不恰当使用万古霉素预防产时产妇群 B 链球菌（GBS）病。

Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA.

J Perinat Med. 2009;37(5):487-9. doi: 10.1515/JPM.2009.090.

OBJECTIVE

The 2002 CDC guidelines for the prevention of perinatal group B streptococcus (GBS) stipulate that vancomycin is reserved for penicillin-allergic women at high risk for beta-lactam anaphylaxis with resistance to clindamycin or erythromycin. Our objective was to evaluate practitioner adherence to these guidelines.

METHODS

This is a retrospective chart review of patients admitted to labor and delivery who received vancomycin for GBS prophylaxis from January 1st, 2005 to June 1st, 2007. Identification and documentation of allergic reactions to beta lactams and performance of GBS sensitivities at the time of screening were recorded.

RESULTS

Eighty-seven patients reporting a penicillin allergy received vancomycin during labor. In 71 patients screened at 35-37 weeks, sensitivities were not performed for 55 patients, of which 10 reported an anaphylactic-like reaction to penicillin. Of 15 patients who had sensitivities performed at the time of screening and were resistant to clindamycin and/or erythromycin, only two patients, however, described an anaphylactic-like reaction to penicillin. Fourteen patients received vancomycin due to an unknown GBS status at <35 weeks of gestation and only three patients from this group reported an anaphylactic-like reaction to penicillin. There were deviations from the CDC protocol in 82 (94%) of 87 patients who received intrapartum vancomycin there were deviations in the CDC protocol.

CONCLUSION

Most patients receiving intrapartum vancomycin for perinatal GBS prophylaxis either did not have a culture with sensitivities performed at the time of GBS screening due to a history of anaphylactic-like reactions to penicillin or received vancomycin for a mild or unknown allergy. Physician adherence to the CDC guidelines with regards to the use of vancomycin is far from optimal.

目的

2002 年疾病预防控制中心（CDC）关于预防围产期 B 组链球菌（GBS）的指南规定，万古霉素仅用于对青霉素过敏且β-内酰胺类药物过敏、对克林霉素或红霉素耐药的高风险青霉素过敏女性。我们的目的是评估医生对这些指南的遵循情况。

方法

这是一项回顾性图表审查，纳入了 2005 年 1 月 1 日至 2007 年 6 月 1 日期间因 GBS 预防而接受万古霉素治疗的分娩患者。记录了对β-内酰胺类药物的过敏反应以及在筛查时进行 GBS 药敏性检测的情况。

结果

87 例报告青霉素过敏的患者在分娩期间接受了万古霉素治疗。在 35-37 周进行筛查的 71 例患者中，55 例未进行药敏性检测，其中 10 例报告对青霉素有类似过敏反应。在同时进行了药敏性检测且对克林霉素和/或红霉素耐药的 15 例患者中，仅有 2 例患者报告对青霉素有类似过敏反应。由于在<35 周妊娠时 GBS 状态未知，14 例患者接受了万古霉素治疗，而仅有 3 例来自该组的患者报告对青霉素有类似过敏反应。在接受了产时万古霉素治疗的 87 例患者中，有 82 例（94%）违反了 CDC 方案，这些患者要么由于对青霉素有类似过敏反应的病史，要么由于轻度或未知的过敏，未在 GBS 筛查时进行药敏性检测。医生在使用万古霉素方面遵循 CDC 指南的情况远非理想。