Open AccessCompliance with a risk‐factor‐based guideline for the prevention of neonatal group B streptococcal sepsis
Author(s) -
Fleming Maureen T.,
McDuffie Robert S.,
Russell Kathy,
Meikle Susan
Publication year - 1997
Publication title -
infectious diseases in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.656
H-Index - 48
eISSN - 1098-0997
pISSN - 1064-7449
DOI - 10.1002/(sici)1098-0997(1997)5:5<345::aid-idog7>3.0.co;2-u
Subject(s) - chorioamnionitis , medicine , guideline , risk factor , premature rupture of membranes , neonatal sepsis , antibiotic prophylaxis , sepsis , obstetrics , neonatal infection , group b , clindamycin , chemoprophylaxis , pregnancy , pediatrics , gestational age , antibiotics , surgery , pathology , microbiology and biotechnology , biology , genetics
Objective The purpose of this study was to determine the compliance rate with a maternal risk‐factor‐based guideline for the prevention of neonatal group B streptococcal (GBS) sepsis. Methods In August 1994, a risk‐factor‐based guideline for selective intrapartum prophylaxis against neonatal GBS was adopted by a group model health maintenance organization. This guideline identified the following maternal risk factors for neonatal GBS sepsis: preterm delivery, rupture of membranes for >18 h, fever/chorioamnionitis, and history of a previous GBS‐affected child. Patients with one or more risk factors were to receive intrapartum antibiotic prophylaxis consisting of either ampicillin, erythromycin, or clindamycin. We conducted a retrospective chart review to record risk factors and use of antibiotics. We hypothesized that >90% of patients with risk factors would receive intrapartum chemoprophylaxis. Results A total of 805 maternal charts were reviewed. Of these, 105 (13%) were candidates for intrapartum prophylaxis. We found an overall compliance rate of 65%. Compliance rates by risk factor were preterm delivery (51%), prolonged rupture of membranes (73%), fever/chorioamnionitis (87%), and previous affected child (100%). Conclusions Our results show unexpectedly low compliance rates with a risk‐factor‐based guideline for the prevention of neonatal GBS sepsis. Only 65% of women with any risk factor for neonatal GBS sepsis received intrapartum antibiotic prophylaxis appropriately. Educational efforts to improve compliance with a risk‐factor‐based guideline should specifically address mothers delivering at 34–36 weeks gestation and mothers with prolonged rupture of membranes. Infect. Dis. Obstet. Gynecol. 5:345–348, 1997. © 1998 Wiley‐Liss, Inc.