Desravines Nerlyne, Venkatesh Kartik K, Hopkins Austin, Waldron Jamie, Grant Megan, McGuire Colleen, Boggess Kim A
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
AJP Rep. 2019 Jul;9(3):e238-e243. doi: 10.1055/s-0039-1694031. Epub 2019 Jul 30.
To estimate the prevalence of and identify modifiable risk factors for alternative antibiotics for group B (GBS) prophylaxis in penicillin-allergic women. Retrospective cohort study of pregnant women within a health care network from January 1, 2014, to December 31, 2017. Included women were GBS colonized, delivered at ≥ 37 weeks' gestation, and reported penicillin/cephalosporin allergy. The primary outcome was the use of alternate antibiotics GBS prophylaxis, defined per Centers for Disease Control and Prevention guidelines as antibiotics other than penicillin, ampicillin, or cefazolin. We identified 190 GBS-colonized pregnant women self-reporting a penicillin/cephalosporin allergy; 5% reported anaphylaxis, 44% high-risk symptoms (isolated hives, shortness of breath, swelling, or vomiting), and 51% low-risk symptoms (isolated rash, itching, or nausea). Two-thirds (63%) had alternative antibiotic prophylaxis. In adjusted analyses, nonwhite race (adjusted odds ratio [aOR]: 2.42; 95% confidence interval [CI]: 1.19-4.94) and high-risk allergic reaction (aOR: 2.42; 95% CI: 1.30-4.49) were associated with higher odds of alternative antibiotics prophylaxis compared with low-risk allergic reaction. Low-risk allergic reaction group was less likely to receive alternative antibiotic prophylaxis (aOR: 0.36; 95 CI%: 0.19-0.66). Alternative antibiotic use for GBS prophylaxis is frequent with penicillin/cephalosporin allergies. Efforts to confirm allergy and perform penicillin hypersensitivity testing may increase compliance with guidelines for antibiotic administration.
评估青霉素过敏女性中用于B族链球菌（GBS）预防的替代抗生素的患病率，并确定可改变的风险因素。 对2014年1月1日至2017年12月31日期间医疗保健网络内的孕妇进行回顾性队列研究。纳入的女性为GBS定植、妊娠≥37周分娩且报告对青霉素/头孢菌素过敏。主要结局是使用替代抗生素预防GBS，根据疾病控制与预防中心指南定义为除青霉素、氨苄西林或头孢唑林以外的抗生素。 我们确定了190名自我报告对青霉素/头孢菌素过敏的GBS定植孕妇；5%报告有过敏反应，44%有高风险症状（孤立性荨麻疹、呼吸急促、肿胀或呕吐），51%有低风险症状（孤立性皮疹、瘙痒或恶心）。三分之二（63%）接受了替代抗生素预防。在多因素分析中，与低风险过敏反应相比，非白人种族（调整后的优势比[aOR]：2.42；95%置信区间[CI]：1.19 - 4.94）和高风险过敏反应（aOR：2.42；95% CI：1.30 - 4.49）与接受替代抗生素预防的较高几率相关。低风险过敏反应组接受替代抗生素预防的可能性较小（aOR：0.36；95% CI：0.19 - 0.66）。 对于青霉素/头孢菌素过敏的女性，频繁使用替代抗生素预防GBS。努力确认过敏并进行青霉素过敏试验可能会提高抗生素给药指南的依从性。
