at risk of infection varied widely among institutions. Comparisons of rates of endometritis among maternity units, but not urinary tract infection rates, should take into account antibiotic prophylaxis as a significant confounding factor.
Dumas
Anne-Marie
AM
Service de Gynécologie Obstétrique, Centre Hospitalier Lyon Sud, Pierre Bénite, France. anne-marie.dumas@chu-lyon.fr
Girard
Raphaëlle
R
Ayzac
Louis
L
Beaumont
Geneviève
G
Caillat-Vallet
Emmanuelle
E
Depaix
Florence
F
Gignoux
Chantal
C
Haond
Catherine
C
Pral
Noelle
N
Robert
Jacqueline
J
Tissot-Guerraz
Françoise
F
Vincent-Bouletreau
Agnès
A
Berland
Michel
M
Fabry
Jacques
J
D019072:Antibiotic Prophylaxis; D015986:Confounding Factors, Epidemiologic; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D036861:Delivery, Obstetric / Q000379:methods; D004716:Endometritis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D009775:Obstetrics and Gynecology Department, Hospital; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D018571:Sentinel Surveillance; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control