McIlwaine Kate, Kneebone Kim, Barkehall-Thomas Andrea, Wallace Euan M
Maternal-Fetal Medicine Unit, Southern Health, Clayton, Victoria, Australia.
Aust N Z J Obstet Gynaecol. 2006 Jun;46(3):199-201. doi: 10.1111/j.1479-828X.2006.00565.x.
The US Centre for Disease Control (CDC) recently amended their guidelines for the prevention of early-onset group B streptococcal disease (EOGBSD) of the newborn to recommend bacteriological screening, rather than risk factor-based screening, as the preferred method of identifying 'at risk' mother-infant pairs. This recommendation was derived from population data suggesting that the effectiveness of bacteriological screening was superior to a risk-factor approach because antibiotic compliance was better with the former. Whether poor compliance and therefore impaired prevention is inherent in risk-factor screening has not been widely tested.
For a 6-month period we audited compliance with an established risk-factor EOGBSD prophylaxis program.
During the audit period, 1243 women delivered, of whom 287 (23%) had at least one risk factor. Of these women, 193 (67%), representing 15% of all women giving birth, received antibiotics. Thus, there were 94 women who were eligible for antibiotics but did not receive prophylaxis. There were sound clinical reasons for withholding antibiotics in 68 of these. Therefore, the corrected compliance rate within our program was 73%.
This compares favourably with published compliance rates with bacteriological-based programs, but we have suggested mechanisms to improve compliance further.
美国疾病控制中心（CDC）最近修订了预防新生儿早发型B族链球菌病（EOGBSD）的指南，建议采用细菌学筛查而非基于风险因素的筛查作为识别“高危”母婴对的首选方法。这一建议源于人群数据，表明细菌学筛查的效果优于风险因素法，因为前者的抗生素依从性更好。风险因素筛查是否存在依从性差进而导致预防效果受损的问题尚未得到广泛验证。
在6个月的时间里，我们对一项既定的基于风险因素的EOGBSD预防方案的依从性进行了审核。
在审核期间，1243名妇女分娩，其中287名（23%）至少有一项风险因素。在这些妇女中，193名（67%）接受了抗生素治疗，占所有分娩妇女的15%。因此，有94名符合使用抗生素条件的妇女未接受预防治疗。其中68名有合理的临床理由停用抗生素。因此，我们方案中的校正依从率为73%。
这与已公布的基于细菌学方案的依从率相比具有优势，但我们提出了进一步提高依从性的机制。
