Background: CDC guidelines for prevention of EOGBSS which recommended intrapartum antimicrobial prophylaxis (IAP) for GBS positive (+) or GBS unknown (unk) women with risk factors (RF=fever >38°C, PROM≥18hrs or <37wks GA) were instituted 10/1/95 at Magee-Womens Hospital(MWH). The purpose of this study was to document the effectiveness of these guidelines.

Study Design: Prevalence of EOGBSS was compared before(1/1/92-6/30/95) and after (10/1/95-11/30/97) institution of CDC protocol by review of infant GBS+ blood cultures. Chart review was performed for deliveries ≥23wks GA (1/1/96-6/30/96) with maternal GBS status as + or unk to determine the presence of RF and IAP. Maternal IAP: Adequate IAP=≥ 4hrs prior to delivery (PTD) and Any IAP = any antibiotic dose (for any indication) PTD.

Results: The prevalence of EOGBSS was 1.15 per 1000 (36 of 31,133) live births before and 0.18 per 1000 (3 of 16,508) live births after institution of CDC protocol (p=0.009). Of 4083 deliveries, 1409 women were GBS+/unk, and 1065 met CDC criteria for IAP. The overall compliance of IAP by CDC guidelines was 83.2%. Compliance with CDC (by route of delivery and RF) are shown below: Table Despite excellent compliance(93.9%) with CDC guidelines for GBS+/unk with RF vaginal deliveries, 50.6% of GBS+/unk with RF cesarean deliveries did not receive IAP. In addition to those women who met CDC criteria for IAP, 58.7% of women who were GBS unk w/o RF received IAP.

Table 1 No caption available.
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Conclusion: Institution of the CDC protocol in a large women's hospital was accomplished with 94% compliance for vaginal deliveries and was associated with a >80% reduction in EOGBSS.