Jafari H S, Schuchat A, Hilsdon R, Whitney C G, Toomey K E, Wenger J D
Childhood and Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Pediatr Infect Dis J. 1995 Aug;14(8):662-7. doi: 10.1097/00006454-199508000-00003.
During 1992 the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) issued statements on prevention of group B streptococcal (GBS) disease. To assess prevention practices and identify barriers to preventing GBS disease, we surveyed obstetricians, family practitioners and general practitioners in Georgia during 1993. A standard questionnaire was mailed to 1190 clinicians in August and to nonresponders again in September. Of 436 (38%) physicians who responded, 192 (44%) provided obstetric care. Among these 192 obstetric care providers, 121 (63%) screened patients for GBS carriage antenatally. The most frequently cited reasons for not screening were "no clear guidelines" and "not cost-effective" (52 and 39%, respectively). Clinicians who screened patients were significantly more likely to believe that screening was cost-effective (P = 0.05). Of obstetric care providers who screened, only 9% obtained specimens using culture sites recommended by ACOG or AAP. Although most clinicians were aware that antenatal antibiotic treatment of carriers does not prevent perinatal GBS disease, 64% of those who screened reported that they gave oral antibiotics when carriage was detected during pregnancy. Of clinicians who reported using obstetric risk factors to guide prophylaxis choices, < 15% reported using intrapartum antibiotics for the conditions identified in the ACOG and AAP statements as those that suggest the need for prophylaxis when screening is not performed. Many Georgia obstetric care providers do not use effective practices to prevent perinatal GBS disease. Education on appropriate culture methods, obstetric risk factors and the cost effectiveness of prevention strategies might lead to more effective preventive practices.
1992年，美国妇产科医师学会（ACOG）和美国儿科学会（AAP）发布了关于预防B族链球菌（GBS）疾病的声明。为评估预防措施并确定预防GBS疾病的障碍，我们于1993年对佐治亚州的产科医生、家庭医生和普通医生进行了调查。8月向1190名临床医生邮寄了标准问卷，9月再次向未回复者发送问卷。在436名（38%）回复的医生中，192名（44%）提供产科护理。在这192名产科护理提供者中，121名（63%）在产前对患者进行GBS携带筛查。未进行筛查最常被提及的原因是“没有明确的指南”和“不具有成本效益”（分别为52%和39%）。对患者进行筛查的临床医生明显更有可能认为筛查具有成本效益（P = 0.05）。在进行筛查的产科护理提供者中，只有9%使用ACOG或AAP推荐的培养部位获取标本。尽管大多数临床医生都知道对携带者进行产前抗生素治疗并不能预防围产期GBS疾病，但在筛查出携带GBS的孕妇中，64%的临床医生报告称他们会给予口服抗生素。在报告使用产科风险因素来指导预防措施选择的临床医生中，<15%的医生报告针对ACOG和AAP声明中确定的、在未进行筛查时提示需要预防的情况使用产时抗生素。许多佐治亚州的产科护理提供者没有采用有效的措施来预防围产期GBS疾病。对适当培养方法、产科风险因素以及预防策略成本效益的教育可能会带来更有效的预防措施。
