Cheon-Lee E, Amstey M S
Department of Obstetrics and Gynecology, Genesee Hospital and University of Rochester School of Medicine and Dentistry, New York, USA.
Am J Obstet Gynecol. 1998 Jul;179(1):77-9. doi: 10.1016/s0002-9378(98)70253-4.
Our purpose was to measure the compliance with the Centers for Disease Control and Prevention antenatal culture protocol for preventing group B streptococcal sepsis after extensive education of physicians and staff.
After 2 months of educational activities to familiarize attending physicians, nurses, and laboratory staff with the guidelines, a retrospective chart review of all vaginal deliveries over a 6-month period were analyzed for protocol compliance and failures either of culturing or antibiotic use.
Overall, there was a 20% prevalence rate of group B streptococci found at > or = 35 weeks' gestation. The enhanced broth preincubation did not significantly increase this rate. Compliance with the protocol was 80% for appropriately timed cultures and 84% for use of antibiotics; 0.7% received unindicated antibiotics.
The area of greatest compliance failure was neglecting to treat women with antepartum risk factors that did not require antepartum cultures: previously affected neonates with group B streptococcal sepsis, antepartum group B streptococcal bacteriuria, and preterm labor and delivery. Twenty-one percent (14/66) of women having these antepartum risk factors were not treated. Protocol failure resulting in no cultures being done occurred in 9% of the women studied (87/956). Further education and quality assurance activities can lower these numbers. There were no cases of group B streptococcal sepsis during the 6 months of this study.
我们的目的是在对医生和工作人员进行广泛教育后，衡量对疾病控制与预防中心预防B族链球菌败血症的产前培养方案的依从性。
在开展为期2个月的教育活动以使主治医生、护士和实验室工作人员熟悉相关指南后，对6个月内所有阴道分娩病例进行回顾性图表审查，分析方案依从性以及培养或抗生素使用方面的失误情况。
总体而言，在妊娠≥35周时发现B族链球菌的患病率为20%。强化肉汤预温育并未显著提高该患病率。适时培养的方案依从率为80%，抗生素使用的依从率为84%；0.7%的患者接受了不必要的抗生素治疗。
依从性最差的方面是忽视了对有产前危险因素但无需产前培养的女性进行治疗，这些危险因素包括既往有B族链球菌败血症的新生儿、产前B族链球菌菌尿以及早产和分娩。有这些产前危险因素的女性中有21%（14/66）未接受治疗。在9%的研究女性（87/956）中出现了未进行培养的方案失误情况。进一步的教育和质量保证活动可以降低这些数字。在本研究的6个月期间未出现B族链球菌败血症病例。
