Inappropriate use of vancomycin for preventing perinatal group B streptococcal (GBS) disease in laboring patients.
OBJECTIVE
The 2002 CDC guidelines for the prevention of perinatal group B streptococcus (GBS) stipulate that vancomycin is reserved for penicillin-allergic women at high risk for beta-lactam anaphylaxis with resistance to clindamycin or erythromycin. Our objective was to evaluate practitioner adherence to these guidelines.


METHODS
This is a retrospective chart review of patients admitted to labor and delivery who received vancomycin for GBS prophylaxis from January 1st, 2005 to June 1st, 2007. Identification and documentation of allergic reactions to beta lactams and performance of GBS sensitivities at the time of screening were recorded.


RESULTS
Eighty-seven patients reporting a penicillin allergy received vancomycin during labor. In 71 patients screened at 35-37 weeks, sensitivities were not performed for 55 patients, of which 10 reported an anaphylactic-like reaction to penicillin. Of 15 patients who had sensitivities performed at the time of screening and were resistant to clindamycin and/or erythromycin, only two patients, however, described an anaphylactic-like reaction to penicillin. Fourteen patients received vancomycin due to an unknown GBS status at <35 weeks of gestation and only three patients from this group reported an anaphylactic-like reaction to penicillin. There were deviations from the CDC protocol in 82 (94%) of 87 patients who received intrapartum vancomycin there were deviations in the CDC protocol.


CONCLUSIONS
Most patients receiving intrapartum vancomycin for perinatal GBS prophylaxis either did not have a culture with sensitivities performed at the time of GBS screening due to a history of anaphylactic-like reactions to penicillin or received vancomycin for a mild or unknown allergy. Physician adherence to the CDC guidelines with regards to the use of vancomycin is far from optimal.
Peláez
Linda M
LM
Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA. lip9014@med.cornell.edu
Gelber
Shari E
SE
Fox
Nathan S
NS
Chasen
Stephen T
ST
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D004342:Drug Hypersensitivity / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007743:Labor, Obstetric; D008826:Microbial Sensitivity Tests; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000150:complications / Q000517:prevention & control* / Q000635:transmission; D013292:Streptococcus agalactiae / Q000187:drug effects; D014481:United States; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin