title: Choice of antibiotic for group B streptococcus in women in labour based on antibiotic sensitivity testing.
abstract: OBJECTIVE
  To determine whether pregnant women testing positive for Group B Streptococcus (GBS) are receiving appropriate antibiotic prophylaxis in labour based on sensitivity testing.
  
  
  METHODS
  We performed a retrospective chart review of all women who delivered at our institution from January 1 to December 31, 2008. We identified all GBS-positive women, and then abstracted data regarding demographic characteristics, method of GBS detection (recto-vaginal or urine culture), prevalence, and antibiotic use. The main outcome measure was the proportion of GBS-positive women who were managed appropriately.
  
  
  RESULTS
  During the study period 628 (22%) of 2878 women were identified as having GBS-positive cultures. Sensitivity testing was available for 481 of the recto-vaginal cultures. All were sensitive to penicillin. The rates of resistance for recto-vaginal culture were 22% for erythromycin, 19% for clindamycin, and 18% for both. Four hundred eighty-one women (93%) were treated with penicillin, 30 (6%) with clindamycin, three with cefazolin, and two with vancomycin. One hundred nine women (17%) who were GBS-positive did not receive antibiotics. Forty-four women (9%) did not receive appropriate antibiotic prophylaxis based on sensitivity testing.
  
  
  CONCLUSIONS
  Most GBS-positive women at our institution received an appropriate antibiotic during labour based on sensitivity testing. Our population reflects the Canadian GBS-positivity rate, which is similar to those observed in published studies from other populations. Future work should focus on developing strategies that re-emphasize GBS testing and treatment guidelines for prenatal care providers and on systems to ensure GBS-positive women are given the appropriate antibiotics during labour.
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto ON.
authors.forename: Eliane M
authors.initials: EM
authors.lastname: Shore
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto ON.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Yudin
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D002981:Clindamycin / Q000627:therapeutic use; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007743:Labor, Obstetric; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000517:prevention & control* / Q000635:transmission; D013292:Streptococcus agalactiae / Q000187:drug effects / Q000254:growth & development; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002981:Clindamycin; D004917:Erythromycin