Avoiding Inadequate Intrapartum Antibiotic Prophylaxis for Group B Streptococci.

OBJECTIVE: To estimate the frequency and reasons for inadequate group B streptococci (GBS) prophylaxis at our institution and to estimate what proportion of cases can be avoided with perfect protocol adherence.

METHODS: This was a retrospective cohort study of neonates born to GBS-colonized women who received inadequate prophylaxis between April 30, 2013, and May 1, 2014. The maternal chart was analyzed to categorize each case as avoidable (adequate time on labor and delivery to receive antibiotics 4 hours before birth and β-lactam antibiotic-eligible) or unavoidable and to determine whether a violation of the 2010 Centers for Disease Control and Prevention (CDC) protocol (delayed or incorrect antibiotics) occurred.

RESULTS: A total of 197 of 488 (40.4%, 95% confidence interval 36.1-44.8%) newborns of group B-colonized women received inadequate prophylaxis. Of these, 157 cases (79.7%, 73.4-84.8%) were unavoidable and would have occurred even with perfect protocol adherence. The 40 (20.3%, 15.3-26.5%) avoidable cases due to protocol violations resulted from delayed antibiotic administration (first dose of antibiotics more than 1 hour after admission [median 9.33 hours, range 3.83-25 hours] in 25 patients; no antibiotics in four patients; total 29 patients, 72.5%) or incorrect antibiotic selection (11 patients, 27.5%).

CONCLUSIONS: Forty percent of patients received inadequate prophylaxis, and four of five cases are unavoidable with our current labor management and the 2010 CDC guidelines. Timeliness and selection of antibiotics remain areas for improvement, but the overall effects on sepsis prevention will be modest.