An area-based study on intrapartum antibiotic prophylaxis for preventing group B streptococcus early-onset disease: advances and limitations.
BACKGROUND
The prevalence of maternal group-B-streptococcus (GBS) colonization and risk factors (RFs) for neonatal early-onset disease (EOD) in Europe are poorly defined. Large-scale information concerning adherence to recommendations for preventing GBS-EOD are lacking.


METHODS
This was a 3-month retrospective area-based study including all regional deliveries  ≥35 weeks' gestation (in 2012). The sensitivity, specificity, positive and negative predictive values, odds ratio and receiver operating characteristic (ROC) curve for intrapartum antibiotic prophylaxis (IAP) among full-term and preterm deliveries and prolonged membrane rupture (PROM) were calculated.


RESULTS
Among 7133 women, 259 (3.6%) were preterm (35-36 weeks' gestation). Full-term women were 6874, and 876 (12.7%) had at least 1 RF. Most women (6495) had prenatal screening and 21.4% (1390) were GBS positive. IAP was given to 2369 (33.2%) women (preterm, n = 166; full term, n = 2203). Compared to full-term, preterm women were less likely to receive IAP when indicated (73.2% versus 90.3%, p < 0.01). Full-term women represented the largest area under the curve (AUC, 0.87). PROM showed the highest sensitivity (98.6%), but the lowest specificity (6.9%) and AUC (0.53).


CONCLUSIONS
Large-scale prenatal screening and IAP are feasible. Women delivering preterm are less likely to receive IAP when indicated. Most unnecessary antibiotics are given in cases of PROM.
a Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy.
Alberto
A
Berardi
b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy.
Cecilia
C
Rossi
c Dipartimento di Medicina Specialistica, Diagnostica e Sperimentale, Azienda Ospedaliero Universitaria S. Orsola-Malpighi , Bologna, Italy.
Maria Letizia
ML
Bacchi Reggiani
d Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Materno Infantile, Ospedale Maggiore , Bologna, Italy.
Annalisa
A
Bastelli
e Unità Operativa di Neonatologia, Dipartimento del bambino, della donna e delle malattie urologiche, Azienda Ospedaliero Universitaria S. Orsola-Malpighi , Bologna, Italy.
Maria Grazia
MG
Capretti
f Unità Operativa di Pediatria, Ospedale Civile , Sassuolo , Italy.
Claudio
C
Chiossi
g Unità Operativa di Pediatria, Ospedale B Ramazzini , Carpi, Italy.
Valentina
V
Fiorini
h Unità Operativa di Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico , Parma , Italy.
Lucia
L
Gambini
b Terapia Intensiva Neonatale, Dipartimento Ostetrico e Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico IRCCS, Arcispedale Santa Maria Nuova , Reggio Emilia , Italy.
Sara
S
Gavioli
i Unità Operativa di Pediatria e Neonatologia, Ospedale Santa Maria della Scaletta , Imola , Italy.
Marcello
M
Lanari
j Unità Operativa di Pediatria, Ospedale San Martino , Belluno , Italy.
Luigi
L
Memo
k Unità Operativa di Terapia Intensiva Neonatale, Ospedale Infermi , Rimini , Italy.
Irene
I
Papa
l Unità Operativa di Pediatria, Ospedale Civile , Lugo , Italy.
Luana
L
Pini
m Unità Operativa di Terapia Intensiva Neonatale e Pediatrica, Ospedale Civile M. Bufalini , Cesena , Italy.
Maria Vittoria
MV
Rizzo
n Unità Operativa di Pediatria, Ospedale Civile , Faenza , Italy , and.
Andrea
A
Zucchini
o Unità Operativa di Ostetricia, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy.
Fabio
F
Facchinetti
a Unità Operativa di Terapia Intensiva Neonatale, Dipartimento Integrato Materno-Infantile, Azienda Ospedaliero-Universitaria Policlinico , Modena , Italy.
Fabrizio
F
Ferrari
D000667:Ampicillin / Q000008:administration & dosage*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D018743:Perinatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D047928:Premature Birth; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000151:congenital / Q000517:prevention & control* / Q000635:transmission; D014621:Vagina / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000667:Ampicillin
Group B streptococcus; intrapartum antibiotic prophylaxis; newborn; prevention; risk factors; sepsis