Compliance With Protocols for Prevention of Neonatal GroupB Streptococcal Sepsis: Practicalities and Limitations

摘要

Objective:To compare two protocols for intrapartum antibiotic prophylaxis (IAP) against neonatal group Bstreptococcal (GBS) sepsis, with respect to staff compliance, in a prospective cohort study in the obstetric unitsof a community hospital (A) and a university teaching hospital (B).Methods:Cohorts comprised about 500 women attending antenatal clinics at each hospital (total 1096). Womenidentified as GBS carriers at 26–32 weeks'gestation and those who had intrapartum clinical risk factors (CRF) wereeligible for IAP. Compliance was defined as the proportion of women eligible for IAP who received it accordingto protocol–as determined by audit of case records–and compared between hospitals and according to indication.Results:Overall, 39% of women were eligible for IAP. Indications were GBS carriage alone (21%), CRF alone(13% ) and both (5% ). Compliance was similar for GBS carriers at both hospitals: 78% at Hospital A and 76% atHospital B. However, because of the poor predictive value of screening before 32 weeks, only 65%of intrapartumGBS carriers actually received IAP. For women with CRF only, compliance was significantly lower at Hospital Bthan Hospital A (56 vs. 75%;p= 0.03).Conclusions:According to currently recommended protocols, about one-third of healthy women are eligible forintrapartum antibiotics to prevent neonatal GBS sepsis. In practice, antibiotics are often used inefficiently becauseof poor compliance with protocols and poor predictive values of selection criteria. Better implementationstrategies should improve compliance, but GBS vaccines are needed to replace prophylactic antibiotic use, withits associated disadvantages.