Santillan Donna A, Hubb Alexander J, Nishimura Taryn E, Rosenfeld-O'Tool Sandra R, Schroeder Kathleen J, Conklin Jona M, Karras Alexandra E, Gumusoglu Serena B, Brandt Debra S, Miller Emily, Hunter Stephen K, Santillan Mark K
Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, Iowa.
Carver College of Medicine, University of Iowa Hospitals & Clinics, Iowa City, Iowa.
AJPM Focus. 2022 Aug 28;1(2):100028. doi: 10.1016/j.focus.2022.100028. eCollection 2022 Dec.
Pregnancy is a time of increased healthcare screening, and past adherence to evolving guidelines informs best practices. Although studies of Group B guideline adherence have focused primarily on treatment of Group B carriers, this study broadly evaluated long-term adherence to both Group B screening and treatment guidelines. Adherence was evaluated across provider types (obstetrics and gynecology, certified nurse midwives, and family medicine).
We conducted a retrospective cohort study. Demographic and clinical information were extracted from all prenatal care and delivery patients at a single institution in a single year. Vancomycin prescriptions in pregnancy were tracked for 10 years to determine long-term adherence. was defined as no deviation from 2010 Group B screening and treatment guidelines.
Adherence occurred in 89% (1,610/1,810) of patients. Reasons for deviations from guidelines could not always be determined. There was no significant difference in maternal age, race, prenatal provider type, provider type at delivery, gestational age at delivery, delivery mode, or whether antibiotic sensitivities were performed between compliant and noncompliant groups. Significant differences in adherence were found between obstetric clinics (high-risk obstetrics clinic, maternal‒fetal medicine fellows clinic, continuity of care clinic, and faculty private clinic) (<0.0001) and between the faculty family medicine clinic and resident family medicine clinic (=0.001). Vancomycin prescription practice did not change significantly over the10-year period.
High rates of adherence to Group B screening and treatment guidelines in pregnancy have positive implications for reducing antibiotic resistance. Given evolving guidelines, there is a need to periodically evaluate adherence and to re-educate providers about standard practices and best documentation practices.
孕期是医疗筛查增加的时期，过去对不断演变的指南的遵循情况为最佳实践提供了参考。虽然关于B族链球菌指南遵循情况的研究主要集中在B族链球菌携带者的治疗上，但本研究广泛评估了对B族链球菌筛查和治疗指南的长期遵循情况。对不同类型的医疗服务提供者（妇产科医生、认证护士助产士和家庭医生）的遵循情况进行了评估。
我们进行了一项回顾性队列研究。从某一机构某一年所有接受产前护理和分娩的患者中提取人口统计学和临床信息。追踪孕期万古霉素的处方情况达10年，以确定长期遵循情况。遵循定义为未偏离2010年B族链球菌筛查和治疗指南。
89%（1610/1810）的患者遵循了指南。偏离指南的原因并非总能确定。在遵循组和未遵循组之间，产妇年龄、种族、产前医疗服务提供者类型、分娩时的医疗服务提供者类型、分娩时的孕周、分娩方式或是否进行了抗生素敏感性检测方面，均无显著差异。在产科诊所（高危产科诊所、母胎医学研究员诊所、连续护理诊所和教师私人诊所）之间，遵循情况存在显著差异（<0.0001），在教师家庭医学诊所和住院医师家庭医学诊所之间也存在显著差异（=0.001）。在这10年期间，万古霉素的处方实践没有显著变化。
孕期对B族链球菌筛查和治疗指南的高遵循率对降低抗生素耐药性具有积极意义。鉴于指南不断演变，有必要定期评估遵循情况，并对医疗服务提供者进行关于标准实践和最佳记录实践的再教育。
