Introduction of the new Centers for Disease Control and Prevention group B streptococcal prevention guideline at a large West Coast health maintenance organization

Davis, Robert L.; Hasselquist, Mary Beth; Cardenas, Vicky; Zerr, Danielle M.; Kramera, Jerome; Zavitkovsky, Ann; Schuchat, Anne

doi:10.1067/mob.2001.110308

« Previous Next »American Journal of Obstetrics & Gynecology
Volume 184, Issue 4 , Pages 603-610, March 2001

Introduction of the new Centers for Disease Control and Prevention group B streptococcal prevention guideline at a large West Coast health maintenance organization☆

Seattle, Washington, and Atlanta, Georgia

From the Center for Health Studies,^a the Clinical Planning and Improvement Division,^b and the Department of Obstetrics and Gynecology,^c Group Health Cooperative of Puget Sound; the Department of Epidemiology, University of Washington School of Public Health^d; the Department of Pediatrics, University of Washington School of Medicine^e; and the National Center for Infectious Diseases, Centers for Disease Control and Prevention.^f

Received 16 December 1999; received in revised form 12 June 2000; accepted 19 July 2000.

Abstract

Objective: Our purpose was to assess the impact of new consensus guidelines issued by the Centers for Disease Control and Prevention, The American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics to prevent perinatal group B streptococcal disease. Study Design: We performed a descriptive analysis and a before-and-after analysis of implementation of the group B streptococcal disease prevention guidelines among singleton-birth pregnancies in 2 Group Health Cooperative hospitals from October 1, 1995, through December 31, 1997. We studied the speed and completeness of implementation and the effect on pregnancy care practices including intrapartum antibiotic use, test ordering, and maternal and neonatal health. Results: Guideline implementation occurred rapidly. The proportion of term pregnancies screened according to the guideline increased markedly, and overall intrapartum antibiotic use more than doubled. Among group B streptococci–positive women, intrapartum antibiotic prophylaxis increased from 24% before to 74% after guideline implementation. Median duration of treatment before delivery increased from 1.8 to 4.3 hours. The rate of rash did not increase, and there were no cases of anaphylaxis or pseudomembranous colitis. The proportion of infants undergoing evaluation decreased after implementation of the neonatal guidelines; among infants of group B streptococci–negative women, test ordering dropped by almost 40%. Conclusions: Implementation of the new guidelines is feasible and can be accomplished rapidly. The guidelines were associated with increased maternal intrapartum antibiotic use, particularly among women at highest risk, and with a decrease in laboratory use for infants. (Am J Obstet Gynecol 2001;184:603-10.)

Keywords: Group B streptococci, guidelines, intrapartum antibiotic prophylaxis, perinatal infection