Gilbert Gwendolyn L, Hewitt Moira C, Turner Catherine M, Leeder Stephen R
Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, University of Sydney, Westmead Hospital, New South Wales, Australia.
Infect Dis Obstet Gynecol. 2003;11(1):1-9. doi: 10.1155/S1064744903000012.
To compare two protocols for intrapartum antibiotic prophylaxis (IAP) against neonatal group B streptococcal (GBS) sepsis, with respect to staff compliance, in a prospective cohort study in the obstetric units of a community hospital (A) and a university teaching hospital (B).
Cohorts comprised about 500 women attending antenatal clinics at each hospital (total 1096). Women identified as GBS carriers at 26-32 weeks' gestation and those who had intrapartum clinical risk factors (CRF) were eligible for IAP. Compliance was defined as the proportion of women eligible for IAP who received it according to protocol - as determined by audit of case records - and compared between hospitals and according to indication.
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% at Hospital B. However, because of the poor predictive value of screening before 32 weeks, only 65% of intrapartum GBS carriers actually received IAP. For women with CRF only, compliance was significantly lower at Hospital B than Hospital A (56 vs. 75%; p = 0.03).
According to currently recommended protocols, about one-third of healthy women are eligible for intrapartum antibiotics to prevent neonatal GBS sepsis. In practice, antibiotics are often used inefficiently because of poor compliance with protocols and poor predictive values of selection criteria. Better implementation strategies should improve compliance, but GBS vaccines are needed to replace prophylactic antibiotic use, with its associated disadvantages.
在一家社区医院（A）和一家大学教学医院（B）的产科病房进行一项前瞻性队列研究，比较两种产时抗生素预防（IAP）方案预防新生儿B族链球菌（GBS）败血症的效果以及医护人员的依从性。
每个医院约500名参加产前检查的妇女组成队列（共1096名）。妊娠26 - 32周时被确定为GBS携带者以及有产时临床危险因素（CRF）的妇女符合IAP条件。依从性定义为符合IAP条件且根据方案接受IAP的妇女比例 - 通过病例记录审核确定 - 并在医院之间以及根据指征进行比较。
总体而言，39%的妇女符合IAP条件。指征分别为单纯GBS携带（21%）、单纯CRF（13%）以及两者皆有（5%）。两家医院GBS携带者的依从性相似：A医院为78%，B医院为76%。然而，由于32周前筛查的预测价值较差，实际上只有65%的产时GBS携带者接受了IAP。对于仅患有CRF的妇女，B医院的依从性显著低于A医院（56%对75%；p = 0.03）。
根据目前推荐的方案，约三分之一的健康妇女符合产时使用抗生素预防新生儿GBS败血症的条件。在实际操作中，由于方案依从性差和选择标准的预测价值低，抗生素的使用往往效率低下。更好的实施策略应能提高依从性，但需要GBS疫苗来取代预防性抗生素的使用及其相关弊端。
