Effectiveness of Intrapartum Antibiotic Prophylaxis for Prevention of Early-Onset Group B Streptococcal Disease.
Fairlie, Tarayn MD, MPH; Zell, Elizabeth R. MStat; Schrag, Stephanie DPhil
Obstetrics & Gynecology.
121(3):570-577, March 2013.
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OBJECTIVE: To estimate the effectiveness against early-onset group B streptococcal (GBS) disease of intrapartum antibiotic prophylaxis among term and preterm deliveries, deliveries with fewer than 4 hours of antibiotics, and deliveries receiving clindamycin regimens.
METHODS: We performed a secondary analysis of the Birthnet cohort, a survey of 7,691 births to residents of the Active Bacterial Core surveillance system from 2003 to 2004. We used propensity score matching on covariates associated with prophylaxis and early-onset GBS disease to evaluate the effectiveness (1-risk ratio) of specific intrapartum antibiotic prophylaxis regimens against the disease end point.
RESULTS: The effectiveness of 4 or more hours of prophylaxis with penicillin or ampicillin was high among term (91%, 95% confidence interval [CI] 63% to 98%) and preterm (86%, 95% CI 38% to 97%) neonates. Effectiveness was significantly lower for clindamycin (22%, 95% CI -53% to 60%). The effectiveness of 2 or fewer to fewer than 4 hours of prophylaxis with penicillin or ampicillin before delivery (47%, 95% CI -16% to 76%) and the effectiveness of prophylaxis with penicillin or ampicillin fewer than 2 hours before delivery (38%, 95% CI -17% to 67%) were both lower than the effectiveness of prophylaxis durations at 4 or more hours.
CONCLUSION: Beta-lactam prophylaxis given 4 or more hours before delivery is highly effective for prevention of early-onset GBS disease. Prophylaxis of shorter durations or with clindamycin is less effective, reinforcing the need for health care providers to adhere to prevention recommendations, particularly for preterm deliveries, penicillin-allergic women, and neonates exposed to fewer than 4 hours of prophylaxis.
LEVEL OF EVIDENCE: II
(C) 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.