Adherence to perinatal group B streptococcal prevention guidelines.
OBJECTIVE
To estimate compliance with the 2002 revised perinatal group B streptococci (GBS) prevention guidelines in Tennessee, which recommend universal GBS screening of pregnant women at 35-37 weeks of gestation and, when indicated, administration of intrapartum chemoprophylaxis.


METHODS
Active Bacterial Core surveillance conducts active, population-based surveillance for invasive GBS disease in 11 Tennessee counties. A retrospective case-cohort study was conducted using a stratified random sample of all live births in surveillance hospitals during 2003-2004, including all early-onset GBS cases. Factors associated with GBS screening and lack of optimal GBS chemoprophylaxis were analyzed using logistic regression.


RESULTS
Screening was performed for 84.7% of pregnant women, but 26.3% of prenatal tests with documented test dates were performed before 35 weeks of gestation. Among women with an indication for GBS prophylaxis, 61.2% received optimal chemoprophylaxis, defined as initiation of a recommended antibiotic 4 hours or more before delivery. When the analysis was restricted to women who were admitted 4 hours or more before delivery, 70.9% received optimal chemoprophylaxis. Women not receiving optimal chemoprophylaxis were more likely to have penicillin allergy (11.7% compared with 2.5%, adjusted odds ratio [OR] 8.58, 95% confidence interval [CI] 1.57-47.04) or preterm delivery (45.5% compared with 13.2%, adjusted OR 5.52, 95% CI 2.29-13.30) and were less likely to have received the recommended prenatal serologic testing for other infectious diseases (77.9% compared with 91.1%, adjusted OR 0.30, 95% CI 0.09-0.98). Forty cases of early-onset GBS were identified (0.36 per 1,000 live births); 25% of these neonates were born to women who received screening at 35 weeks of gestation or later and, when indicated, optimal chemoprophylaxis.


CONCLUSIONS
Universal prenatal GBS screening was implemented widely in Tennessee, although the timing of screening and administration of chemoprophylaxis often were not optimal. A substantial burden of early-onset GBS disease occurs despite optimal prenatal screening and chemoprophylaxis, suggesting that alternative strategies, such as vaccination, are needed.


METHODS
II.
Goins
William P
WP
From the Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas; the Department of Medicine, Divisions of Infectious Diseases and General Internal Medicine and Public Health, and the Departments of Preventive Medicine and Pediatrics, Vanderbilt Vaccine Research Program, Vanderbilt University School of Medicine, Nashville, Tennessee; the Tennessee Department of Health, Communicable and Environmental Disease Services, Nashville, Tennessee; and the Respiratory Diseases Branch, Division of Bacterial and Mycotic Disease, Centers for Disease Control and Prevention, Atlanta, Georgia.
Talbot
Thomas R
TR
Schaffner
William
W
Edwards
Kathryn M
KM
Craig
Allen S
AS
Schrag
Stephanie J
SJ
Van Dyke
Melissa K
MK
Griffin
Marie R
MR
D000328:Adult; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008485:Medical Audit; D018743:Perinatal Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology / Q000517:prevention & control*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000517:prevention & control*; D013292:Streptococcus agalactiae; D013714:Tennessee; D055815:Young Adult