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G206(P) Group B Streptococcus: Intrapartum antibiotic management and neonatal outcome
  1. L Graley,
  2. Y Nishihara,
  3. A Arasu
  1. Neonatal Unit, Kings College Hospital, London, UK

Abstract

Objective We audited the use of intrapartum intravenous antibiotics in mothers who were Group B Streptococcus (GBS) positive in their current pregnancy, and compared the neonatal management and outcomes in those who received adequate, and inadequate antibiotic cover.

Method All deliveries logged between 1st October–31st December 2012 were crosschecked with maternal microbiology results to identify those GBS positive in their current pregnancy. We then audited whether these women were given adequate antibiotic cover in labour (at least 1 dose 4 h before delivery) as per local guidelines. Subsequent neonatal outcomes and length of hospital stay was analysed.

Results Total live births were 1185 babies from 1166 mothers, 131 (11%) women were GBS positive and 111 (9%) required intrapartum antibiotics as per protocol. Of which 43 (39%) received no antibiotics, 17 (15%) were inadequately covered and 51 (46%) had adequate intrapartum antibiotic cover.

Most common reason for no/inadequate antibiotic cover was too quick delivery, followed by GBS microbiology results that were not acted upon, or not available in time. Other reasons included emergency caesarean section, home births, and maternal refusal.

Of the total 135 babies born to mothers with GBS, 55 (41%) started IV antibiotic treatment, 41 (75%) of these because the mother was inadequately covered in labour. There was one GBS positive neonatal blood culture.

Average length of stay for babies whose mothers received adequate antibiotics (and only required 12 h of observations) was 1.6 days. However, for babies who required IV antibiotics because of inadequate intrapartum antibiotics, the average length of stay was significantly longer at 4.2 days.

Conclusion The results demonstrate that over half of women who require intrapartum antibiotics were receiving no, or inadequate antibiotic cover. This not only has implications for postnatal antibiotic use, but also for patient satisfaction, hospital bed availability and costs.

Intrapartum antibiotic use in GBS needs to improve, and we suggest this can be achieved by reinforcing patient education so GBS positive women present to labour ward earlier. Also, we must ensure GBS positive swab results are not missed.

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