Shore Eliane M, Yudin Mark H
Department of Obstetrics and Gynecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto ON.
J Obstet Gynaecol Can. 2012 Mar;34(3):230-235. doi: 10.1016/S1701-2163(16)35183-0.
To determine whether pregnant women testing positive for Group B Streptococcus (GBS) are receiving appropriate antibiotic prophylaxis in labour based on sensitivity testing.
We performed a retrospective chart review of all women who delivered at our institution from January 1 to December 31, 2008. We identified all GBS-positive women, and then abstracted data regarding demographic characteristics, method of GBS detection (recto-vaginal or urine culture), prevalence, and antibiotic use. The main outcome measure was the proportion of GBS-positive women who were managed appropriately.
During the study period 628 (22%) of 2878 women were identified as having GBS-positive cultures. Sensitivity testing was available for 481 of the recto-vaginal cultures. All were sensitive to penicillin. The rates of resistance for recto-vaginal culture were 22% for erythromycin, 19% for clindamycin, and 18% for both. Four hundred eighty-one women (93%) were treated with penicillin, 30 (6%) with clindamycin, three with cefazolin, and two with vancomycin. One hundred nine women (17%) who were GBS-positive did not receive antibiotics. Forty-four women (9%) did not receive appropriate antibiotic prophylaxis based on sensitivity testing.
Most GBS-positive women at our institution received an appropriate antibiotic during labour based on sensitivity testing. Our population reflects the Canadian GBS-positivity rate, which is similar to those observed in published studies from other populations. Future work should focus on developing strategies that re-emphasize GBS testing and treatment guidelines for prenatal care providers and on systems to ensure GBS-positive women are given the appropriate antibiotics during labour.
根据药敏试验确定B族链球菌（GBS）检测呈阳性的孕妇在分娩时是否接受了适当的抗生素预防。
我们对2008年1月1日至12月31日在我院分娩的所有妇女进行了回顾性病历审查。我们识别出所有GBS阳性的妇女，然后提取有关人口统计学特征、GBS检测方法（直肠-阴道或尿培养）、患病率和抗生素使用情况的数据。主要结局指标是接受适当管理的GBS阳性妇女的比例。
在研究期间，2878名妇女中有628名（22%）被确定为GBS培养阳性。481份直肠-阴道培养物可进行药敏试验。所有培养物对青霉素均敏感。直肠-阴道培养物对红霉素的耐药率为22%，对克林霉素的耐药率为19%，对两者的耐药率均为18%。481名妇女（93%）接受了青霉素治疗，30名（6%）接受了克林霉素治疗，3名接受了头孢唑林治疗，2名接受了万古霉素治疗。109名GBS阳性妇女（17%）未接受抗生素治疗。44名妇女（9%）未根据药敏试验接受适当的抗生素预防。
我院大多数GBS阳性妇女在分娩时根据药敏试验接受了适当的抗生素治疗。我们的人群反映了加拿大GBS阳性率，这与其他人群发表的研究中观察到的率相似。未来的工作应侧重于制定策略，再次强调产前护理提供者的GBS检测和治疗指南，以及确保GBS阳性妇女在分娩时获得适当抗生素的系统。
